1
|
Chaves C, Bellemère P. Tenosynovial chondromatosis of the wrist: A case report. HAND SURGERY & REHABILITATION 2023; 42:258-260. [PMID: 36933830 DOI: 10.1016/j.hansur.2023.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 02/23/2023] [Accepted: 02/24/2023] [Indexed: 03/18/2023]
Abstract
We report the case of an 80-year-old woman who presented with an asymptomatic slowly growing mass in the dorsal aspect of her right wrist. Radiographs revealed a snail-shaped radiopaque structure. Surgical exploration and excision revealed a calcified lesion over the extensor digitorum communis. Histopathological analysis confirmed the diagnosis of tenosynovial chondromatosis. At the last follow-up, four years after surgery, the patient was asymptomatic and free of recurrence. Practitioners and hand surgeons should be aware of the dorsal involvement and evocative radiological calcifications of tenosynovial chondromatosis, which is a rare benign soft tissue neoplasm that affects all tendon sheaths of the hand.
Collapse
Affiliation(s)
- C Chaves
- Centre de Chirurgie de la Main, Clinique du Pré, 72000 Le Mans, France; Lymphoedema Center, Clinique Ambroise Paré, 92200 Neuilly-sur-Seine, France.
| | - P Bellemère
- Institut de la Main Nantes Atlantique, Boulevard Charles-Gautier, 44800 Saint-Herblain, France
| |
Collapse
|
2
|
Jang MG, Heo YM, Kim AY. Intracapsular Chondroma Occurring in Metacarpophalangeal Joint of the Hand: A Rare Presentation. J Hand Surg Asian Pac Vol 2023; 28:134-138. [PMID: 36803477 DOI: 10.1142/s2424835523720062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Abstract
Extraskeletal chondroma comprises synovial chondromatosis, intracapsular chondroma and soft tissue chondroma, its presentation in the hand, however, is very rare. A 42-year-old woman presented with a mass around right fourth metacarpophalangeal (MCP) joint. She had no pain or discomfort in activities. The radiographs showed soft tissue swelling, but no calcification or ossifying lesions. The magnetic resonance imaging (MRI) showed a lobulated juxta-cortical encircling mass existing around the fourth MCP joint. We did not suspect any cartilage-forming tumour in MRI. The mass was easily removed because there was no adhesion with surrounding tissues and the specimen had the appearance of a cartilage. The histological diagnosis was chondroma. Based on the tumour location and histological results, we diagnosed it as intracapsular chondroma. Although intracapsular chondroma is very rare-ly seen in the hands, it is important to consider an intracapsular chondroma when differentiating a tumour in the hand because it is difficult to diagnose one in an imaging examination. Level of Evidence: Level V (Therapeutic).
Collapse
Affiliation(s)
- Min Gu Jang
- Department of Orthopaedic Surgery, Konyang University Hospital, Daejeon, Republic of Korea
| | - Youn Moo Heo
- Department of Orthopaedic Surgery, Konyang University Hospital, Daejeon, Republic of Korea
| | - A Youn Kim
- Department of Orthopaedic Surgery, Konyang University Hospital, Daejeon, Republic of Korea
| |
Collapse
|
3
|
Garry CB, Ernst A, Sanderson G, Wilson AW. Synovial chondromatosis of the flexor hallucis longus tendon sheath. BMJ Case Rep 2022; 15:e252067. [PMID: 36270739 PMCID: PMC9594586 DOI: 10.1136/bcr-2022-252067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023] Open
Abstract
This case report discusses a rare case of secondary tenosynovial chondromatosis of the flexor hallucis longus (FHL). Synovial chrondomatosis is a rare, benign proliferative cartilaginous lesion arising from the synovial tissue or bursal lining of or near joints. When it is extra-articular, it is considered tenosynovial chondromatosis. The diagnosis is often delayed given the rarity of presentation and non-specific symptoms. The case was highly unusual in that hindfoot pain was caused by several centimetre-sized osteochondral bodies within the FHL tendon sheath. Anterior cheilectomy was performed. The patient returned to full activity following surgery without recurrence of the disease. The condition can be successfully treated operatively.
