Our knowledge of orthopaedics. Your best health.

from the American Academy of Orthopaedic Surgeons

Diseases & Conditions

Treatment

Recovery

Staying Healthy

Osteoid Osteoma

An osteoid osteoma is a benign (noncancerous) bone tumor that usually develops in the long bones of the body, such as the femur (thighbone) and tibia (shinbone). Although osteoid osteomas can cause pain and discomfort, they do not spread throughout the body. Osteoid osteomas can affect people of all ages, but they occur more frequently in children and young adults.

Description

Osteoid osteomas tend to be small—less than 1.5 cm in size—and they do not grow. They do, however, typically cause reactive bone to form around them. They also make a new type of abnormal bone material called osteoid bone. This osteoid bone, along with the tumor cells, forms the nidus of the tumor, which is a clear spot seen on x-rays.

Osteoid osteomas may occur in any bone in the body, but are most often found in the bones of the leg. They are also found in the hands, fingers, and spine.

Osteoid osteomas may occur at any age, but are most common between the ages of 4 and 25 years old. Males are affected approximately three times more often than females.

Osteoid osteomas are benign (noncancerous). They do not spread throughout the rest of the body (metastasize).

Cause

The cause of osteoid osteomas is not known.

Symptoms

An osteoid osteoma causes a dull, aching pain that is moderate in intensity but can worsen and become severe—especially at night. The pain is not usually related to activity. In some cases, a person will suffer the aching bothersome pain of an osteoid osteoma for years before seeing a doctor for diagnosis.

Depending on the location of the tumor, there may also be swelling.

photo and x-ray of an osteoid osteoma

(Left) Photo shows swelling of the proximal finger from an osteoid osteoma. The “X” is over the nidus (center) of the tumor. (Right) An x-ray of the tumor shows thickened bone around the nidus, a characteristic feature of an osteoid osteoma.

Reproduced from Julka A, Jebson P, Tomaino M: Common benign tumors of the hand. Orthopaedic Knowledge Online Journal 2015; 13(8)1. Accessed August 2019.

Doctor Examination

Your doctor will perform a physical examination and use imaging studies and other tests to diagnose your tumor.

Imaging Studies

X-rays. X-rays create clear pictures of dense structures such as bone and are helpful in diagnosing an osteoid osteoma. An x-ray of the painful area may reveal thickened bone surrounding a small central core of lower density—a distinctive characteristic of the tumor.

Computerized tomography (CT) scan. A CT scan provides a cross-sectional image of your bone and can also be helpful in evaluating the lesion. A CT scan will commonly show the nidus—or center of the tumor.

X-ray and CT scan of an osteoid osteoma in the tibia

(Left) This x-ray shows an osteoid osteoma in the tibia. (Right) A cross-section CT scan of the same tumor.

Biopsy. A biopsy may be necessary to confirm the diagnosis of osteoid osteoma. In a biopsy, a tissue sample of the tumor is taken and examined under a microscope. Your doctor may give you a local anesthetic to numb the area and take a sample using a needle. A biopsy can also be performed as a small operation.  If imaging studies are highly suggestive of an osteoid osteoma, your doctor may not perform a biopsy. 

Other tests. To exclude other possible bone problems such as an infection or malignant tumor, your doctor may order additional imaging studies. Certain blood tests may also be used to rule out an infection.

Treatment

Nonsurgical Treatment

Most osteoid osteomas will disappear on their own over several years. For some patients, regular use of over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin, ibuprofen, and naproxen, provides pain relief.

Surgical Treatment

Many patients, however, cannot tolerate taking NSAIDs for years, or do not want to wait years for the tumor to resolve on its own. In these cases, a patient or family may wish to consider surgery.

Curettage. One option for surgical treatment of an osteoid osteoma is to scrape or scoop out the entire tumor, particularly the nidus—or central core. Your doctor will take great care to ensure that the entire tumor is removed; otherwise, it may grow back.

This is a traditional open procedure in which your surgeon makes an incision in the skin and soft tissues over the tumor site in order to reach the bone. In most cases, this type of surgery is highly successful. It does, however, carry risksincluding general anesthesia, infection, bleeding, and possible damage to surrounding tissues.

Radiofrequency ablation. A newer treatment option is to use minimally invasive techniques such as CT-guided radiofrequency ablation. In this procedure, the tumor is heated and destroyed with a high-frequency electrical current. The procedure can be done by either an interventional radiologist or an orthopaedic surgeon.

Before the procedure, you will be given either general anesthesia or a regional pain block with sedation. Your doctor will identify the site of the tumor using a CT scan. A radiofrequency probe is then inserted into the tumor. The probe heats the tumor tissues to about 90 degrees Celsius, effectively killing them. There is minimal damage to surrounding tissues.

In most patients, the tumor is adequately treated following one radiofrequency probe treatment. This procedure is often done on an outpatient basis, after which you may go home with a mild pain reliever.

Recovery

The time it takes to return to daily activities will vary depending on the procedure and the location of the tumor. In many cases, patients return to work or school in a few days with some restrictions. After radiofrequency ablation, most patients have resolution of their symptoms within 24 hours. Your doctor will provide you with specific instructions to guide your recovery.

Last Reviewed

August 2019

Contributed and/or Updated by

Rajiv Rajani, MD, FAAOS

Peer-Reviewed by

Stuart J. Fischer, MD, FAAOS

AAOS does not endorse any treatments, procedures, products, or physicians referenced herein. This information is provided as an educational service and is not intended to serve as medical advice. Anyone seeking specific orthopaedic advice or assistance should consult his or her orthopaedic surgeon, or locate one in your area through the AAOS Find an Orthopaedist program on this website.