Exostosis of bone, bone exostosis of bones

Bone exostosis or osteochondroma is the most common skeletal tumor. It accounts for about 20% of all cases of the formation of bone tumors and almost 40% of the development of all benign bone tumors. Most often it is detected before the age of 20, although it is usually asymptomatic. Only in isolated cases does pain and other disorders occur. Nevertheless, the formation of a growth on the bone necessarily requires consultation with a doctor, since malignancy or malignancy of osteochondroma is rare, but still possible.

What is bone exostosis

Osteochondral exostosis is a benign osteochondral formation on the outer surface of the bone. Most often, it is detected at a young age before the end of skeletal growth, including in children.

The formation of osteochondroma provokes a disruption of the natural processes of resorption (resorption) and the formation of new bone tissue (remodeling).

Exostosis is a growth formed by spongy bone and having a cortical layer (a strong, hard “shell”). It can grow on a stalk or be attached to a bone with a wide base. On the outside, the bone growth is covered with cartilage tissue, which has much in common with articular cartilage. Its thickness does not exceed 1 cm. The top layer of exostosis is also called a cartilaginous cap.

MRI of the pelvic bones: preparation

The duration of the scan is 25-30 minutes; maximum immobility is required during the procedure.

No special measures are required to study this anatomical area: you must leave all objects containing metal outside the diagnostic room and choose comfortable, loose clothing without zippers, rivets, jewelry, etc.

Pain in the pelvis can be caused by a pathological process of internal structures (irradiation to the bones or joints). Therefore, to be able to evaluate parts of the reproductive, urinary and intestinal tract in the area of interest, 2-3 days before the scan, gas-forming foods and drinks should be excluded from the diet: peas, beans, cabbage, black bread, milk, kvass, beer, etc. For examination You should come after a 4-6 hour fast.

To prevent vegetative reactions to the administration of the drug, it is recommended to have a light snack 20-30 minutes before diagnosis with contrast. Eating a small amount before the procedure will not interfere with visualization.

MRI of the pelvic bones and vital organs of a given anatomical region is technically carried out in different ways: to study a specific structure, they use variable sequences and modes, wait a certain period of time to achieve contrast, etc. The doctor, with a preliminary assessment of the images and a clear suspicion of a disease of any organ may change the diagnostic algorithm. Proper preparation for an MRI will allow you to get better images. All identified changes will be described in the conclusion.

Take with you the results of previous diagnostics: X-ray and ultrasonography, MRI, PET, hospital discharge. To conduct the study, you need a passport, a referral, and a Compulsory Medical Insurance/VHI policy (if the MRI is paid for by an insurance company).

Exostosis in a child

It is in children that osteochondroma is most often first diagnosed, which is due to its formation from cells of the epiphyseal plate that is present only until the end of the growth period, which is adjacent to the metaphysis. It is also called the bone growth zone, since it is a hyaline cartilage whose cells are in constant miotic division. As a result, new chondrocytes (cartilaginous tissue cells) are formed, forming the epiphyseal plate, and the old ones are shifted to the metaphysis and subsequently replaced by osteoblasts (bone tissue cells).

In infants, violation of the rules for the prevention of rickets, in particular excessive use of vitamin D preparations, increases the likelihood of the formation of exostoses.

After puberty, the growth plates gradually close and are replaced by bone tissue, transforming into a thin epiphyseal line. If hormonal imbalances occur during this period, it is possible that the growth zones may remain open, which creates the preconditions for the formation of osteochondromas.

Usually, until the age of 7-8 years, bone exostosis does not manifest itself in any way in a child and makes itself felt only during the period of intensive growth, i.e., at 8-16 years, since it also begins to grow actively. In young children, such growths are present in the metaphysis area immediately near the epiphyseal plate, but subsequently move away from it and approach the diaphysis. Therefore, by how far the bone exostosis in children is from the epiphysis, the time of its formation is determined.

The growth of the neoplasm continues until the end of the growth period.

Female pelvis in obstetrics

The bony pelvis creates a solid foundation for the soft tissues of the birth canal and determines its direction and size. The bones of the female pelvis are thinner, the plane of the entrance to the small pelvis usually has the shape of a transversely narrowed oval, while the plane of the entrance to the male pelvis is funnel-shaped. The female pelvis is lower, wider and more spacious compared to the male; the pubic symphysis is shorter. The cavity of the female pelvis towards the exit becomes wider due to the flatness of the iliac bones, a greater distance between the ischial tuberosities and a large subpubic angle (90-100 ° compared to 70-75 ° in men).

From an obstetric point of view, the female pelvis is divided into two parts. The boundary between them is the boundary line. It runs along the inner surface of each ilium from the sacroiliac joint at the iliopubic eminence and divides the pelvis into two parts: the upper (large pelvis) and the lower (lesser, or true pelvis).