Collapse
Affiliation(s)
- Conor B Garry
- Department of Orthopaedic Surgery, University of Tennessee Health Science Center College of Medicine Chattanooga, Chattanooga, Tennessee, USA
- Department of Orthopaedic Surgery, Naval Medical Center Portsmouth, Portsmouth, Virginia, USA
| | - Andrew Ernst
- Department of Orthopaedic Surgery, Naval Medical Center Portsmouth, Portsmouth, Virginia, USA
| | - Galen Sanderson
- Department of Orthopaedic Surgery, Naval Medical Center Portsmouth, Portsmouth, Virginia, USA
| | - Andrew W Wilson
- Department of Orthopaedic Surgery, University of Tennessee Health Science Center College of Medicine Chattanooga, Chattanooga, Tennessee, USA
| |
Collapse
|
4
|
Trevisan M, Di Lenarda L, Pastore S, Saccari A, Canton G, Lucangelo U, Taddio A, Murena L. "Shoulder pain and limitation of motion in a young girl: think different". Ital J Pediatr 2022; 48:139. [PMID: 35908061 PMCID: PMC9338533 DOI: 10.1186/s13052-022-01332-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 07/26/2022] [Indexed: 11/10/2022] Open
Abstract
Background Primary Synovial Chondromatosis (PSC) is a rare benign tumor of the synovial membrane in which cartilage metaplasia produces calcific loose bodies within the articular space. Only a few cases are reported in the pediatric population and its etiology remains unknown. This condition typically affects large weight-bearing joints with pain, swelling and decrease range of motion. Due to its slow progressions, delayed diagnosis is frequent and differential diagnosis should consider other chronic arthritis and malignancies. While arthroscopic removal of loose bodies is the current treatment up to now, the association of partial or complete synovectomy is debated. Case presentation We report about a 14-year-old girl with a long-lasting right shoulder pain, especially during movements or exercise, localized tenderness and hypotonia of the glenohumeral joint. No previous trauma was mentioned. Blood exams, Mantoux test and plain radiography of the right shoulder were unremarkable. Ultrasound imaging revealed echogenic and calcified bodies stretching the glenohumeral joint and dislocating the long head of biceps tendon. Magnetic resonance showed a “rice-grain” pattern of the right shoulder. From an arthroscopic surgery, multiple loose white bodies were removed within the synovial membrane, and synovial chondromatosis was confirmed by histological analysis. At one month follow up visit, the patient completely recovered without pain. Conclusion Synovial chondromatosis is a very uncommon cause of mono articular pain in children, especially when it affects shoulder. Pediatricians should keep in mind this condition to avoid delayed diagnosis and treatment, even in consideration of the low risk of malignant transformation. Through this case, we would highlight common diagnostic pitfalls and treatment of synovial chondromatosis. Supplementary Information The online version contains supplementary material available at 10.1186/s13052-022-01332-4.
Collapse
Affiliation(s)
- Matteo Trevisan
- Department of Medicine, Surgery, and Health Sciences, University of Trieste, Via dell'Istria 65/1, 34100, Trieste, Italy.
| | - Luca Di Lenarda
- Department of Medicine, Surgery, and Health Sciences, University of Trieste, Via dell'Istria 65/1, 34100, Trieste, Italy
| | - Serena Pastore
- Institute for Maternal and Child Health, IRCCS "Burlo Garofolo", Trieste, Italy
| | - Alessia Saccari
- Institute for Maternal and Child Health, IRCCS "Burlo Garofolo", Trieste, Italy
| | - Gianluca Canton
- Orthopaedics and Traumatology Unit, Cattinara Hospital, Azienda Sanitaria Universitaria Giuliano-Isontina (ASUGI), University of Trieste, Trieste, Italy
| | - Umberto Lucangelo
- Department of Perioperative Medicine, Intensive Care and Emergency, Cattinara Hospital, Trieste University, Trieste, Italy
| | - Andrea Taddio
- Department of Medicine, Surgery, and Health Sciences, University of Trieste, Via dell'Istria 65/1, 34100, Trieste, Italy.,Institute for Maternal and Child Health, IRCCS "Burlo Garofolo", Trieste, Italy
| | - Luigi Murena
- Orthopaedics and Traumatology Unit, Cattinara Hospital, Azienda Sanitaria Universitaria Giuliano-Isontina (ASUGI), University of Trieste, Trieste, Italy
| |
Collapse
|
5
|
Yue KLC, Lans J, Castelein RM, Suster DI, Nielsen GP, Chen NC, Lozano-CalderÓn SA. Benign Hand Tumors (Part I): Cartilaginous and Bone Tumors. Hand (N Y) 2022; 17:346-353. [PMID: 32506966 PMCID: PMC8984707 DOI: 10.1177/1558944720922921] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Abstract
Background: Benign tumors of the hand present in a wide array of histological subtypes and compose most of the bony tissue tumors in the hand. This study evaluates the characteristics and treatment of benign bone tumors in light of one institution's experience. Methods: Histologically confirmed benign tumors of the hand were retrospectively identified using International Classification of Diseases codes from 1992 to 2015. A medical chart review was conducted to collect patient characteristics and tumor epidemiology and treatment. Results: A total of 155 benign bone tumors were identified. The median age of patients at the time of surgery was 39.9 ± 12.8 years. All bone tumors were located in the digits, and most were treated by intralesional curettage (n = 118, 76%). Pathologic fractures occurred in 79 bone tumors (51%). Conclusion: Enchondromas (n = 118, 76%) were the most common bone tumor in this series, whereas giant cell tumors were the most destructive and also had the highest recurrence rate (40%). Awareness of tumor features may help physicians with diagnosis, and awareness of recurrence rates is important when counseling patients.
