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Snapshot diagnosis - what's causing this painful arm swelling?

Dr Mike Wyndham describes a case where a boy’s swollen arm was causing huge worry

Dr Mike Wyndham describes a case where a boy's swollen arm was causing huge worry

The patient

A 12-year-old boy presented with a swelling that had been ‘growing out of his arm' over the previous six months. It had started to cause mild discomfort over the last two months and was particularly uncomfortable after a tackle during a school rugby match. His mother was hugely anxious and fearing the worst.

First instinct

He reported rapid growth, large swelling and pain – my first thought was that this was something malignant. However, it's always difficult to talk with any confidence in general practice about conditions that are so uncommon that they are barely even on my radar.

Differential diagnosis

• Osteochondroma

• Osteogenic sarcoma

• Haematoma

The hidden clue

The relatively mild amount of pain suggested the lump was not a sarcoma and it seemed too large to be a haematoma. This left osteochondroma as the likely diagnosis, with the growth of a mass with mild discomfort.

Getting on the right track

An X-ray confirmed the clinical diagnosis. The boy was unhappy with the shape of his arm and felt he could not play rugby with it in this state. The tumour was surgically removed and histology confirmed the diagnosis.

Dr Mike Wyndham is a GP in Edgware, north London

What's causing this painful arm swelling? What's causing this painful arm swelling?

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