The large pelvis cannot serve as a guide for the capacity of the small pelvis, but it is easily accessible for measurement, and therefore some of its dimensions are used to roughly estimate the size of the small pelvis:

Interspinous distance - the distance between the anterior superior spines of the iliac bones (25-26 cm);
Intercrest distance - the distance between the most distant points of the iliac crests (28-29 cm);
Interacetabular distance - the distance between the most distant points of the hip joints (30-31 cm);
External conjugate - Baudeloc's conjugate, external obstetric conjugate - the distance from the fossa between the spinous processes of the last lumbar and first sacral vertebrae to the most protruding point of the symphysis (20-21 cm).

Small (true) pelvis

It is of greatest importance for childbirth. It is bounded above by the promontory of the sacrum, the border line and the upper edge of the pubic bones, and below by the outlet of the pelvis. The anterior wall of the small pelvis in the symphysis area is about 5 cm long, the posterior wall (in the sacral area) is about 10-12 cm. The lateral walls of the small pelvis are represented by the inner surfaces of the ischial bones. When a woman is in an upright position, the upper part of the pelvic canal is directed down and back, and the lower part forms an arc and goes down and forward. The lateral walls of the pelvis in an adult woman have a somewhat converging direction. The descending branches of the pubic bones in the normal female pelvis form a circular arch (subpubic angle 90-100 °), which allows the passage of the fetal head.

In the pelvis there are 4 conventional planes that help to navigate in determining the location of the presenting part of the fetus during childbirth:

— The plane of entry into the pelvis;

— The plane of the wide part of the pelvic cavity (passes through the largest diameter of the pelvis);

— The plane of the narrow part of the pelvic cavity (passes through the small diameter of the pelvis);

— The plane of exit of the small pelvis.

The plane of entrance to the small pelvis is limited posteriorly by the promontory and wings of the sacrum; on the sides - by the border line, in front - by the symphysis and the upper (horizontal) branches of the pubic bones. The configuration of the entrance to the female pelvis in 50% of women is more round than oval (gynecoid type of pelvis). In the plane of the entrance to the pelvis, 4 diameters have obstetric significance: straight (antero-posterior, true conjugate), transverse and two oblique.

The straight diameter is the real conjugate (internal obstetric conjugate) - the most important anteroposterior diameter, which is the smallest distance between the promontory and the internal superior edge of the symphysis (10-11 cm). The distance between the promontory of the sacrum and the upper edge of the symphysis (the anteroposterior diameter of the anterior opening of the pelvis) is called the anatomical conjugate and is equal to 11.5 cm.

Transverse diameter - the distance between the most distant points of the intermediate line (13-13.5 cm).

Oblique diameter - the distance between the sacroiliac joint on one side and the iliopubic eminence on the opposite side (12-12.5 cm). The right diameter is measured from the right sacroiliac joint, the left - from the left.

The plane of the wide part of the pelvic cavity is limited in front by the middle of the inner surface of the symphysis, on the sides by the middle of the hip sockets, and behind by the communication of the II and III sacral vertebrae. In the wide part of the small pelvis, the straight (12.5 cm) and transverse (12.5 cm) diameters are determined.

The plane of the narrow part of the pelvic cavity is limited in front by the lower edge of the pubic symphysis, on the sides by the spines of the ischial bones, and behind by the sacrococcygeal joint. In this plane, straight (11.5 cm) and transverse (10.5 cm) diameters are also distinguished.

The plane of exit of the small pelvis is limited in front by the lower edge of the pubic arch, on the sides by the ischial tuberosities, and behind by the apex of the coccyx. It has a straight diameter of 9.5 cm, but when the coccyx deviates, it can increase by 1.5-2 cm and equals 11-11.5 cm; and transverse diameter (between the ischial tuberosities), which is 11 cm (at least 8 cm). In the plane of the pelvic outlet, the anal sagittal diameter is also distinguished (a segment of the direct diameter from the apex of the coccyx to the point of intersection with the transverse diameter), which in a normal pelvis should not be less than 7.5 cm. When the narrow part of the pelvic cavity or the pelvic outlet is narrowed, the prognosis of vaginal birth depends on the size of the anal sagittal diameter.

So, in the plane of the entrance to the pelvis, the largest is the transverse diameter; in the wide part of the pelvic cavity, the straight and transverse diameters are the same (this plane has no special obstetric significance); in the narrow part of the pelvic cavity and in the exit plane, the largest are straight diameters. These provisions are important for understanding the biomechanism of childbirth with a normal pelvis.

Pelvic axis, or leading line of the pelvis , connecting the midpoints of the straight diameters of all planes of the small pelvis and is directed down and back when entering the pelvis, and down and forward when exiting.

The angle of inclination of the pelvis is formed between the plane of the entrance to the pelvis and the horizontal line when the woman is in a vertical position and is 45-60 ° (for non-pregnant women - 45-46 °).

Types and stages of development

Exostosis can be present only on one bone, i.e., be solitary, or affect all metaphyses of the bones of the skeleton. In the second case, they talk about a generalized form of the disease, which is more common in men and is mainly hereditary. It is also called multiple exostotic chondrodysplasia. In this case, several bones or the vast majority of them are affected, but the formations have different shapes and sizes.

