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).^[31]

Solitary osteochondroma. Anatomic and age distribution of solitary osteochondromas.

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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.^{[32, 33]} 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.^{[34, 35, 36]}

Osteochondromas of the spine, though rare, can give rise to symptoms of compressive myelopathy.^{[37, 38, 39, 40]}

Workup

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Media Gallery

Solitary osteochondroma. Anteroposterior radiograph of a pedunculated osteochondroma of the distal femur.
Solitary osteochondroma. Lateral radiograph of a pedunculated osteochondroma of the distal femur. Orientation is away from the growth plate, and medullary continuity is clear.
Solitary osteochondroma. Lateral radiograph of a sessile osteochondroma of the distal femur.
Solitary osteochondroma. Anatomic and age distribution of solitary osteochondromas.
Solitary osteochondroma. CT scan of the pelvis depicting a massive solitary osteochondroma.
Solitary osteochondroma. Anteroposterior radiograph of sessile osteochondroma of the humerus.
Solitary osteochondroma. CT scan of the same sessile osteochondroma of the humerus as in Image 6.
Solitary osteochondroma. MRI of sessile osteochondroma of the femur demonstrating the thickness of the cartilage cap.
Solitary osteochondroma. Gross osteochondroma specimen at the time of resection. Bone stalk and overlying membrane on cartilage cap.
Solitary osteochondroma. Cut surface of surgical osteochondroma specimen. Cartilage cap and underlying bone with medullary continuity.
Solitary osteochondroma. Histology of cut osteochondroma specimen. Cartilage cap and orientation of enchondral bone formation.
Solitary osteochondroma. High-power view of benign cartilage cells arranged in vertical growth plate pattern.
Solitary osteochondroma. Radiograph demonstrating the deformation of the distal tibiofibular joint in a patient with a solitary osteochondroma.

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Solitary Osteochondroma Clinical Presentation

History and Physical Examination

References

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