Dr. Kozin serves on the Scientific and Medical Advisory Board of the MHE Research Foundation

Publications authored by Dr. Kozin
Click the tab and a window will appear.
List of Publications via PubMed
(NIH National Library of Medicine)
Questions to the Scientific & Medical Advisory Board,
Please use the contact Scientific & Medical Advisory Board Tab or you may email directly

Have a Question  or  Comments for the Board of Directors,  
Please use the contact Board of Directors Tab or General enquiries can be emailed to

Dr. Scott Kozin
Dr. Kozin treats many case of MHE / MO / HME every week, he is one of the best in the world dealing with the arm deformities
that can occur in children with Multiple Hereditary Exostoses. Dr. Kozin cheif of staff at Shriners Hospital for
Children-Philadelphia. Dr. Kozin served as President of the
American Association for Hand Surgery (2008) and is a member
of the Scientific and Medical Advisory Board of our Foundation and served on the Conference Advisory Committee
Be notified of page updates
it's private

Home page
Wings of HOPE as we REACH
for the CURE to
Multiple Hereditary Exostoses Syndrome
Multiple Osteochondroma Syndrome

MHE of the Upper Extremity

Kozin, SH
Shriners Hospital for Children, Philadelphia, 3551 N. Broad Street, Philadelphia,PA 19140-4131.

Hereditary multiple exostoses (HME) is an inheritable disorder of enchondral bone growth. HME is inherited in an autosomal
dominant pattern with high penetrance and variable expressivity. Cartilaginous exostoses, grow from the physes of long bones
and from the pelvis, ribs, scapula, and vertebrae. The most common upper extremity sites of involvement are the, humerus,
scapula, distal radius and ulna, elbow, and hands. Approximately 1/2 of all patients have forearm involvement.

A clinical "bump search" of all long bones is indicated if HME is suspected. Shoulder, elbow, forearm, wrist, and digit range of
motion should be measured. Radiographs should be obtained of any part of the extremity where osteochondromas are
suspected or that have decreased range of motion. Serial measurements of forearm rotation are used to document progressive
forearm deformity.

Most exostoses are asymptomatic and do not require removal. Exostoses may cause local discomfort, nerve or tendon
impingement, decreased range of motion, and longitudinal and angulatory growth abnormalities. Several reports of adults with
untreated forearm deformities due to HME indicated that they maintained function and were comfortable with their appearance.
These reports question the role of aggressive surgical treatment to maintain or improve function.  

Upper Extremity Surgery: Osteochondromas may cause visible local pain, deformity, and growth disturbance. Malignant
transformation is uncommon. Local pain, caused by impingement of the osteochondroma on surrounding tissue, is a frequent
indication for exostosis removal, and is effectively relieved by excision.  If forearm rotation is blocked by an exostosis, removal
will often improve motion.

Forearm osteochondromas frequently cause a length discrepancy between the radius and ulna. The radius becomes longer than
the ulna and accepts the entire forearm load, resulting in radial bowing, radial tilting, and possible radial head dislocation. The
increased radial inclination and lack of ulnar support positions the wrist into ulnar deviation and causes the carpus to "slip"
toward the ulna.

Early osteochondroma removal to retard or prevent progressive growth disturbances is controversial. Hemiepiphyseal stapling
of the radial side of the distal radius retards radial growth and allows correction of the radial articular angle and ulnar length
discrepancy with growth. Ulnar lengthening may be performed in a single stage or using gradual distraction osteogenesis.
Differential lengthening combined with angular correction can be used to reduce the radial head, because restoration of normal
forearm anatomy may result in spontaneous radial head reduction.  In patients with an isolated distal ulnar lesion, freeing the
soft tissue tether between the ulna and ulnar sided carpus and distal radius may prevent radial head dislocation. The dislocated
radial head may become painful in the adolescent; resection relieves pain and removes the associated prominence. Radial head
resection is delayed until skeletal maturity, because removal of the radial head in the growing child may cause cubitus valgus or
proximal radial overgrowth.  Creation of a one-bone forearm may be used to salvage a severely disorganized forearm.

In adults, an indication for HME excision is suspected malignant transformation. Symptoms and signs of malignant
transformation include local pain and growth of an osteochondroma after skeletal maturity. Radiographic changes include
internal lytic areas, erosion or destruction of the adjacent bone, and/ or presence of a soft tissue mass containing irregular
calcifications.  Malignant transformation, however, is quite rare in the upper extremity.

Written consent must be obtained to attach web pages or the files attached to this website, please email the webmaster.

Email the webmaster:
Materials on this website are protected by copyright
Copyright © 2014 The MHE Research Foundation

Disclaimer:   While many find the information useful, it is in no way a substitute for professional medical care.
The information provided here is for educational and informational purposes only. This website does not engage in the practice of medicine.
In all cases we recommend that you consult your own physician regarding any course of treatment or medicine.

This web page was updated last on 6/25/15, 12:0O pm Eastern time
The MHE Research Foundation, we comply with the HONcode standard for health trust worthy information: By the Health On the Net Foundation.      
here to verify.# HON Conduct 282463  and is the patient support link on the US Government Genetics Home Reference (http://ghr.nlm.nih.gov)
website, also linked for Patient Information on
The Diseases Database a cross-referenced index of human disease, as well as the
Intute: health & life sciences  a free online service  providing access to the very best Web resources for education and research located in the  UK
This website is regularly reviewed by members of the Scientific and Medical Advisory Board of the MHE Research Foundation.

All online submission forms use (SSL AES 256 bit encryption (High); RSA 1024 bit exchange) Protocol with
Privacy protection.
Our goal is to make this website as safe and user friendly as possible.
The MHE Research Foundation is a participating member organization of the
United States Bone and Joint Decade/Initiative,  (USBJD/I) & the  USBJD/I Rare Bone Disease Patient Network
number of users on this website page now :

The MHE Research Foundation is proud to be an affiliate of the Society For Glycobiology
The MHE Research Foundationis proud to be a partnering society with ASMB  / MSTS  / CTOS