Depending on the shape and direction of growth, there are:

hilly;
linear;
spherical exostoses.

Single exostoses have a narrow or wide base, while multiple ones are usually spherical or oval growths measuring 2-12 cm, sometimes more.

In its development, any osteochondroma goes through 3 successive stages:

the formation of cartilaginous exostosis, which is not determined by palpation (palpation);
ossification and active growth of growth;
stopping the growth of the bone part of the neoplasm while maintaining the possibility of increasing the size of the cartilaginous cap.

Bone exostoses can already be felt during examination and can lead to discomfort, pain during physical activity and other symptoms.

Based on the nature of development and clinical picture, osteochondromas are divided into the following types:

With normal growth rate. The osteochondral formation grows slowly, and there is a correspondence between the growth rate of the cartilage and the affected bone. Such osteochondromas have the most favorable prognosis, since after the end of the growth period they do not tend to continue to grow and almost never become malignant.
With a high growth rate. An increase in the size of the growth occurs due to the proliferation of cartilage tissue and can also continue after the completion of the formation of the skeleton due to the preservation of the growth zone. In such cases, removal of exostosis is indicated, since there is a fairly high risk of malignancy.
Malignant exostosis has the most unfavorable prognosis. Most often, osteochondral neoplasms of the ribs, pelvic bones, scapula and spine degenerate into chondrosarcoma or osteogenic sarcoma.

Large and small pelvis

There are large and small pelvises. The boundary line separating them runs along the inner surface of the pelvic bones from the protrusion on the spine - the promontory (the junction of the last lumbar vertebra with the sacrum) to the upper edge of the pubic symphysis.

Large pelvis The large pelvis is the upper section of the pelvis, formed by the unfolded wings of the ilium. It is the lower wall of the abdominal cavity and serves as a support for the internal organs.

Small pelvis The small pelvis is located below the large pelvis and is limited from behind by the sacrum and coccyx, in front and from the sides by the ischial and pubic bones. It distinguishes between entrance, exit and cavity. The pelvic cavity contains the bladder, rectum and internal genital organs (ovaries, fallopian tubes, uterus and vagina, prostate, seminal vesicles and vas deferens). The entrance to the small pelvis is open to the abdominal cavity and corresponds to the border line with the large pelvis. The exit from the pelvic cavity is closed by the muscles that form the pelvic diaphragm, through which the urethra and rectum pass in men, and the urethra, rectum and vagina in women. From the outside, this area of the body stands out as the perineum.

The pelvic organs differ from the abdominal organs in that they can significantly change their volume: the bladder and rectum periodically fill and empty, the uterus enlarges and moves during pregnancy. This affects the functioning of other organs and blood supply.

Causes of exostosis

There is still no consensus on the reasons for the appearance of exostoses. A number of authors believe that they are of a tumor nature. But most agree that they are a consequence of disorders of enchondral ossification processes that arise as a result of dysembryogenesis (disorders of embryonic development). Therefore, today the main theory of the formation of bone exostoses is the displacement of the epiphyseal plate during intrauterine development of the fetus. It is a bone growth zone located directly below the epiphysis and is responsible for its lengthening. Therefore, the disease is considered congenital, and its development continues throughout the entire period of growth.

The following can increase the risk of osteochondroma:

ionizing radiation (in 10% of cases the disease develops in patients who underwent radiation therapy in childhood);
disturbances in the functioning of the endocrine system, taking hormonal drugs;
smoking and alcohol abuse of parents.

The disease can also be hereditary and transmitted to the child from one of the parents. Especially often, multiple bone lesions due to exostoses are genetically determined.

The acquired nature of the disease cannot be ruled out. The following can provoke the appearance of neoplasms:

bone injuries;
microtraumas caused by excessive physical activity, which is typical for professional sports;
infectious diseases and chronic inflammatory processes of any localization (for example, a heel spur often develops against the background of plantar or plantar fasciitis);
pathologies of the periosteum, degenerative-dystrophic diseases of cartilage, ankylosing spondylitis;
microcirculation disorders in soft tissues;
muscle dystrophy;
obesity;
severe forms of allergic diseases;
compression of the limbs, including an incorrectly applied plaster cast or tourniquet.

Wearing improperly selected clothing and shoes, in particular frequent hypothermia of exposed areas of the body, increases the risk of developing bone tumors.

Of particular importance in the development of osteochondroma is hormonal imbalance in children during puberty. Often the formation of bone exostoses is observed against the background of increased synthesis of sex hormones in adolescents. This can provoke the growth zones to remain open, which can subsequently cause gigantism. Also, an increase in the size of osteochondral exostoses can continue after the closure of growth plates in women as a result of hormonal changes.

