Forty-six patients with histologically confirmed osteoid osteoma of the upper extremity seen from 1947 to 1990 were retrospectively reviewed. The patients' age at presentation averaged 20 years. Twenty-four of the lesions were located in the wrist and hand and 22 in the arm and forearm. The average duration of symptoms before diagnosis was 15 months. Pain was the presenting symptom in 44 of 46 patients. Of the 28 patients who took aspirin for pain, 24 obtained at least partial relief. A mass or swelling was more commonly noted in lesions of the hand and wrist as compared to the arm and forearm. The diagnosis of osteoid osteoma was made by plain x-ray films alone in 35 cases. Bone scans were performed on 13 patients; all were positive at the site of the lesion. Tomography was performed in 13 cases to identify the intraosseous location of the lesion. All lesions were treated by excision and curettage. Thirty-four of the 46 patients were followed at our institution for more than 6 months, with an average follow-up period of 27 months. Six of the patients had persistent lesions. Of the six persistent osteoid osteomas, five occurred in the wrist or hand (p = .0012). A total of 15 procedures were required to excise these lesions.