Working Diagnosis:
Osteochondroma

Treatment:
Surgical excision was recommended. The patient and family decided to wait 4 months for the convenience of having surgery over Christmas break. Other treatments included activity modification, NSAIDs, and ice. His symptoms subsided with cessation of basketball team play, and he joined the golf team. He was able to complete the golf season, playing 18 holes five times per week with mild soreness over lateral knee after 9 holes. He also continued to have pain in gym class especially when running more than 30 minutes or playing basketball.
Surgical excision was completed 12/28/11 Case Photo #3 . Pathological evaluation of the 8 X 2 cm sessile mass showed a raised calcified mass with a cartilaginous cap consistent with an osteochondroma.

Outcome:
The patient used crutches for 2 weeks and used a knee immobilizer for 4 weeks. He gradually increased weight bearing activity over the next 4 weeks, avoiding high impact activities. Eight weeks after surgery he was cleared for all activities. Since then he has had no pain with any activities, including golf, running and basketball.

Author's Comments:
This case illustrates the need for a broad differential diagnosis and the utility of radiographs in arriving at the correct diagnosis. Osteochondromas are the most common type of benign bone tumors, occurring most commonly at long bone physes. They usually occur in adolescents between 10 and 20 years of age. They can become symptomatic with compression against the surrounding structures, which in this case was the IT band and underlying bursa.

Editor's Comments:
This case is a classic example of a common bone neoplasm that can present in a Sports Medicine clinic. An astute physical exam showed this was not your ordinary ITB syndrome, and radiographs were sufficient in making an accurate diagnosis. When neoplasms seen on radiographs are not obviously benign, as in this case, advanced imaging such as MRI or CT will be useful.

References:
Tis, JE. Overview of benign bone tumors in children and adolescents. UpToDate. Accessed May 12, 2012.

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