summary Melorheostosis is a rare benign painful disorder of the extremities characterized by formation of periosteal new bone. Patients typically present in the first 4 decades of life with localized pain and reduced range of motion. Diagnosis is made radiographically with a "dripping candle wax” appearance with dense hyperostosis that flows along the cortex of the bone. Treatment is observation and medical management for those with mild symptoms and normal joint motion. Surgical bone resection and contracture release is indicated for those with severe symptoms and joint contractures. Epidemiology Demographics usually presents before age 40 no sex predilection Anatomic location more common in the lower extremities, but can occur in any bones Etiology 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 adequate motion bisphosphonates are shown to help with pain and swelling Operative hyperostotic bone resection with contracture release indications severe contractures, limited mobility, and pain
QUESTIONS 1 of 3 1 2 3 Previous Next Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK (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? QID: 3665 FIGURES: A B C D Type & Select Correct Answer 1 Metastatic prostate cancer 32% (752/2342) 2 Periosteal osteosarcoma 5% (121/2342) 3 Melorheostosis 42% (987/2342) 4 Spindle cell sarcoma of bone 4% (89/2342) 5 Healing stress fracture of the second metatarsal 16% (373/2342) L 4 Question Complexity C Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 3 Review Tested Concept Review Full Topic Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK