Synovial osteochondromatosis of the distal radio-ulnar joint

Synovial Chondromatosis in a Rural Healthcare Setting

Synovial chondromatosis is a rare, benign, and metaplastic cause of joint swelling resulting in the formation of cartilaginous nodules in the joint space. It is usually an oligoarticular disorder of large joints that typically manifests in the third to fifth decade of life. Synovial chondromatosis can be primary or secondary depending on whether an underlying etiology can be identified. Diagnosis can be made using imaging studies of the affected joint and confirmed on histopathology. Management of synovial chondromatosis can be done arthroscopically or surgically. We present a case of a 23-year-old male who presented with a long history of right knee pain, swelling, and limitation in range of motion. An X-ray of the knee showed multiple intra-articular and soft tissue calcifications. Due to the limitations of our setting, we proceeded with an open biopsy. During arthrotomy, clear straw-colored fluid with multiple nodules of varied sizes was found. A google image search helped put us in the direction of the diagnosis of synovial chondromatosis. We did a complete evacuation of loose bodies and a biopsy of synovium, which confirmed the diagnosis. The rarity of synovial chondromatosis results in a delay in the diagnosis. With the thoughtful application of resources and surgical principles, synovial chondromatosis can be safely and effectively managed in resource-limited settings.

Synovial chondromatosis of the distal radio-ulnar joint

Synovial chondromatosis (SC) is a benign metaplastic proliferation of cartilaginous nodules within the synovial membrane. Primary SC, though a rare monoarticular disease, significantly impacts patients' functional and pain-related outcomes. We outline the case of a 52-year-old man who presented with a large mass on the volar-ulnar aspect of his left wrist. Biopsy and workup revealed SC of the distal radio-ulnar joint. Though most cases of SC can be managed with arthroscopic or intralesional resection of the mass, a subset of extremely aggressive cases of SC may ultimately fail intralesional resection. Patients must be counseled about the possibility of amputation as an ultimate treatment option for the resolution of their pain and symptoms.

Arthroscopic resection of an osteochondral loose body in the distal radioulnar joint: A case report

We report a 34-year-old man who presented with ulnar wrist pain, painful click, and locking during forearm rotation following a motorcycle accident. Plain radiographs showed a loose body in the distal radioulnar joint (DRUJ), deformity of the sigmoid notch and ulnar head, and ulnar minus variant. The DRUJ deformity was assumed to be associated with physeal injury of the distal ulna during childhood. Conservative treatment with a splint and oral analgesics for 3 months failed. During DRUJ arthroscopy, osteoarthritic changes were found, and the loose body was resected using DRUJ arthroscopy. Histological examination showed an osteochondral loose body. The patient remained asymptomatic without recurrence or DRUJ instability 2 years postoperatively.

Atypical synovial chondromatosis of the right knee: A case report

Synovial chondromatosis, also known as synovial osteochondromatosis, is a rare, benign condition characterized by the formation of multiple cartilaginous nodules in the synovium of facet spaces. Synovial chondromatosis affects many joints, the knee being the most common. The present report examined a 47-year-old male with symptoms of swelling and pain in the right knee, who was admitted to hospital in September 2015. Following admittance, arthroscopic explorations were conducted. Viscous fluid and multiple cartilage-like clumps were identified in the patient's joints during surgery. There was evidence of synovial hyperemia and edema in the inner and outer lateral recesses of the patellar bursa, accompanied by villous projections. Synovium debridement and removal of cartilage-like free masses were performed. Following 6-month follow-up, the motion of the right knee ranged from 0-150° and no further swelling or pain was experienced by the patient. Following arthroscopy, the international knee documentation committee function score improved from 70.6 to 89.4 points. The results of the present report indicate that arthroscopic exploration is an effective treatment for patients with synovial chondromatosis.

Soft Tissue Chondroma—Result of Surgery in a Local Hospital and Review of the Literature

Background/Purpose

This was a retrospective case series that aimed to study the clinical features and results of surgery for soft tissue chondroma, which is a benign extraskeletal cartilage tumour.

Methods

Ten patients with a histological diagnosis of soft tissue chondroma were recruited between 2001 and 2012. Tumours involved the hand and wrist (n = 4), foot (n = 3), popliteal fossa (n = 2), and deltoid (n = 1).

Results

The most common complaints were progressive enlargement of the size of the mass (50%) and pain (50%). Radiographs showed calcified soft tissue mass in 90% of cases. Marginal excision was performed. The mean follow-up duration was 27.6 months. There was one suspected recurrence case with a mass over the index finger. Surgical re-excision was performed and the second histological diagnosis was bizarre parosteal osteochondromatous proliferation. At final follow-up, nine out of ten cases were symptom free. One patient had residual finger joint stiffness and deformity.

Conclusion

The results of marginal excisions for soft tissue chondroma is satisfactory with low complication and recurrence rates.

Bakers Cyst with Synovial Chondromatosis of Knee - A Rare Case Report

INTRODUCTION

Synovial chondromatosis is a rare intraarticular benign condition arising from the synovial membrane of the joints, synovial sheaths or bursae around the joints. Primary synovial chondromatosis typically affects the large joints in the third to fifth decade of life, although involvement of smaller joints and presentation in younger age group is also documented. The purpose of this case report is to document this rare extra articular synovial pathology present inside the baker's cyst which required open synovectomy and debridement to eradicate it.