Symptoms

The clinical picture depends on the form of the disease, location, size, shape of exostoses, and the degree of their influence on surrounding tissues. Single neoplasms are usually immobile and their growth is slow. Therefore, in most cases they are asymptomatic and there is no pain. The condition of the skin with solitary exostoses is usually not changed.

But in some cases, there is active growth and acquisition of large osteochondromas. They can mechanically compress blood vessels, nerves, and joints passing near them and provoke the development of reactive bursitis and myositis. This is accompanied by the appearance of pain of varying severity, swelling, redness of the tissues, and sometimes a feeling of numbness. If joint exostosis is present, the range of motion may be limited.

What symptoms exostosis will have depends largely on its location. With multiple exostoses, often the first signs of the disease are stunted growth, valgus deformity of the knee joints and clubhandedness. Fractures of the osteochondroma pedicle may also occur.

Exostosis of the knee joint

It may be caused by the formation of a growth at the end of the tibia and or femur. Exostosis of the tibia provokes severe deformation of the knee joint and is easily detected with the naked eye. Upon palpation, it is possible to detect a dense but painless formation under the skin, which can be either smooth or rough. Reaching large sizes, it provokes pain in the knee when walking (especially often in women who tend to wear high-heeled shoes). In this case, exostosis of the joint tends to injure the adjacent soft tissues, which provokes the development of tendonitis (inflammation of the tendons) and bursitis (inflammation of the synovial bursa).

Damage to the femur in the early stages of development is asymptomatic. But when the tumor reaches a large size, pain in the thigh and dysfunction of the affected limb may occur. Often there are many areas of deformation up to the covering of its entire surface. Since the femur is located deep in the soft tissues, it is difficult to detect exostoses during palpation.

Distortion (displacement) of the pelvic bones

Functions of the pelvic bones

As already mentioned, the main functions of the pelvic bones are protective and supporting. Being the receptacle of the so-called pelvic organs, the pelvic bones prevent them from being injured by rough physical external influences and support them in space.
The pelvic bones participate in the process of hematopoiesis due to the presence of a large amount of red bone marrow.
The pelvis plays an important role in the movement of the body and maintaining natural balance, helping to evenly distribute the load on the limbs while in an upright position (standing) and during various movements.
The pelvic bones support the spinal column, which is also attached to them, and their normal location relative to the axis of balance allows you to maintain correct posture.

Consequences of incorrect location (distortion) of the pelvis

Changing the location of the pelvis can cause quite unpleasant consequences:

curvature of the spine and dysfunction. When the pelvis is displaced, the spinal axis is displaced, which often leads to uneven distribution of the load within the spinal column, excessive pressure on some points, as a result of which bone structures are gradually destroyed in these places. Subsequently, this can cause degenerative changes in the vertebrae, the formation of intervertebral hernias, the development of deforming osteoarthritis, spinal canal stenosis, radiculitis and many other spinal diseases.
As a result of displacement and dysfunction of the spine, a person experiences pain in various parts of the back, shoulders, neck and limbs. Limb functions may be impaired and carpal tunnel syndrome may develop.
Increased load on one of the lower extremities. When the pelvis is positioned correctly, the load is divided evenly between both limbs. When it is skewed, the center of gravity shifts, and the force of gravity acts more on one leg.

Causes of pelvic bone misalignment

Muscle imbalance. Lack of adequate physical activity, a sedentary lifestyle, and “sedentary” work often lead to the fact that some muscle groups of the human body gradually weaken and even atrophy, while others are in constant tension, a state of increased tone. The balance of muscle tissue is disrupted, which normally should form a kind of supporting corset for the entire musculoskeletal system. As a result of tension in some muscle groups while others are weakened, the pelvis may shift.
Injuries to the pelvic bones (consequence of mechanical impact - a fall or blow). The most serious injuries include fractures of the pelvic bones and, especially, fractures accompanied by rupture of the pelvic ring. Improper healing of these fractures can lead to distortion of the shape and subsequent displacement of the pelvis.
Physical overexertion (sharp lifting of heavy objects, prolonged carrying of heavy objects on one side of the body, etc.). Often, pelvic distortion occurs in people involved in powerlifting and weightlifting, especially if these classes are carried out without the supervision of an experienced and competent instructor.
Pregnancy. The female pelvis is quite flexible and elastic by nature, which is designed so that a woman can subsequently give birth to a child. Therefore, during pregnancy, especially when carrying a large fetus, the female pelvis may well shift. A woman may also experience a disruption (displacement) of her pelvis during childbirth.
Damage to the muscles of the pelvis and adjacent areas of the body. As a rule, damaged muscles are less elastic, denser and tighter than healthy ones. If an area of muscle tissue in the pelvic area is damaged, tension and compaction of the fibers of this area will cause tension in the ligaments and displacement of the bones that form the joints and fixed joints relative to each other. If the muscles do not recover completely and remain in increased tone, the pelvic bones will eventually shift relative to each other and change the position of the pelvis in relation to other parts of the skeletal skeleton. Depending on which muscle is damaged in this case, the pelvis will shift in different directions. For example: - damage to the psoas muscle causes a forward displacement of the pelvis; - damage to the quadriceps muscle leads to hip flexion; - Damage to the hip adductors will cause the pelvis to tilt forward and rotate the hip inward.
The difference in the length of the lower limbs, which is a manifestation of anatomical features or a consequence of the disease. Most often, different leg lengths cause the pelvis to shift from right to left, but sometimes in such cases the pelvis shifts from front to back or back to front. Twisting of the pelvis may also occur.
The presence of a herniated disc. Displacement of the pelvis in such cases occurs due to a long-term muscle spasm, and the misalignment is functional in nature. The mechanism for the formation of pelvic distortion in this case is similar to that for muscle damage.
Surgical interventions in the area of the bones that form the pelvis, as well as in the area of the hip joints.
The presence of scoliotic changes in the spine (congenital or acquired), especially in the lumbar region.

