Arthroscopic treatment of synovial chondromatosis, an unusual cause of shoulder pain

Management of Synovial Chondromatosis of the Elbow With Ulnar Nerve Palsy by Open Approach: A Case Report

Synovial chondromatosis is a rare condition characterized by benign metaplasia of the synovial membrane, leading to nodular growths within the joint space. We present the case of a 58-year-old woman with persistent pain and stiffness in her right elbow, ultimately diagnosed with synovial chondromatosis. Examination revealed joint effusion, tenderness, and restricted range of motion, with palpable loose bodies and ulnar nerve symptomatology. X-ray confirmed the diagnosis. Open synovectomy was performed, with meticulous attention to ulnar nerve protection and decompression. Postoperative care included analgesics, anti-inflammatories, and physiotherapy. Synovial chondromatosis of the elbow requires prompt diagnosis and surgical intervention to alleviate symptoms and prevent complications. Prognosis is favorable with complete removal of the affected tissue. Ulnar nerve palsy should be carefully addressed during surgical management.

Arthroscopic management of synovial chondromatosis of the shoulder: a systematic review of literature

BACKGROUND

Synovial chondromatosis (SC) of the shoulder is rare, with limited literature on its management. This systematic review of literature aimed to characterize common arthroscopic techniques for the treatment of shoulder SC and patient outcomes. We hypothesized that arthroscopy is an effective operative modality for the management of shoulder SC.

METHODS

PubMed and Embase databases were searched for articles on arthroscopic management of shoulder SC, published before 6 August 2020. All articles meeting inclusion criteria received an independent full-text review by two authors.

RESULTS

An initial search found 64 articles. Following duplicate removal and title, abstract, and full-text reviews, 27 articles (48 patients) remained eligible. The mean age of patients was 33.0 years, with 2:1 male-to-female ratio. The mean follow-up was 41.8 months. SC was found to affect various intra- and extra-articular locations of the shoulder. Overall, arthroscopic treatment of shoulder SC was successful in 70.8%. Treatment failure was common in SC involving the bicipital tendon sheath. Disease recurrence was seen in 14.7%.

CONCLUSION

Literature on arthroscopic management of shoulder SC is limited, and significant heterogeneity in arthroscopic techniques was observed. Although arthroscopic management of shoulder SC is effective, further optimization is necessary to minimize treatment failure and disease recurrence.

Arthroscopic surgery for synovial chondroma of the subacromial bursa with non-traumatic shoulder subluxation complications: Two case reports

BACKGROUND

Synovial chondromatosis is a disease originating from the synovium and characterized by the presence of metaplastic cartilaginous nodules in synovial cavities. The exact prevalence of synovial chondromatosis remains unknown, and the involvement of the shoulder joint is very rare. Synovial chondromatosis accompanied by subluxation of the humeral head without a history of trauma is rarely encountered, and to our knowledge, no published reports describe this condition.

CASE SUMMARY

We present two cases of synovial chondromatosis in the shoulder joint, accompanied by subluxation of the humeral head, in two arthroscopically managed adult patients. We performed arthroscopic labrum fixation and removal of the loose body from the shoulder joint. To identify primary and secondary categories, pathological analysis was arranged. Clinical and radiographic evaluations at the 1-mo follow-up were satisfactory.

CONCLUSION

The biomechanical function of the shoulder joint requires attention, especially following the detection of loose bodies, as observed with synovial chondroma occurring in rare sites. Arthroscopic management is successful in patients with synovial chondromatosis combined with shoulder subluxation.

Synovial chondromatosis of the hip joint in a 6 year-old child: A case report

BACKGROUND

Synovial chondromatosis (SC) is a rare benign lesion first reported by Ambrose Pare in 1558. It is most common in the knee joint, followed by the hip joint and elbow joint. It is characterized by the presence of multiple pearl-like osteochondral bodies in the joint. The incidence in children is extremely low.

CASE SUMMARY

We report a 6-year-old Chinese boy who presented to our hospital with left hip joint pain and claudication for more than one year. We performed total surgical resection of SC tissue in the left hip. A good prognosis was confirmed at the 6-wk follow-up. Pain and swelling symptoms were totally relieved, range of motion of his left hip returned to normal, and there was no clinical evidence of lesion recurrence at last follow-up. Our case is the youngest reported patient with SC occurring in the hip.

CONCLUSION

SC is a rare disease and can be easily misdiagnosed. When we encounter children with hip pain and claudication, increased vigilance and a comprehensive physical examination and imaging examination should be considered, in order to avoid misdiagnosis and delayed treatment in patients.

Synovial chondromatosis combine with synovial tuberculosis of knee joint: a case report

Backgroud

Synovial chondromatosis is a rare synovial-derived metaplasia disease that comes from the formation of cartilage nodules within the synovial connective tissue of the joint. Knee tuberculosis is a disease caused mostly by the pulmonary tuberculosis and a few by tuberculosis of the digestive tract and lymphatic.

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Case presentation

Herein we report a 3-year-old child admitted by intermittent swelling of left knee joint with lameness for half a year, the patient received surgical treatment. The loose bodies filled in the joint cavity was taken out and the degenerative synovium was excised. Biopsy confirmed as synovial chondromatosis combined with synovial tuberculosis of knee joint. After 6 months follow-ups, knee swelling and claudication get totally recovered and the gait of patient recover back to normal.

Conclusion

Careful investigation of children with knee pain is recommended to avoid misdiagnosis, Synovial chondromatosis combine with tuberculosis should be considered a differential diagnosis in a child with knee pain.

