[Osteoid osteoma of the hand and wrist]

Osteoid osteoma is a painful benign bone tumour and very rare in the hand and wrist. Diagnosis may be very difficult and often is made after multiple previous diagnostic errors.

From 1992 until 2003, 22 patients (11 men, 11 women) were operated on because of an osteoid osteoma of the hand or wrist in our hospital. The mean age was 30 years, ranging from 14 to 62 years. We retrospectively analysed patient records. A clinical examination with X-ray control was performed in 14 patients. Five patients were questioned by phone; three patients were lost to follow-up.

The mean time interval between onset of symptoms and surgical removal of the tumour was approximately two years. Symptoms were often non-specific; clinical findings varied according to localisation of the tumour. Conventional X-rays did not always show typical pathological findings. Bone scanning and gadolinium-enhanced MRI proved to be very sensitive in detecting the pathological process. High-resolution CT-scan demonstrated the nidus exactly. Usually, operative removal of the nidus resulted in immediate pain relief. At follow-up, 18 patients were free of pain. However seven patients had had a revision operation; in four of those, osteoid osteoma recurred once again.

In our opinion, it is important to consider osteoid osteoma as a possible cause of otherwise unexplained pain of the hand or wrist. If there is clinical suspicion, we recommend the early use of gadolinium-enhanced MRI as a sensitive screening method. Thus, it should be possible to shorten the time interval until correct diagnosis is established.