Collapse
Affiliation(s)
| | - Jonathan Lans
- Harvard Medical School, Boston, MA,
USA,Jonathan Lans, Department of Orthopaedic
Surgery, Hand and Upper Extremity Service, Massachusetts General Hospital,
Harvard Medical School, Yawkey Center, Suite 2100, 55 Fruit Street, Boston, MA
02114, USA.
| | | | | | | | | | | |
Collapse
|
6
|
Abstract
Synovial chondromatosis of the finger is a rare metaplasia affecting either the finger joint or the tendon sheath. It is a benign extraosseus cartilage tumor that often occurs in numbers and is not solitary in nature. This accumulation of masses within the finger can lead the patient to seek medical care. Symptoms are often painful and functionally disabling. Although rare, synovial chondromatosis must be considered in the differential diagnosis for patients with multiple lesions or masses within the hand and finger. Patient workup involves advanced imaging, including magnetic resonance imaging, ultrasonography, and computerized tomography. However, the results of these studies may be inconclusive. Conservative management can be discussed with the patient but has proven to be ineffective. Surgical excision is the recommended first-line treatment. Whether the surgery is arthroscopic or open, with or without synovectomy, is at the surgeon's discretion. Mass recurrence after surgery is an unfortunate complication, and subsequent treatment strategies are undefined. Recurrence may not occur at the same anatomical site. This condition can be intra-articular (within the figure joint) or extra-articular (within the tendon sheath or bursa). Revision surgery in the form of open excision with synovectomy is the mainstay of treatment. There have been only a few case reports of synovial chondromatosis involving the finger. This case series and up-to-date review of the literature presents a discussion of current surgical care. [Orthopedics. 2021;44(3):e454-e457.].
Collapse
|
7
|
Tenosynovial chondromatosis of the flexor pollicis longus tendon: A subtype of primary synovial chondromatosis. Radiol Case Rep 2020; 16:487-492. [PMID: 33363688 PMCID: PMC7753090 DOI: 10.1016/j.radcr.2020.12.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 12/07/2020] [Accepted: 12/07/2020] [Indexed: 11/22/2022] Open
Abstract
Primary synovial chondromatosis is a rare benign neoplastic process, in which cartilaginous nodules are produced in the subsynovial tissue. It has 3 main subtypes (intra-articular, tenosynovial and bursal). We present the case of a 61-year-old female, with a mass involving her right thumb for at least 5 years, which had recently increased in size. X-ray showed a soft tissue mass, without calcification or any underlying bony abnormality. Ultrasound and MRI showed a 6-cm mass surrounding the right flexor pollicis longus tendon of the right thumb. The patient went on to have surgical resection and was given a diagnosis of tenosynovial chondromatosis.
Collapse
|
8
|
Xu C, Yang X. Staged arthroscopic procedure for treating simultaneous shoulder and elbow synovial chondromatosis: A case report and literature review. SAGE Open Med Case Rep 2020; 8:2050313X20951340. [PMID: 32922795 PMCID: PMC7446550 DOI: 10.1177/2050313x20951340] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 07/27/2020] [Indexed: 11/21/2022] Open
Abstract
It is extremely rare for ipsilateral shoulder and elbow synovial chondromatosis to occur simultaneously. We report a very rare case of simultaneous shoulder and elbow synovial chondromatosis in a 53-year-old woman who was treated through staged surgeries. Shoulder arthroscopic synovectomy, debridement, biceps tenodesis, and subacromial decompression were conducted first, followed by elbow arthroscopy 2 months later. Post surgery, there was no recurrence either clinically or radiologically at 2 years follow-up. Despite some loss of the range of motion of the shoulder and muscle strength, the elbow functions recovered fully, and the patient was extremely satisfied with the clinical outcome. We recommend a staged arthroscopic procedure consisting of a thorough synovectomy and joint debridement for this condition.
Collapse
Affiliation(s)
- Caiqi Xu
- Department of Sports Medicine, Shanghai Sixth People’s Hospital, Shanghai, China
| | - Xingguang Yang
- Department of Sports Medicine, Shanghai Sixth People’s Hospital, Shanghai, China
| |
Collapse
|
9
|
Utashima D, Matsumura N, Suzuki T, Iwamoto T, Ogawa K. Clinical Results of Surgical Resection and Histopathological Evaluation of Synovial Chondromatosis in the Shoulder: A Retrospective Study and Literature Review. Clin Orthop Surg 2020; 12:68-75. [PMID: 32117541 PMCID: PMC7031439 DOI: 10.4055/cios.2020.12.1.68] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Accepted: 05/30/2019] [Indexed: 11/06/2022] Open
Abstract
Background Synovial chondromatosis occurs rarely in the shoulder, and its details remain unclear. The purpose of this study was to clarify the clinical results of surgical resection and the histopathological findings of synovial chondromatosis in the shoulder. Methods Ten shoulders with synovial chondromatosis that had been operatively resected were reviewed retrospectively. Osteochondral lesions were present in the glenohumeral joint in six shoulders and in the subacromial space in four shoulders. Two patients had a history of trauma with glenohumeral dislocation without recurrent instability, and the other seven patients (eight shoulders) did not have any traumatic episodes or past illness involving the ipsilateral shoulder girdle. The occurrences of osteochondral lesions, inferior humeral osteophytes, and acromial spurs were assessed on radiographs before resection, just after resection, and at final follow-up. The Constant scores were compared before resection and at final follow-up with Wilcoxon signed-rank tests. Resected lesions were histopathologically differentiated between primary and secondary synovial chondromatosis. Results Inferior humeral osteophytes were found in five shoulders with synovial chondromatosis in the glenohumeral joint, and all four shoulders with synovial chondromatosis in the subacromial space had acromial spur formation. Osteochondral lesions appeared to have been successfully removed in all shoulders on postoperative radiographs. At the final follow-up, however, one shoulder with secondary synovial chondromatosis in the subacromial space showed recurrence of osteochondral lesions and acromial spur formation. The mean Constant score improved significantly from 53.0 points before resection to 76.0 points at a mean follow-up of 6.0 years (p = 0.002). On histopathological evaluation, one shoulder was diagnosed as having primary synovial chondromatosis, while nine shoulders had secondary synovial chondromatosis. Conclusions The present study showed that resection of shoulder osteochondral lesions successfully relieved the clinical symptoms and that primary synovial chondromatosis is less common than secondary synovial chondromatosis in the shoulder. Although most of the present osteochondral lesions were clinically determined to be primary chondromatosis, only one case was histopathologically categorized as primary synovial chondromatosis. These results suggest that histopathological identification is needed to differentiate between primary and secondary synovial chondromatosis.
Collapse
Affiliation(s)
- Daisuke Utashima
- Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Noboru Matsumura
- Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Taku Suzuki
- Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Takuji Iwamoto
- Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Kiyohisa Ogawa
- Department of Orthopedic Surgery, Eiju General Hospital, Tokyo, Japan
| |
Collapse
|
10
|
Evenski AJ, Stensby JD, Rosas S, Emory CL. Diagnostic Imaging and Management of Common Intra-articular and Peri-articular Soft Tissue Tumors and Tumorlike Conditions of the Knee. J Knee Surg 2019; 32:322-330. [PMID: 30449023 PMCID: PMC6445722 DOI: 10.1055/s-0038-1675609] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Intra-articular (IA) and peri-articular (PA) tumors of the knee are frequently encountered by orthopaedic surgeons. Nonetheless, due to the possibility of great morbidity and potential mortality, it is important to recognize and differentiate between benign and malignant lesions in a timely manner. Therefore, the purpose of this article is to provide a concise, practical, and updated review of commonly encountered IA and PA tumors including intratendinous gout, synovial chondromatosis, schwannoma, pigmented villonodular synovitis, and synovial sarcoma, and a detailed description of differentiating features to include various imaging modalities.
