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The Journal of Bone and Joint Surgery (American) 84:397-403 (2002)
© 2002 The Journal of Bone and Joint Surgery, Inc.

Scientific Article

Evaluation of the Forearm in Untreated Adult Subjects with Multiple Hereditary Osteochondromatosis

Kenneth J. Noonan, MD, Anthony Levenda, MD, James Snead, MD, Judy R. Feinberg, PhD and Alex Mih, MD

Investigation performed at the Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, Indiana

Kenneth J. Noonan, MD
K4 732 Clinical Science Center, 600 Highland Avenue, Madison, WI 53792. E-mail address: noonan{at}surgery.wisc.edu

Anthony Levenda, MD
James Snead, MD
Judy R. Feinberg, PhD
Department of Orthopaedic Surgery, Indiana University School of Medicine, 541 Clinical Drive, CL600, Indianapolis, IN 46202

Alex Mih, MD
Indiana Hand Center, 8501 Harcourt Road, Indianapolis, IN 46260

The authors did not receive grants or outside funding in support of their research or preparation of this manuscript. They did not receive payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.

Background: Limb-length discrepancy or angular deformities as a result of altered bone growth may lead to a decreased range of motion and impaired function as well as premature osteoarthritis in patients with multiple hereditary osteochondromatosis. The purpose of this study was to describe the function of the forearm in untreated patients in order to facilitate comparison with studies of the results of treatment of this condition.

Methods: The medical records of fifty-one pediatric patients were identified and served as the basis for identifying a cohort of adult relatives with the disorder. Participants were asked about pain and limitations in vocational or recreational activities and about concerns with regard to cosmetic appearance. Radiographs of the forearm and wrist were made to quantify the deformity. Functional outcome was assessed on the basis of a comparison with the norms for grip and pinch strength and for scores on the hand function test of Jebsen et al. Limitations in the range of motion of the upper extremities were converted to standard impairment ratings.

Results: Participants included twenty-two men and seventeen women with an average age of forty-two years (range, twenty to eighty years). Most of the patients were employed in careers of their choice, with only five (13%) indicating that they were limited in any way in the performance of their jobs. Twenty-six subjects (67%) participated in recreational activities, and sixty-eight arms (88%) were reported to be free of pain. Objective measurement of function demonstrated greater disability than that found from subjective reporting. Fourteen arms had an impairment rating of >10%, while twenty had decreased pinch strength and sixteen had decreased grip strength. Ten arms (13%) had decreased hand function according to the hand test of Jebsen et al. Radiographic evaluation demonstrated osteoarthritic changes in three limbs.

Conclusions: Affected individuals had definite decreases in hand and wrist function, yet these did not result in major increases in pain or in limitations in daily work and recreation. This cohort provides a basis for comparison with the results of operative treatment in affected individuals with multiple hereditary osteochondromatosis.


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