Indirect signs of the possible presence of pelvic distortion

Pain that occurs primarily during movement.
Stiffness of movements.
Unsteadiness when walking, frequent falls are symptoms of moderate pelvic distortion.
pain in the back, shoulders and neck, especially often pain in the lumbar region with irradiation to the lower limb.
Pain in the hip area.
Pain in the projection of the sacroiliac joints.
Pain in the groin area.
Pain in the knee, ankle, foot or Achilles tendon.
The appearance of a difference in the length of the lower limbs.
Bladder dysfunction.
Intestinal dysfunction.
Dysfunction of the genital organs.

Diagnostics

Taking an anamnesis: clarifying complaints and possible causes of pelvic displacement.
Physical examination of the patient: - visual examination; - palpation (feeling) of painful areas.
The use of instrumental examination methods, namely: - radiography of the spine and pelvic bones; — magnetic resonance imaging (MRI) of the spine and pelvic bones; - computed tomography (CT) of the spine and pelvic bones.

Treatment

Treatment is prescribed after identifying the cause that caused the pelvic displacement and should be aimed, first of all, at eliminating this cause. The following methods are recognized as effective:

manual therapy;
physical therapy complex;
performing a set of special gymnastic exercises;
special massage;
physiotherapy;
If necessary, surgical intervention is performed.

In addition, symptomatic treatment is prescribed:

taking non-steroidal anti-inflammatory drugs (NSAIDs)
in the presence of severe pain, short-term use of analgesics is indicated;
applying medicinal ointments and dry heat to the painful area of the body;
physiotherapeutic methods of treatment.

In any case, which treatment methods will be effective in a particular case should be decided only by a specialist: a neurologist, an orthopedist or a surgeon. The most ideal option is when treatment is prescribed by all these specialists after a joint discussion, that is, on a commission basis.

Forecast

Treatment of this pathology is quite problematic and requires some time, and the duration of the course of treatment depends on the duration of the period of pelvic displacement.

Obtaining a positive result from the treatment is often difficult due to the fact that during the existence of pelvic distortion, a person develops an incorrect pattern of movements. In addition, as practice shows, the correction of the distortion can very often be hindered by the muscles, which, in response to the appearance of the distortion, create a so-called block - a reflex tension of some muscle groups, thus trying to eliminate this displacement.

Prevention

Active lifestyle, regular exercise, maintaining good physical shape. Well-developed muscles support all the bones of the human skeleton; Even regular work of all muscle groups will help avoid the occurrence of muscle imbalance. Swimming, training on simulators under the guidance of a competent specialist, and horseback riding are considered effective for preventing pelvic distortion and alleviating symptoms when there is already a slight distortion. These sports eliminate overload of the spine and pelvis. In addition, there is evidence that people who were diagnosed with pelvic distortion significantly improved their condition with regular horse riding exercises under the supervision of specialists.
Prevention of spinal curvature. Helps prevent certain spinal diseases, including pelvic distortion.

Author: K.M.N., Academician of the Russian Academy of Medical Sciences M.A. Bobyr

Exostosis of the calcaneus (calcaneal spur)

This is a well-known type of osteochondroma. The growth can take on different shapes, which determines the characteristics of the symptoms that arise. With a spherical or mushroom-shaped neoplasm, after it reaches a size of 3-4 cm, pain appears when walking and the inability to fully step on the foot. Since the growth is located in an area that is constantly subject to friction from shoes, the skin in its projection gradually becomes coarser and thickens. A characteristic symptom is an increase in pain in the morning and a gradual decrease in its severity during the day. In the evening, swelling of the lower extremities is often observed.

Anatomy of the Ilium

The ilium (os ileum) has:

The wing of the ilium (ala ossis ilii) is the upper expanded section.
Iliac crest (crista iliaca) on top of the wing. The ridge is divided by three rough lines: the outer lip (labium externum), located laterally,
inner lip (labium internum),
intermediate line (linea intermedia).

