Solitary Osteochondroma Clinical Presentation

Updated: Aug 12, 2019
  • Author: Ian D Dickey, MD, FRCSC, LMCC; Chief Editor: Harris Gellman, MD  more...
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Presentation

History and Physical Examination

Although osteochondromas can be located almost anywhere in the skeleton, almost half of them are found around the knee, in either the distal femur or the proximal tibia (see the image below). [30]

Solitary osteochondroma. Anatomic and age distribu Solitary osteochondroma. Anatomic and age distribution of solitary osteochondromas.

Osteochondromas are most commonly diagnosed incidentally on radiographs that were obtained for other reasons. The second most common presentation is a mass, which may or may not be associated with pain. Most of these lesions need not be treated, and asymptomatic lesions can be safely ignored. When painful, however, they must be evaluated properly.

Pain is usually caused by a direct mechanical mass effect of the osteochondroma on the overlying soft tissue. This can result in an associated sac or bursitis over the exostosis. Irritation of surrounding tendons, muscles, or nerves can result in pain. [31, 32]  Pain can also result from fracture of the stalk of the osteochondroma from direct trauma. The bony cap of the stalk may infarct or undergo ischemic necrosis.

Osteochondroma may be associated with pseudoaneurysm of an extremity artery (eg, the popliteal artery), commonly evidenced by pain and swelling. [33, 34, 35]

Osteochondromas of the spine, though rare, can give rise to symptoms of compressive myelopathy. [36, 37, 38, 39]