Osteoid Osteoma Clinical Presentation

Updated: Aug 12, 2021
  • Author: Gerard Librodo, MD; Chief Editor: Harris Gellman, MD  more...
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Symptoms of osteoid osteoma can last from weeks to years before diagnosis and eventual surgery.

Pain is the principal symptom of both initial and recurrent disease. It is described as a continuous, deep, aching, and intense pain with varying quality and severity. It is typically localized to the site of the lesion. Pain is usually worse at night (in 95% of patients) and diminishes by morning. The pain may awaken the patient (29% of cases). In some patients, especially those with intracapsular lesions with synovitis and restricted range of motion (ROM), there may be an exertional component. The pain may also affect the patient's gait.

The pain usually occurs before the lesions are visible on radiographs. It frequently (~50-75% of cases) responds to oral salicylates, often with dramatic beneficial results, but the response is not universal. Pain symptoms can be exacerbated with the use of ethanol.

Osteoid osteoma should be considered in any young patient with pain in the back or neck, painful scoliosis, or radicular or referred-type pain into the lower limb or shoulder. Its symptoms can simulate those of a herniated disk, or the lesion may produce radicularlike symptoms in the shoulders and arms. Unexplained, rigid, or painful scoliosis, especially if the pain is referred to the concavity of the curve, has been associated with osteoid osteoma. Local pain is most commonly noted in the area of the tumor.

Swelling can also occur in osteoid osteoma and is sometimes the only presenting symptom. This is usually observed in patients with diaphyseal lesions.

Osteoid osteoma involving the hand can manifest as monoarticular arthritis, [29]  macrodactyly, clubbing, and painless swelling with absence of reactive bone or bony lysis. [30]


Physical Examination

Physical findings can vary in patients with osteoid osteoma. Tenderness is present in 62% of patients and usually occurs with subperiosteal lesions; it is relatively uncommon with medullary lesions. Local warmth and erythema are possible but unusual.

Intracapsular lesions are rare. Epiphyseal lesions mimic intra-articular derangement and can delay the true diagnosis. These lesions may be associated with proliferative synovitis due to prostaglandin secretion that decreases ROM. Joint effusion can be present, mimicking inflammatory arthritis. Soft-tissue swelling, contractures, and a soft-tissue mass can also be noted. Radiographs may reveal the lack of an intense perifocal sclerotic margin and perinidal bone marrow edema.

Neurologic findings are variable. Janin et al [31] and MacLellan et al [32] noted a 25% incidence of neurologic abnormalities. Reports in the literature have described fewer neurologic abnormalities (eg, monoparesis and paraparesis) with osteoid osteoma than with osteoblastoma because osteoid osteomas are smaller than osteoblastomas.