Awnings are small protrusions:

superior anterior iliac spine

inferior anterior iliac spine (spina iliaca anterior inferior),

superior posterior iliac spine (spina iliaca posterior superior),

inferior posterior iliac spine (spina iliaca posterior inferor).

Gluteal lines: Anterior gluteal line (linea glutea anterior) - visible on the dorsolateral surface of the iliac wing. Starts from the superior anterior iliac spine. Then it goes posteriorly and reaches the greater sciatic notch.
Posterior gluteal line (linea glutea posterior) - located anterior to the superior posterior iliac spine, directed downward.
The lower gluteal line (linea glutea inferior) is located above the upper edge of the acetabulum.

Iliac fossa (fossa iliaca) - located on the concave surface of the iliac wing.

Arc-shaped line (linea arcuata) - limits from below.

The auricular surface (facies auricularis) is a continuation of the line at the back.

The iliopubic eminence (eminentia iliopubica) is a continuation of the line in front.

The iliac tuberosity (tuberositas iliaca) is the site of attachment of powerful ligaments.

Spinal exostosis

The lesion can occur at any level, but the thoracic region is most often affected. The neoplasm is located in the area of the arches or processes of the vertebrae. It can grow towards the vertebral or spinal canal or in an anterior direction. The first option is more dangerous, since it is capable of mechanically compressing the spinal cord and the nerve roots extending from it. This provokes the development of the so-called radicular syndrome with sharp, severe pain, radiating in accordance with the level of damage to the body part, impaired sensitivity and mobility.

Hip bone

Each pelvic bone is formed by the fusion of the ilium, ischium and pubis. Connecting with each other, these bones form the acetabulum.

The ilium has an upper section, the wing, and a lower section, the body. The place where they connect has an arcuate shape - an arcuate line. There are several projections on the wing of the ilium: in front - the anterior superior iliac spine, slightly below it - the anterior inferior iliac spine; behind - the posterior superior iliac spine and the posterior inferior iliac spine.

The ischium makes up the lower and posterior third of the pelvic bone. It has a body, which participates in the formation of the acetabulum, and branches. The body and the branch form an angle between themselves, at the top of which there is a thickening - the ischial tuberosity. The ischial ramus joins the inferior ramus of the pubis. On the posterior surface, the branch of the ischium has a protrusion - the ischial spine. The ischium is involved in the formation of the lesser sciatic notch.

The pubic bone forms the anterior wall of the pelvis and consists of a body and two branches: the superior, horizontal and inferior, descending. The lower branches of the pubic bones form an angle - the pubic arch. The body of the pubis is involved in the formation of the acetabulum. At the junction of the ilium and pubic bones there is an iliopubic elevation. A bony ridge runs along the upper edge of the superior ramus of the pubis, ending in the pubic tubercle. Both pubic bones are attached to each other via the pubic symphysis. The pubic symphysis has a cavity inside that is filled with fluid and increases during pregnancy. Relaxation of the symphysis begins in the first half of pregnancy and is especially pronounced during the last 3 months. Regression of such relaxation begins immediately after childbirth and is completely completed after 3-5 months.

The sacrum consists of 5-6 vertebrae that are motionlessly connected to each other and has a uniformly concave anterior surface. The first vertebra of the sacrum is connected by cartilage to the fifth lumbar vertebra, forming a promontory. The sacrum is connected to each of the pelvic bones by flat cartilaginous sacroiliac joints, which have some mobility, and two ligaments: the sacroosteal and sacrohumpy.

The sacrospinal ligament runs from the posterior surface of the sacrum to the ischial spine, the sacrohumpy ligament runs from the posterior surface of the sacrum to the ischial tuberosity. These ligaments bend around the lesser and greater sacrosciatic notches and form the greater and lesser sciatic foramina. The coccygeal bone is usually formed by 4-5 fused vertebrae, and is attached to the distal end of the sacrum via a movable coccygeal joint. During childbirth, thanks to this joint, the tailbone can deviate by 1-1.5 cm.

The pelvic floor (perineum) is a group of fascia and muscles that supports the pelvic organs and is located in the area between the thighs from the tailbone to the pubic bone. The perineum is limited in front by the pubic symphysis, on the sides by the ischial tuberosities, and behind by the coccyx. The inferior surface of the levator anus muscle forms the superior border of the perineum. The floor of the perineum consists of skin and two layers of superficial fascia - the superficial subcutaneous fat layer (Camper's fascia) and the deep membranous layer (Collis' fascia). A transverse line drawn through the center of the perineum divides it into the anterior and posterior parts, or triangles - the urogenital (genitourinary diaphragm) and anal triangles (pelvic diaphragm).

The pelvic diaphragm (anal triangle) is a wide but thin layer of muscle that forms the lower border of the abdominal (and pelvic) cavity and consists of a wide funnel-shaped belt of fascia and muscle, extending from the symphysis to the coccyx between the walls of the pelvis. The pelvic diaphragm consists of 3 groups of muscles and fascia that cover:

Elevator anus muscles;
Coccygeus muscle;
External sphincter of the anus.

