osteochondroma or exostosis is most common primary benign bony tumor comprising of more than one third of the total occurrences .
osteochondromas are considered as an aberration in the normal physial growth plate and originate from the metaphysis of long bone with more than third ( 35 - 46% ) of cases affecting the bone around the knee ( lower end femur > upper end tibia ) , 10% cases involve the small bones of the hand and 5% involve the pelvis and flat bones like scapula ( 4 - 6% ) are least involved .
these tumors usually affect the growing skeleton and cease to increase in size after skeletal maturity .
these are usually painless but may become painful due to neurovascular entrapment / compression , fracture at the stalk , bursal inflammation or malignant transformation .
this article presents a case of osteochondroma on superior angle of scapula in a 23-year - old male presented with pseudo winging and snapping of scapula , crepitus on scapulothoracic motion and occasional pain since 5 years . however , there was no increase in size of the swelling or local and systemic signs of malignant transformation .
x - ray demonstrated a pedunculated exophytic mass on supero medial aspect of the right scapula .
the patient demonstrated full painless range of motion after 1 month and no recurrence was demonstrated during 1 year follow up .
usually a patient presents in early to late childhood , however , in some cases it may be presented in adults .
osteochondroma is the most common primary benign bone tumor that most of tenoccursnear the end of long bone usually solitary ( 90% ) , may be multiple in the form of hereditary multiple exostosis ( hme ) in about 10% of cases .
. a scapular osteochondroma may be symptomatic mainly due to its mass effect as it may cause scapular pseudo winging and crepitus and snapping on scapulothoracic motion .
winging of scapula is defined as prominence of medial border or vertebral border of scapula [ 3 , 4 ] .
it can be attributed to many causes but most commonly due to paralysis of serratus anterior muscle which needs to be ruled out .
these tumors usually affect the growing skeleton and cease to increase in size after skeletal maturity . any increase in swelling of an asymptomatic swelling turning symptomatic
herein , we describe a case of a 23-year - old patient who presented with a swelling on superomedial aspect of right scapula since 5 years . diagnostic work up and management along with clinical pictures
a 23 year old male patient presented to the orthopaedic clinic with complaints of an isolated scapular swelling ( right ) since 5 years ( figure 1 ) .
the swelling was also associated with crepitus and snapping of the right shoulder and slight restriction and pain on abduction .
the patient reported no increase in size of the swelling over the years and demonstrated no increase in symptoms as well .
there was no history of antecedent trauma , weight loss , loss of appetite or any other constitutional symptom .
the patient wanted the swelling to be removed due to cosmetic reasons mainly as he was about to get married .
however , snapping and crepitus / grating could be demonstrated on scapulothoracic movements and restriction in abduction was evident .
an antero posterior skiagram of the right shoulder revealed a pedunculated mass arising from the supero medial angle of the scapula ( figure 2 ) .
scapula shows the anteroposterior view of right shoulder with an exostosis arising from the superior angle of scapula ct scan and mri revealed a mushroom shaped exostosis over the superior angle of scapula ( figure 3 ) .
shows the anteroposterior view of right shoulder with an exostosis arising from the superior angle of scapula the swelling diagnosed as ventral osteochondroma was excised . a laparoscopic resection of the same has been described , however , we performed an open excision of the swelling .
an incision was used along the medial border of scapula wherein it was most prominent ( figure 4 ) .
post operative course was uneventful and patient was able to perform full range of motion at his right shoulder after 1 month ( figures 5,6 ) .
follow up was done till 1 year and no recurrence of the swelling was reported .
osteochondroma is the most common benign tumor affecting the metaphysis of long bones , rarely involving the flat bones like scapula .
usually the swelling is painless , however , symptoms may be detected when the swelling becomes large in size due to sheer bulk of the same .
symptoms are usually attributed to neurovascular compression , bursal thickening , fracture through the stalk and rarely malignancy .
however in case of scapula , symptoms may include snapping , grating / crepitus on scapulothoracic movements [ 2 , 3 , 4 ] and on and off pain etc may be present .
ventral swellings may cause most of these symptoms and may also lead to untoward prominence of medial border which remains so even on pushing against a wall , hence called pseudowinging as opposed to winging which increases on performing this maneuver .
snapping occurs when the normal smooth gliding of the concave portion of the anterior scapula over the convex thorax is disrupted .
scapulo thoracic crepitus may also be produced by an abnormal shape of the scapula which interferes with scapulo - thoracic motion as can be expected in ventral swellings .
sometimes ventral swellings may impinge on thoracic cage and restrict abduction which is again a feature of such swellings .
usually this condition is benign however , growth in size after skeletal maturity , asymptomatic swelling turning symptomatic and other constitutional and local symptoms / signs may raise the suspicion of malignancy and other radiographic assessment modules need to relied upon like an mri or a ct scan which will clearly demonstrate the margins and cartilage cap thickness ( > 2 cm signifies malignancy , < 1 cm benign and 1 - 2 cm questionable ) . in our case , the patient with scapular swelling demonstrated no increase in size or other features of malignancy .
but we still opted for radiological assessment as it helped both in the surgical approach as well as ruled out any malignant transformation and hence malignancy .
it is mandatory to get a biopsy for hpe analysis no matter how benign the swelling appears to rule out any traces of malignancy .
however , proponents of arthroscopic excision claim that there is slow functional recovery and cosmetic disadvantage due to the larger incision .
many authors have advocated arthroscopic excision for ventral mass , however it has risks of incomplete removal and recurrence .
usually a patient presents in early to late childhood however in some cases it may be presented in adults .
 introduction : osteochondroma or exostosis is most common primary benign bony tumor comprising of more than one third of the total occurrences . 
 osteochondromas are considered as an aberration in the normal physial growth plate and originate from the metaphysis of long bone with more than third ( 35 - 46% ) of cases affecting the bone around the knee ( lower end femur > upper end tibia ) , 10% cases involve the small bones of the hand and 5% involve the pelvis and flat bones like scapula ( 4 - 6% ) are least involved . 
 these tumors usually affect the growing skeleton and cease to increase in size after skeletal maturity . 
 these are usually painless but may become painful due to neurovascular entrapment / compression , fracture at the stalk , bursal inflammation or malignant transformation.case presentation : this article presents a case of osteochondroma on superior angle of scapula in a 23-year - old male presented with pseudo winging and snapping of scapula , crepitus on scapulothoracic motion and occasional pain since 5 years . however , there was no increase in size of the swelling or local and systemic signs of malignant transformation . 
 x - ray demonstrated a pedunculated exophytic mass on supero medial aspect of the right scapula . 
 the findings were confirmed on ct and excision of the lesion was done . 
 the patient demonstrated full painless range of motion after 1 month and no recurrence was demonstrated during 1 year follow up.conclusion:scapular osteochondroma is a relatively rare condition . 
 usually a patient presents in early to late childhood , however , in some cases it may be presented in adults . 
 growth after maturity is indicative of a metastatic transformation . 
 so an excision of the same should be accompanied with histopathological examinations . 
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