Collapse
Affiliation(s)
- Andrea J. Evenski
- Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri
| | | | - Samuel Rosas
- Department of Orthopedic Surgery, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Cynthia L. Emory
- Department of Orthopedic Surgery, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| |
Collapse
|
11
|
Wang W, Huang Y, Wang C, Hong J, Ma C, Lin N, Ye Z, Yan S, Wu H. Intra-articular nodular fasciitis: a rare lesion case report and an updated review of the literature. BMC Musculoskelet Disord 2019; 20:5. [PMID: 30611237 PMCID: PMC6320623 DOI: 10.1186/s12891-018-2375-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Accepted: 12/07/2018] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Nodular fasciitis is a benign proliferation of myofibroblasts that usually arises in subcutaneous tissues of the trunk, neck, head, and upper extremities of young adults. It is not reported to arise in the joints. CASE PRESENTATION In this report, we describe a rare case where nodular fasciitis occurred in an intra-articular location in the right knee of a 20-year-old man. The patient presented with 3-months' duration of knee pain without history of trauma to the extremity. Physical examination revealed pain, joint effusion, and limited range of motion (ROM) of the affected knee. Magnetic resonance imaging (MRI) showed a 2.5 × 2 × 1 cm lesion in front of the posterior cruciate ligament. Arthroscopically, the soft tissue mass was removed and pathologically diagnosed as a rare, benign, intra-articular nodular fasciitis. Symptoms resolved 1 month after the operation and no recurrence was found at the 6 months follow-up. CONCLUSION The present paper describes detailed characteristics of intra-articular nodular fasciitis and provides an updated comprehensive summary of 21 prior case reports.
Collapse
Affiliation(s)
- Wei Wang
- Department of Orthopaedic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, No.88 Jiefang Road, Hangzhou, 310009, People's Republic of China
| | - Yiting Huang
- Division of Reproductive Medicine & Infertility, The Second Affiliated Hospital, School of Medicine, Zhejiang University, 88#, Jiefang Rd., Hangzhou, Zhejiang, 310009, China
| | - Changxing Wang
- Department of Pathology, The Second Affiliated Hospital, School of Medicine, Zhejiang University, 88#, Jiefang Rd., Hangzhou, Zhejiang, 310009, China
| | - Jianqiao Hong
- Department of Orthopaedic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, No.88 Jiefang Road, Hangzhou, 310009, People's Republic of China
| | - Chiyuan Ma
- Department of Orthopaedic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, No.88 Jiefang Road, Hangzhou, 310009, People's Republic of China
| | - Nong Lin
- Department of Orthopaedic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, No.88 Jiefang Road, Hangzhou, 310009, People's Republic of China
| | - Zhaoming Ye
- Department of Orthopaedic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, No.88 Jiefang Road, Hangzhou, 310009, People's Republic of China
| | - Shiyuan Yan
- Department of Orthopaedic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, No.88 Jiefang Road, Hangzhou, 310009, People's Republic of China.
| | - Haobo Wu
- Department of Orthopaedic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, No.88 Jiefang Road, Hangzhou, 310009, People's Republic of China.
| |
Collapse
|
12
|
Abstract
OBJECTIVE We aimed to identify factors that affect pain, complications, and function following elbow arthroscopy for elbow synovial chondromatosis. METHODS We retrospectively reviewed the cases of all patients with elbow synovial chondromatosis treated by arthroscopic synovectomy and loose body removal between January 2000 and January 2016 at our institution. Eleven patients were enrolled (8 male; mean age, 41.7 years). The mean duration of symptoms was 13.7 months, and all patients had a decreased range of motion (ROM) in the affected elbow. By Milgram criteria, there was 1 phase II case, and 10 cases were phase III. RESULTS All patients were followed postoperatively (mean follow-up, 65 months). The preoperatively restricted ROM of 100° flexion (range, 78°-120°) and extension of 30° (range, 15°-40°) were improved to 130° flexion (range, 120°-140°) and -5° hyperextension (range, -10°-0°). Pain, recorded as the pain subscore of the American Shoulder and Elbow Surgeons questionnaire for elbows, was significantly improved from 32 points (range, 20-50) preoperatively to 85 (range, 70-100) postoperatively (on a scale ranging from 0 [worst pain] to 100 [pain-free]). Recurrence occurred in 2 patients (18.2%) who then received arthroscopic synovectomy and loose body removal again. There were no fractures or neurovascular complications, and no patient developed an infection. CONCLUSION Arthroscopic management of synovial chondromatosis of the elbow was an effective and safe therapeutic method. After the intervention, immediate and durable improvement of elbow function can be expected.
