Working Diagnosis:
Chondroblastoma

Treatment:
Patient had the option to have open curettage or radiofrequency ablation. The open curettage would be more definitive but since he wanted to continue skiing competitively, he decided to have radiofrequency ablation, which would likely also have good outcomes. He underwent radiofrequency ablation with the Interventional Radiologist.

Outcome:
A couple of weeks after the ablation, his shoulder pain had improved. He had gained nearly full range of motion but still needed to protect his shoulder due to weakness in the cortical and metaphyseal regions. About a month after the ablation, the patient was pain free and cleared to ski. He continues to see the Orthopedic Musculoskeletal Oncologist with repeat x-rays every 2 months. There has been no change in the appearance of the lucent humeral head.

Author's Comments:
Chondroblastoma is a benign tumor most often found in the epiphyses of long bones of pediatric patients. As seen in this patient, pain is the most common presenting symptom. Open curettage is the most commonly used treatment but radiofrequency ablation has also been shown to be safe and effective. The patient is currently stable and able to participate in regular activities, but if the lesion progresses or he has recurrent pain, an alternate treatment may need to be considered.

Editor's Comments:
The utility of the reported lab tests are unclear, and one would hope the authors repeated the films (depending on how recent the previous ones were), then went on to MRI before obtaining labs, which would be unlikely to find a cause for shoulder pain in a young athlete.
This is an unsual cause for bone pain in a young athlete but certainly should be on the differential especially when the trauma history is vague.

References:
Damron T, Murray D. "Chondroblastoma Treatment and Management." Medscape. Updated 4/1/14. Accessed 4/10/14.
Damron T. "Chondroblastoma." Medscape. Updated 4/1/14. Accessed 4/10/14.
Damron T. "Chondroblastoma Clinical Presentation." Medscape. Updated 4/1/14. Accessed 4/10/14

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