Difficulties in diagnosis and treatment of elbow osteoid osteoma in a four-year-old girl: case report and review of the literature

Abstract

Osteoid osteoma localized at intra-articular or juxta-articular sites typically does not present with the usual night pain but rather constant pain. Besides this, eventually joint eff usion develops as a result of synovitis, followed by joint contracture and atrophy of nearby muscles. Additional diffi culty in the diagnosis is the fact that osteoid osteoma of these locations is diffi cult to visualize on magnetic resonance imaging, which is the usual imaging method of choice for painful joint conditions. We present a case of a fouryear- old girl who presented with elbow pain without any prior injury and eventually developed joint eff usion and contracture of the elbow. Her treatment consisted of a course of physical therapy, followed by antibiotic therapy, both of which proved ineff ective, therefore biopsy was indicated and performed. Upon reevaluation of the entire work-up, especially radiographic fi ndings, suspicion arose that the cause was osteoid osteoma. After the operation, the patient did not complain of any pain anymore and eventually regained full elbow mobility. With this case report and literature review, we wish to warn readers of the diffi culties in reaching an accurate diagnosis in cases of intra- and/or juxta-articular localizations of osteoid osteoma of the elbow, which can be successfully treated arthroscopically in children.