Collapse
|
13
|
Sakamoto A, Naka T, Shiba E, Hisaoka M, Matsuda S. Extra-Articular Tenosynovial Chondromatosis of the Finger: A Case Series Study of Three Cases, One Including Excessive Osseous Invasion. Open Orthop J 2017; 11:417-423. [PMID: 28603573 PMCID: PMC5447904 DOI: 10.2174/1874325001711010417] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Revised: 03/21/2017] [Accepted: 04/16/2017] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Synovial chondromatosis is characterized by cartilaginous metaplasia in synovial tissues. Extra-articular tenosynovial chondromatosis is considered to be an anatomical counterpart of articular synovial chondromatosis. Extra-articular tenosynovial chondromatosis occurs preferentially in the hand, although its frequency is low. RESULTS We report three cases of extra-articular tenosynovial chondromatosis. A 65-year-old female presented with a history of symptoms over 40 years related to the dorsum of her index finger (Case 1), A 46-year-old female presented with a 6-month history of symptoms at the volar surface of her middle finger (Case 2), and a 66-year-old male presented with a 3-month history of symptoms in a dorsal ring finger. Case 2 had evidence of ossification, which could be classified as osteochondromatosis. Interestingly, the index finger lesions (Case 1) were accompanied by excessive bone involvement. The signal intensity of T2-weighted magnetic resonance imaging varies from low to high, possibly reflecting histological variations, such as ossification and fatty tissue changes. All lesions were resected without complications. CONCLUSION Variations in anatomical sites suggest that overuse or mechanical overloading was not causative. Extensive involvement of the nearby tendon and joint capsule, as well as the bone, would require attention during the resection. Preoperative analysis of images is important, not only for the diagnosis, but also to assess the extent of the lesion, particularly given the complex anatomy of the finger.
Collapse
Affiliation(s)
- Akio Sakamoto
- The Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Takahiko Naka
- Shimosone Clinic of Orthopedics and Osteoporosis, Kitakyushu, Japan
| | - Eisuke Shiba
- The Department of Pathology and Oncology, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Masanori Hisaoka
- The Department of Pathology and Oncology, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Shuichi Matsuda
- The Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| |
Collapse
|
14
|
Morris CJ, Younan Y, Singer AD, Johnson G, Chamieh J, Datir A. Masses of the hand and wrist, a pictorial review. Clin Imaging 2016; 40:650-65. [DOI: 10.1016/j.clinimag.2016.02.019] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Revised: 02/17/2016] [Accepted: 02/19/2016] [Indexed: 01/07/2023]
|
15
|
Terra BB, Moraes EW, Souza ACD, Cavatte JM, Teixeira JCDM, De Nadai A. Tratamento artroscópico da osteocondromatose sinovial do cotovelo. Relato de caso e revisão da literatura. Rev Bras Ortop 2015. [DOI: 10.1016/j.rbo.2014.09.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
|
16
|
Terra BB, Moraes EW, de Souza AC, Cavatte JM, Teixeira JCDM, De Nadai A. Arthroscopic treatment of synovial osteochondromatosis of the elbow. Case report and literature review. Rev Bras Ortop 2015; 50:607-12. [PMID: 26535210 PMCID: PMC4610989 DOI: 10.1016/j.rboe.2015.08.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2014] [Accepted: 09/01/2014] [Indexed: 12/26/2022] Open
Abstract
Synovial osteochondromatosis is a benign proliferative disorder with metaplasia of the synovial membrane that affects the fibroblasts of the synovial joints, tendons and bursae. In literature, there are few descriptions of synovial osteochondromatosis of the elbow. The objective of this article was to report a case of synovial osteochondromatosis of the elbow in a patient aged 32, basketball athlete, in which surgical treatment was chosen because of the pain and functional limitation and stage of disease with multiple loose bodies. Patient 32, male, presented with pain and limitation of motion of the elbow. The range of passive motion was 100° of flexion and 30° extension. The range of active motion was 40-90°. Magnetic resonance observed many loose bodies mainly in the posterior compartment in the olecranon fossa plus some chondral lesions in the capitellum. The arthroscopic treatment was chosen with two anteriors portals (medial and lateral) and two posterior portals (standard posterior and posterolateral) for easing loose bodies and osteoplasty of the olecranon fossa. The visual analog scale pain was 9-3 and its arc of active motion was 110° to -20° of flexion and extension. On a scale of performance from Mayo Clinic patients was 65 points preoperatively to 90 postoperatively with 9 months follow-up and the patient was satisfied with the treatment outcome. Arthroscopic treatment of synovial osteochondromatosis of the elbow is an effective and safe therapeutic management with low morbidity and early return to activities.
