An Atypical Cause Of Persistent Elbow Pain In A Recreational Athlete - Page #4

Working Diagnosis:
Chondromyxoid fibroma

Curettage and allograft of the lesion

At a six-week follow-up appointment, the patient was found to be noncompliant with the use of a shoulder sling, and he reported continued use of his left arm to complete job requirements (operating heavy machinery, installing septic tanks, etc.).

At five-month follow-up appointment, range of motion at the elbow was approximately 0 to 130 degrees without significant discomfort. Radiograph of the elbow revealed slight resorption of bone graft material but no acute abnormalities. Against recommendations, he reported lifting 40-50 pounds without significant pain.

Eleven months following the index procedure the patient had returned to full work and recreational activity, although intermittent elbow pain and numbness in the fourth and fifth digits persisted.

Author's Comments:
Chondromyxoid fibroma (CMF) is an exceedingly rare cause of chronic elbow pain in an athlete.

CMF, itself, is a rare benign cartilage tumor that accounts for less than 0.5 percent of all primary bone tumors. CMF is most commonly found in the proximal tibial metaphysis in patients 10 to 30 years of age. The ulna is an atypical location, accounting for less than three percent of all CMF neoplasms.

Treatment consists of resection or curettage followed by bone grafting. Up to twenty percent of patients experience local recurrence, requiring repeat surgery.

Editor's Comments:
Chondromyxoid Fibromas are characterized as a rare cause of painful benign bone lesions. They comprise of less than one percent of all bone tumors, and less than two percent of benign bone tumors. It usually occurs during the second and third decade of life and in males more often than females. Typical locations are within the long bones of the body, such as the proximal tibia, then femur, and lastly calcaneus however there are case reports in the literature of occurrences in the facial bones, pelvis, jaw, hands, feet and forearms.

Initial work up involves plain radiographs, where lesions are commonly described as eccentric, intramedullary, lobulated or bubbly lesion in the metaphysis. It has a sclerotic border that is lucent, sometimes described as scalloped, and rare chondral matrix. Care must be taken to differentiate lesions from chondrosarcomas, which have a much poorer prognosis.

Treatments are typically comprised of curettage and grafting however the tumors can have a recurrence rate of up to 25% if the tumor is not removed in its entirety. Complications of non treatment include increased local destruction resulting in pain and swelling, rare cases of pathologic fracture, and rare malignant transformation at a rate of 1-2%, reported following irradiation.

Heck, RK. Benign Aggressive Tumors of Bone. Canale, ST, ed: Campbells Operative Orthopaedics. January 2013. pp. 887-908

Fomete B, Adeosun OO, Awelimobor DI, Olayemi L. Chondromyxoid fibroma of the mandible: Case report and review of the literature. Ann Maxillofac Surg. 2014 Jan;4(1):78-80.

Roberts EJ, Meier MJ, Hild G, Masadeh S, Hardy M, Bakotic BW. Chondromyxoid fibroma of the calcaneus: two case reports and literature review. J Foot Ankle Surg. 2013 Sep-Oct;52(5):643-9.

Khalatbari MR, Hamidi M, Moharamzad Y. Chondromyxoid fibroma of the anterior skull base invading the orbit in a pediatric patient: case report and review of the literature. Neuropediatrics. 2012 Jun;43(3):140-5.

Lersundi, A, Mankin, HJ, Mourikis, A, et al. Chondromyxoid fibroma: a rarely encountered and puzzling tumor. Clin Orthop Relat Res. 2005;439:171-5.

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