After the benign tumor develops further the pain can not be alleviated with medication and minor to severe swelling starts to occur.

Conventional radiographs reveal a well-demarcated lytic lesion (nidus) surrounded by a distinct zone of sclerosis that allow doctors to identify the tumor.

The usual appearance included a fibrovascular stroma with numerous osteoblasts, osteoid tissue, well-formed woven bone, and giant cells.

Radionuclide scanning shows intense uptake which is useful for localisation at surgery using a hand held detector, and for confirmation that the entire lesion has been removed.

If this therapy fails or the location of the tumor could lead to growth disturbances, scoliosis, or osteoarthritis, surgical or percutaneous ablation may be considered.

Since the procedure was first introduced for the treatment of osteoid osteomas in the early 1990s,[12] it has been shown in numerous studies to be less invasive and expensive, to result in less bone destruction and to have equivalent safety and efficacy to surgical techniques, with 66 to 96% of patients reporting freedom from symptoms.

[16] As early as 2014, treatment has been demonstrated with incisionless surgery utilizing an MRI to guide high-intensity ultrasound waves to destroy an osteoid osteoma.

On November 27, 2020, the Food and Drug Administration approved the Sonalleve MR-HIFU system for the treatment of osteoid osteoma in the extremities.

[18] Clinical results support the probable benefit of Sonalleve MR-HIFU system for the ablation of painful osteoid osteoma.