Collapse
|
17
|
Chen YX, Lu YX, Zhuang ZE, Li ZY. Extra-articular tenosynovial chondromatosis of the left ring finger in a 23-year-old man: A case report and literature review. Exp Ther Med 2015; 10:1581-1583. [PMID: 26622530 DOI: 10.3892/etm.2015.2687] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2014] [Accepted: 07/27/2015] [Indexed: 11/05/2022] Open
Abstract
Tenosynovial chondromatosis is an extra-articular version of articular synovial chondromatosis and a relatively rare condition that can affect the tendon sheath, bursa, or joint synovial tissue. Tenosynovial chondromatosis is rarely reported in the literature and is often misdiagnosed. In the present study, a case of extra-articular tenosynovial chondromatosis of the left ring finger in a 23-year-old man is reported. Three different-sized nodules were identified upon surgery and all were removed via synovectomy. The patient was symptom free 6 months postoperatively, and there were no signs of recurrence after 1.5 years of follow-up. The literature describing tenosynovial chondromatosis in the fingers is also reviewed.
Collapse
Affiliation(s)
- Yu-Xian Chen
- Department of Joint Surgery and Orthopedic Trauma, The Third Affiliated Hospital, Sun Yat-Sen University, Guangzhou, Guangdong 510630, P.R. China
| | - Yun-Xiang Lu
- Department of Joint Surgery and Orthopedic Trauma, The Third Affiliated Hospital, Sun Yat-Sen University, Guangzhou, Guangdong 510630, P.R. China
| | - Z E Zhuang
- Department of Joint Surgery and Orthopedic Trauma, The Third Affiliated Hospital, Sun Yat-Sen University, Guangzhou, Guangdong 510630, P.R. China
| | - Zhi-Yong Li
- Department of Joint Surgery and Orthopedic Trauma, The Third Affiliated Hospital, Sun Yat-Sen University, Guangzhou, Guangdong 510630, P.R. China
| |
Collapse
|
18
|
Vilder EYGD, Vanakker OM. From variome to phenome: Pathogenesis, diagnosis and management of ectopic mineralization disorders. World J Clin Cases 2015; 3:556-574. [PMID: 26244149 PMCID: PMC4517332 DOI: 10.12998/wjcc.v3.i7.556] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2014] [Revised: 02/27/2015] [Accepted: 05/18/2015] [Indexed: 02/05/2023] Open
Abstract
Ectopic mineralization - inappropriate biomineralization in soft tissues - is a frequent finding in physiological aging processes and several common disorders, which can be associated with significant morbidity and mortality. Further, pathologic mineralization is seen in several rare genetic disorders, which often present life-threatening phenotypes. These disorders are classified based on the mechanisms through which the mineralization occurs: metastatic or dystrophic calcification or ectopic ossification. Underlying mechanisms have been extensively studied, which resulted in several hypotheses regarding the etiology of mineralization in the extracellular matrix of soft tissue. These hypotheses include intracellular and extracellular mechanisms, such as the formation of matrix vesicles, aberrant osteogenic and chondrogenic signaling, apoptosis and oxidative stress. Though coherence between the different findings is not always clear, current insights have led to improvement of the diagnosis and management of ectopic mineralization patients, thus translating pathogenetic knowledge (variome) to the phenotype (phenome). In this review, we will focus on the clinical presentation, pathogenesis and management of primary genetic soft tissue mineralization disorders. As examples of dystrophic calcification disorders Pseudoxanthoma elasticum, Generalized arterial calcification of infancy, Keutel syndrome, Idiopathic basal ganglia calcification and Arterial calcification due to CD73 (NT5E) deficiency will be discussed. Hyperphosphatemic familial tumoral calcinosis will be reviewed as an example of mineralization disorders caused by metastatic calcification.
