Teaching Case

Left hand pain

X-ray film of the left hand, performed for carpal pain of unknown cause with sudden onset. Pain resolved after a course of non steroids anti-inflammatory therapy.

Osteopoikilosis is a rare idiopathic, asymptomatic, inherited bone disorder, usually an incidental finding on plain x-ray films performed for other causes, as in this case. It is also known as Albers-Schonberg disease, or with its latin name, describing its main features, osteopathia condensans disseminata. It is charachterised by the presence of multiple and often symmetrical foci of dense radio-opaque spots in the spongious bone tissue, or in the inner bone cortex. It is more commonly found in the epiphysis and metaphysis of the bones in upper and lower limbs, in the hand in carpal and metacarpal and in the foot in tarsal and metatarsal bones, while it is rarely seen in the pelvis, spine, ribs and skull. At histology these foci are formed by dense trabeculae of spongious bone, sometimes forming a nidus without communication with bone marrow. The etiology of this asymptomatic condition is an inherited autosomic disorder, according to some authors more frequently seen in males, sometimes associated with other mesenchimal disorders such as the presence of skin nodules and formation of cheloid scars. Its radiological features are typical: multiple radio-opaque round, oval, or lancelolate spots of uniform density with sometimes relatively clear central zone and often symmetrical. The differential diagnosis, given by the fact the dense spots will infrequently change in size, is with other far more serious sclerosing bone disorders: tuberous sclerosis and sclerosing bone metastasis.