Synovial macrophages in cartilage destruction and regeneration-lessons learnt from osteoarthritis and synovial chondromatosis

Inflammation is a critical process in disease pathogenesis and the restoration of tissue structure and function, for example, in joints such as the knee and temporomandibular. Within the innate immunity process, the body's first defense response in joints when physical and chemical barriers are breached is the synovial macrophages, the main innate immune effector cells, which are responsible for triggering the initial inflammatory reaction. Macrophage is broadly divided into three phenotypes of resting M0, pro-inflammatory M1-like (referred to below as M1), and anti-inflammatory M2-like (referred to below as M2). The synovial macrophage M1-to-M2 transition can affect the chondrogenic differentiation of mesenchymal stem cells (MSCs) in joints. On the other hand, MSCs can also influence the transition between M1 and M2. Failure of the chondrogenic differentiation of MSCs can result in persistent cartilage destruction leading to osteoarthritis. However, excessive chondrogenic differentiation of MSCs may cause distorted cartilage formation in the synovium, which is evidenced in the case of synovial chondromatosis. This review summarizes the role of macrophage polarization in the process of both cartilage destruction and regeneration, and postulates that the transition of macrophage phenotype in an inflammatory joint environment may play a key role in determining the fate of joint cartilage.

Staged arthroscopic procedure for treating simultaneous shoulder and elbow synovial chondromatosis: A case report and literature review

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.

Bilateral synovial chondromatosis of the elbow in an adolescent: a case report and literature review

Background

Primary synovial chondromatosis is a rare benign disease that occurs in the joint mucosa.

Case presentation

In this case report, a 14-year-old gymnast sustained pain in both elbows for 2 months with limited elbow joint activity. The initial diagnosis of bilateral elbow synovial chondromatosis was performed by physical examination and imaging report. Later, the patient was treated with open surgery on both sides of the elbow, including all loose bodies were removed out and the proliferative synovia were cut off. Histopathology reports confirmed synovial chondromatosis.

Conclusions

The report introduced a case about synovial chondromatosis in bilateral elbow found in a 14-year-old girl, which is rarely involved in bilateral elbow and rarely found in adolescents. This case report aims to provide a treatment option for surgeons in similar situations.

Arthroscopic removal of loose bodies in synovial chondromatosis of shoulder joint, unusual location of rare disease: A case report and literature review

INTRODUCTION

Synovial chondromatosis is a benign mono-articular arthropathy affecting synovial joints. It mostly affects knee joint, followed by hip, elbow and wrist and is rarely reported for shoulder joint. The exact pathogenesis is not known. Usual symptoms are pain, difficulty in movement due to mechanical obstruction. The classic treatment is arthrotomy, removal of chondromatoid loose bodies and synovectomy. With recent advances arthroscopic removal of the chondromatoid loose bodies is a good option with relatively better post op rehabilitation and faster recovery.

CASE PRESENTATION

20 years old gentleman presented to clinic with history of pain in right shoulder for 2 years and decreased range of motion. There was no history of trauma or fever. Work up done and diagnosed with synovial chondromatosis. Arthroscopic removal of chondromatoid loose bodies and synovectomy was done. More than 120 loose bodies were removed. On two (2) years follow-up patient is pain free and having full range of motion at right shoulder joint.

DISCUSSION

Synovial chondromatosis is rare in shoulder joint. The Primary synovial chondromatosis of unknown etiology, and secondary synovial chondromatosis due to degenerative joint disease. Classic treatment is arthrotomy and synovectomy. With recent advances, arthroscopic removal of loose bodies and synovectomy is also a good option for its treatment. In literature only few cases have been reported treated with arthroscopic removal of loose bodies and synovectomy.

CONCLUSION

Arthroscopic treatment of synovial chondromatosis is a good option if expertise is available. It causes less surgical trauma, better visualization during surgery, early recovery.

Synovial chondromatosis of the hip joint in childhood: A case report and literature review

RATIONALE

Pain in the hip joint is a common symptom in children. The common diseases leading to pain in the hip joint in children include transient synovitis of the hip, septic arthritis of the hip, and Legg-Calve-Perthes disease.

PATIENT CONCERNS

A 7-year-old boy was admitted due to pain in the right hip joint and limping for more than 1 month.

DIAGNOSIS

Synovial chondromatosis.

INTERVENTIONS

The patient underwent a hip open surgery, all the loose bodies in articular capsule were removed.

OUTCOMES

At the 6-month follow-up, pain and limping disappeared, and the range of activity of the hip joint was restored to a normal level.

CONCLUSIONS

Synovial chondromatosis is an uncommon disease which can cause pain of hip joint in children.

LESSONS

When the pediatric orthopedic surgeon treats the children suffered with hip pain the surgeon should be aware of this rare disease.

Extra-articular Synovial Chondromatosis Eroding and Penetrating the Acromion

Synovial chondromatosis of the shoulder is an uncommon disorder. It usually affects the glenohumeral joint and is characterized by metaplasia of the synovium leading to the formation of osteochondral loose bodies. Few cases of extra-articular subacromial synovial chondromatosis involving the rotator cuff tendon have been reported in the literature. The treatment of previously reported cases consisted of open bursectomy and removal of loose bodies. We report a case of subacromial synovial chondromatosis without rotator cuff involvement but with severe erosion and fracture of the acromion. Treatment consisted of shoulder arthroscopy to remove all loose bodies, total bursectomy, and debridement of the acromion. Potential benefits of arthroscopy were also evaluated.