Collapse
|
19
|
Sachinis NP, Sinopidis C, Baliaka A, Givissis P. Odyssey of an elbow synovial chondromatosis. Orthopedics 2015; 38:e62-7. [PMID: 25611422 DOI: 10.3928/01477447-20150105-91] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2013] [Accepted: 05/13/2014] [Indexed: 02/03/2023]
Abstract
Synovial chondromatosis of the elbow is an uncommon condition. However, a chondrosarcoma arising from the former is remarkably rare. The authors report a case of an elbow chondrosarcoma secondary to synovial chondromatosis in a 38-year-old woman. Before the development of chondrosarcoma, the patient underwent 3 operations and 3 sessions of radiosynovectomy because of continuous recurrence of synovial chondromatosis on the left elbow. After the last radiosynovectomy, magnetic resonance imaging and biopsy showed a grade II chondrosarcoma secondary to synovial chondromatosis. The patient underwent further surgery and custom-made arthroplasty because of aseptic loosening of the prosthesis. Four months after the last intervention, 3 subcutaneous nodes appeared on the patient's elbow and were histologically found to be a recurrence of chondrosarcoma (grade III). Amputation by disarticulation of the shoulder was performed in addition to biopsy of another subcutaneous node on the abdomen. The biopsy showed metastasis of chondrosarcoma. At final follow-up, the patient had lung metastasis 7 years after the initial diagnosis. A reason for the manifestation of primary synovial chondromatosis and its progression to chondrosarcoma has not been found. Synovial chondromatosis progressing to chondrosarcoma in the elbow was reported in only 1 case, with no clear initial diagnosis. The role of radiosynovectomy in the development of chondrosarcoma is unknown, and no reports have described the treatment of elbow synovial chondromatosis. Although synovial chondromatosis is benign, its metaplastic nature is a marker of possible malignancy, especially with signs of recurrence and aggression. The role of radiosynovectomy in malignant changes should be examined in future studies.
Collapse
|
20
|
Ligon CB, Gelber AC. Elbow loose bodies. J Rheumatol 2014; 41:1426-1427. [PMID: 24986963 DOI: 10.3899/jrheum.131141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Affiliation(s)
| | - Allan C Gelber
- Associate Professor of Medicine, Deputy Director for Education and Faculty Development, Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
| |
Collapse
|
21
|
Lin YC, Goldsmith JD, Gebhardt MG, Wu JS. Bursal synovial chondromatosis formation following osteochondroma resection. Skeletal Radiol 2014; 43:997-1000. [PMID: 24453028 DOI: 10.1007/s00256-014-1821-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2013] [Revised: 12/31/2013] [Accepted: 01/06/2014] [Indexed: 02/02/2023]
Abstract
Osteochondroma is a common tumor of the bone and can be complicated by adventitial bursa formation and malignant transformation of the cartilaginous cap. Synovial chondromatosis formation within these bursae is extremely rare and can be confused with malignant transformation of the osteochondroma cap to a chondrosarcoma. We describe a case of extra-articular synovial chondromatosis formation several years following osteochondroma resection. Cartilage nodule formation within the bursal synovial lining and proliferation of cartilage debris shed from the cartilaginous cap during surgery or biopsy are potential etiologies of this rare complication of osteochondromas.
Collapse
Affiliation(s)
- Yu-Ching Lin
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital, Keelung, Taiwan,
| | | | | | | |
Collapse
|
22
|
|
23
|
Clinical evaluation and management of benign soft tissue tumors of the extremities. Cancer Treat Res 2014; 162:171-202. [PMID: 25070236 DOI: 10.1007/978-3-319-07323-1_9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Benign lesions comprise a majority of soft tissue tumors. It has been estimated that their incidence outnumbers that of malignant tumors by a factor of at least 100 [1]. While history and physical examination can start the diagnostic process, imaging including the use of magnetic resonance imaging can be more helpful. Biopsy of these tumors is sometimes necessary and can be performed in a number of ways, often in conjunction with definitive treatment. Specific diagnostic and treatment strategies for a number of the more commonly encountered benign soft tissue tumors including lipomas, pigmented villonodular synovitis and hemangiomas are reviewed. An algorithm for the management of benign soft tissue tumors is discussed.
Collapse
|