Updated: 12/4/2019

Melorheostosis

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Questions
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Evidence
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Cases
1 1
https://upload.orthobullets.com/topic/8043/images/33b_moved.jpg
https://upload.orthobullets.com/topic/8043/images/300px-melorheostosis-002 ulna.jpg
https://upload.orthobullets.com/topic/8043/images/x-ray_of_hand melorheostosis.jpg
https://upload.orthobullets.com/topic/8043/images/picture 1.jpg
https://upload.orthobullets.com/topic/8043/images/melorheostosis histology.jpg
Introduction
  • Rare benign painful disorder of the extremities characterized by formation of periosteal new bone
  • Epidemiology
    • demographics
      • usually presents before age 40
      • no sex predilection
    • location
      • more common in the lower extremities, but can occur in any bones 
  • Genetics
    • non-hereditary
Presentation
  • Symptoms
    • pain
    • reduced range of motion
    • joint contractures
  • Physical exam
    • fibrosis of the skin with significant induration and erythema is common
    • reduced range of motion
    • painful hyperostoses
Imaging
  • Radiographs
    • cortical hyperostosis 
      • “dripping candle wax” appearance with dense hyperostosis that flows along the cortex of the bone  
      • hyperostosis may flow across joints
Studies
  • Histology
    • normal haversian systems with enlarged bone trabeculae and without cellular atypia or mitotic figures 
Treatment
  • Nonoperative
    • symptomatic treatment
      • indications
        • mild symptoms with adeqate motion
        • bisphosphonates shown to help with pain and swelling 
  • Operative
    • hyperostotic bone resection with contracture release
      • indications
        •  severe contractures, limited mobility, and pain
 

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Questions (2)

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(OBQ11.242) A 55-year-old military officer presents with greater than one year of generalized foot pain. On a recent physical examination, he was found to have an elevated prostate specific antigen (PSA), but is otherwise healthy. Radiograph, CT scan, bone scan, and histology slide are shown in Figures A through D. What is the most likely diagnosis? Review Topic | Tested Concept

QID: 3665
FIGURES:
1

Metastatic prostate cancer

32%

(640/2025)

2

Periosteal osteosarcoma

5%

(102/2025)

3

Melorheostosis

42%

(859/2025)

4

Spindle cell sarcoma of bone

4%

(76/2025)

5

Healing stress fracture of the second metatarsal

16%

(329/2025)

L 4 C

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