These structures are evolved remnants of the tail muscles of lower animals. The levator ani muscle is the longest and strongest of all the muscles and forms a wide muscular belt extending from the posterior surface of the superior ramus of the pubis, the inner surface of the ischium, and between these two formations from the obturator fascia. Muscle fibers are distributed in several directions: in the urethra, vagina and rectum, forming functional sphincters around them. The levator anus muscle is divided into three paired components, which are named according to their anatomical location: the pubococcygeus, ischiorectalis and iliococcygeus muscles.

An important space of the pelvic diaphragm is the ischiorectal fossa - the space between the skin and the levator anus muscle on both sides of the anal canal, containing adipose tissue bounded by Collis's fascia. The ischiorectal fossa at the back is combined with the same one on the opposite side, forming a “horseshoe”.

Exostoses of the ribs

The formation of growths on the ribs is more often observed with curvatures of the spine, which also lead to deformation of the chest. Their growth causes fixation of the pathological position of the chest and limitation of the vital volume of the lungs. As a result, respiratory function disorders may occur, which provokes the appearance of signs of hypoxia (oxygen starvation). To a greater extent, the lack of oxygen affects the brain, which can be accompanied by dizziness, headaches and other disorders. The heart, liver, spleen, and other internal organs are also sensitive to changes in the gas composition of the blood.

The structure of the ischium

What the ischium has already been generally mentioned . The detailed anatomy of this part of the skeleton will now be the main topic.

Upon closer examination, the ischium shaft can be seen as a fragment of the acetabulum. The upper edge of the obturator foramen is formed by the small posterior obturator tubercle, and the edge of the posterior crus forms the greater ischial spine. Above it is a large sciatic notch, below it is a smaller sciatic notch. The superior and coccygeus muscles are attached to the surface of the ischial shaft. A network of ligaments, tendons, muscles and nerves passes through the sciatic foramen, greater and lesser, including the piriformis muscle, sciatic nerve, veins and arteries, and the internal vessels of the vulva.

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Exostosis of the humerus

The humerus is one of the most common sites of osteochondroma. During its formation, the following may be observed:

dull pain in the shoulder area that occurs when moving the arm with a large amplitude;
a feeling of stiffness in movements, present mainly in the morning, until you manage to warm up;
limited mobility of the upper limb in the shoulder;
dystrophy of the muscles of the shoulder and forearm, which in difficult cases can be seen with the naked eye.

Complications

Cartilaginous exostosis in children has a dangerous negative impact on the condition of the growth plates, which can result in shortening of the lower leg, thigh, forearm, shoulder, etc. This can also cause curvature of the arms and legs, increase the risk of fractures and cause disability.

Patients with severe forms of the disease feel inferior, which negatively affects their mental and emotional state.

The most dangerous complication of osteochondroma is its malignancy, i.e. transformation into a malignant tumor - chondrosarcoma. The highest risk of malignancy is with multiple exostoses. In this case, growths localized in the pelvic bones are more likely to undergo malignancy. Less commonly, exostoses of the ribs, scapula, and spine turn into malignant neoplasms. Single osteochondromas transform into a malignant tumor in no more than 1% of cases.

Atypical growth can be observed in any part of the exostosis: the cartilaginous cap, at the base or in the middle part.

Diagnostics

Diagnosis of bone exostoses is not difficult. If these symptoms occur, you should consult an orthopedist. Based on the patient’s complaints, medical history and examination results, the doctor can already assume the presence of a neoplasm.

To clarify its size and other features, radiography is prescribed. It is carried out in 2 projections. Osteochondroma on x-rays is visualized as a shadow with smooth, clear contours and a pedicle or wide base connected to the bone. If there is no calcification in the cartilaginous layer, it will not be visible on x-ray.

To obtain additional data, the following may be assigned:

CT scan, which makes it possible to detect the presence of bone marrow contents in exostosis and trace its connection with the medullary canal of the affected bone;
MRI, which provides accurate data on the thickness of the cartilage cap and thereby clarifies the nature of the neoplasm (malignant tumors are characterized by a thickness of the cartilage tissue covering them of more than 2 cm).

If there is a suspicion of the development of oncology, patients are advised to undergo a biopsy - taking a fragment of exostosis for histological examination. In this way, benign osteochondroma is differentiated from malignant neoplasms.

If exostoses are detected in childhood and adolescence, it is imperative to conduct a full endocrine examination and determine the content of all significant hormones in the blood.

Treatment of exostoses

When diagnosing exostosis, treatment is prescribed only when symptoms appear. Otherwise, dynamic monitoring of the tumor is sufficient. If the tumor bothers the patient, depending on its type, the nature of the manifestation of osteochondroma, conservative treatment is selected or surgical intervention is prescribed. But the main method of treating exostosis is surgery.

Conservative, i.e., non-surgical, therapy is indicated mainly for exostosis of the calcaneus and rib, but only in the early stages of development. First of all, the use of special orthopedic insoles, made individually, and the replacement of regular shoes with models with offset edges are prescribed. This helps eliminate mechanical pressure on the tumor, reducing the load on the Achilles tendon and calcaneal tubercle.

If severe pain and inflammation occur, drug therapy is prescribed, including:

NSAIDs in the form of topical agents (Nimid, Dolaren, Ketoprofen, Voltaren);
drug blockades with the introduction of a mixture of anesthetics and corticosteroids (performed for severe pain that cannot be eliminated by other means).

Courses of physiotherapeutic procedures are also indicated. Shock wave therapy (SWT) is the most effective. It involves the impact of infrasonic acoustic waves on the affected area. The mechanism of action of the method is based on the cavitation effect that occurs at the interface between media. The acoustic resistance of soft tissue is less than that of bone. Therefore, sound waves penetrate through them and affect bones and cartilage. This provokes an improvement in blood supply, restoration of normal cartilage tissue and bones, and a reduction in the size of tumors.

Additionally, we may recommend:

electrophoresis with the introduction of anesthetics;
ultrasound therapy;
laser therapy;
Ural Federal District;
magnetotherapy.

How to relieve sit bone pain?

What should you do if your sit bone hurts when sitting or doing other activities? Visiting an orthopedist or physical therapist in this situation will definitely be the right choice.

However, in the beginning, you can try to help yourself by using non-steroidal anti-inflammatory drugs (tablets, ointments, gels), as well as cold or ice compresses on the sore spot. Physiotherapy treatments (eg, ultrasound, laser therapy, cryotherapy) and professional massage that relaxes, stretches and strengthens soft tissue, as well as kinesio taping, may also help.

To get rid of pain in the buttock, you should lie on a flat surface on your back, and place your legs bent at a right angle on the seat of a chair. Another variation of this exercise is to lie as close to a wall or door as possible and place the backs of your feet on that smooth vertical surface (wall or door). After about half an hour, the symptoms should disappear.

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Surgery to remove exostosis

Surgical intervention is indicated for:

large size of osteochondroma and the presence of persistent pain;
development of complications (tendinitis, bursitis, vascular, neurological disorders, etc.);
bone deformations as a result of the growth of exostosis;
fracture of the base leg;
malignancy of the tumor.

For children with bone exostosis, surgery is prescribed only in extreme cases. As a rule, it is carried out only if the testimony remains after reaching adulthood.

But if there are contraindications, surgery is not performed. This:

purulent-inflammatory processes in the area of the upcoming intervention;
exacerbation of chronic diseases;
decompensated form of diabetes mellitus;
acute infectious diseases.

Treatment of exostosis with surgery involves its complete excision with capture of the cartilaginous cap. There are several methods for removing osteochondral growth. A specific one is selected based on the location of the osteochondroma and its size. Usually preference is given to marginal resection of the growth, i.e., its removal within healthy tissue. Only in some cases is it necessary to resort to corrective osteotomy with concomitant resection of osteochondroma, but the cost of removing exostosis in this way is higher, since the operation also corrects bone deformation.

After surgery, complete recovery is observed in 98% of cases. Therefore, almost everyone who has once removed an exostosis forgets about it forever.

Marginal resection is a relatively simple type of surgery. Its essence is to expose the affected bone and remove the entire neoplasm in the front of healthy tissue along with the surrounding capsule using a sharp chisel, drill, oscillating saw or bur. After removal of the pathological formation, curettage of the maternal bone is performed using cutters and bur. In some cases, the extent of resection can be large and create the need for bone grafting using autografts or special implants. It is important to remove the entire cartilaginous cap and neoplasm, otherwise a relapse may develop.

Carrying out a corrective osteotomy involves cutting the mother's bone using an osteotome and removing the osteochondroma. After this, the bone fragments are fixed in the desired position using special plates, screws or knitting needles.

Rehabilitation

After removal of the exostosis, the patient remains in the hospital for 3 days, the sutures are removed on days 7-10. Performing marginal resection does not require any serious restrictions even in the early postoperative period. The patient can completely return to his usual lifestyle after the stitches are removed, and forget about exostosis immediately after the operation.

When performing a corrective osteotomy, complete bone fusion occurs after 6 weeks, but full recovery may require up to 3 months. At this time, it is important to strictly follow all the doctor’s recommendations and not to overload the operated part of the body. All patients who have undergone osteotomy are prescribed drug therapy, exercise therapy, and often physical therapy. The duration of rehabilitation in such cases depends on the type of surgical intervention performed and the individual characteristics of the patient.

Thus, osteochondroma is a very common type of tumor. At the same time, statistics on the frequency of its occurrence are not entirely objective, since exostoses often do not appear throughout a person’s life, and therefore are not diagnosed. However, if the formed formation bothers the patient, causes him pain, or reduces the quality of life, you should not hesitate to contact an orthopedist. A specialist will be able to assess the degree of danger of the tumor and, if necessary, remove it using the most gentle method possible.