CASE REPORT

A 43 yearold male presented with a two year history of pain, swelling and restriction of right knee joint. After the clinical and radiological assessment, open synovectomy, removal of cyst and thorough joint debridement procedure was performed. Histopathological study confirmed the findings of synovial chondromatosis.

CONCLUSION

Synovial chondromatosis is a rare benign condition. Complete synovectomy offers reliable cure rate.

Wrist synovial chondromatosis: case report and literature review

Primary synovial chondromatosis is a proliferation of cartilaginous bodies within the synovial membrane, tendon sheath or bursa. It is a rare orthopaedic entity especially when it occurs in the distal radioulnar joint. We report a 27-year-old man with recurrent synovial chondromatosis, nine years after his first operation. Although rare, synovial chondromatosis must be considered in the differential diagnosis in a patient with pain and swelling of the distal radioulnar joint. From our literature review, we report a 17% (5/30) recurrence rate for synovial chondromatosis involving the wrist joint which has not been documented in the medical literature previously.

Arthroscopic treatment of synovial chondromatosis of the hip

BACKGROUND

Recently, arthroscopic loose body removal and synovectomy have been performed as treatments for synovial chondromatosis of the hip joint. However, to date, no reports have been published on the outcomes of arthroscopic treatments.

HYPOTHESIS

Arthroscopic treatment is effective for synovial chondromatosis of the hip joint and has advantages such as low recurrence rates, faster return to activities of daily life, and few surgical complications.

STUDY DESIGN

Case series; Level of evidence, 4.

METHODS

From June 1996 to July 2008, 24 patients with synovial chondromatosis of the hip who were followed up after arthroscopic removal of loose bodies and synovectomy were evaluated. The common arthroscopic portals were the anterior, anterolateral, and posterolateral portals. In some cases, we applied a medial portal for removal of loose bodies in the posteromedial pouch. Preoperative and postoperative assessments were made through simple radiographs, 3-dimensional computed tomography, magnetic resonance imaging, visual analog scale (VAS) for pain, range of motion of the joint, Harris Hip Score, and Merle D'Aubigné and Postel score.

RESULTS

Postoperative mean follow-up period was 41 months. There were no major complications. Patients were able to walk weightbearing on average 2 days after surgery and were discharged in an average of 3.5 days (range, 3-5 days) after surgery. In postoperative radiological imaging, 4 patients showed progression of joint osteoarthritis, and 1 of them underwent total hip arthroplasty. The VAS score before surgery was 8.1 ± 1.3 and after surgery was 3.1 ± 1.4. Range of motion of the hip joint before surgery was increased after surgery, except in 1 patient who required a third operation. Harris Hip Score before surgery was an average of 39 ± 6.9 and improved to an average of 82 ± 10.2 after surgery. Eighteen patients (75%) had good or excellent outcomes. Symptomatic disease recurred in 4 patients (16.7%), and 1 of these 4 patients showed a subsequent recurrence.

CONCLUSION

The treatment of synovial chondromatosis of the hip using arthroscopic loose body removal and synovectomy is relatively successful, and rehabilitation of patients is fast, therefore making it an effective treatment with satisfactory postsurgical results. However, a technical limitation of arthroscopy is the difficulty in approaching the posterolateral and posteromedial areas of the peripheral compartment.

Benign extraosseous cartilage tumours of the hand and wrist

Benign extraosseous cartilage tumours of the hand and wrist comprise soft tissue chondromas, synovial chondromatosis and tenosynovial chrondromatosis. These tumours can significantly affect patients as they are often painful, functionally limiting and cosmetically displeasing. Although each tumour is generally considered to be a distinct entity, they share radiological and histopathological similarities. Occasionally, all three tumours may be seen in the same patient. This is an important consideration because of the risk of recurrence that may not necessarily occur at the same anatomical site but instead extend to different sites, such as a tendon sheath and/or joint.

SYNOVIAL CHONDROMATOSIS OF THE DISTAL RADIOULNAR JOINT

Synovial chondromatosis is a rare lesion in the wrist and it is extremely uncommon in the distal radioulnar joint. This case presented with wrist pain, swelling and locking secondary to synovial chondromatosis of distal radioulnar joint.

TENOSYNOVIAL OSTEOCHONDROMATOSIS OF BOTH FLEXOR AND EXTENSOR TENDONS

An unusual case of a 52-year-old woman with tenosynovial osteochondromatosis involving both of the wrist flexor and extensor tendons is reported.

Synovial chondromatosis presented as knocking sensation of the knee in a 14-year-old girl

Knee joint is the most common site of synovial chondromatosis with the prevalence in middle-aged male. The following is the description of a 14-year-old girl presented with a knocking sensation during the motion of her joint, which is a less common occurrence at her age. Loose bodies in the left knee joint were excised as much as possible with arthroscopy. The patient was asymptomatic when moving her knee after arthroscopic synovialectomy and removal of the loose bodies. In spite of the less possibility of malignant transformation of synovial chondromatosis, long-term follow-up is still recommended in this 14-year-old girl due to the supposed genetic abnormalities.

Synovial chondromatosis of the hand: Three case reports and literature review

Synovial chondromatosis is a rare condition that is probably caused by synovial connective tissue metaplasia. It is very rare in the hand and wrist and because of its low prevalence and nonspecific symptoms, synovial chondromatosis can present diagnostic difficulties for the hand surgeon and may lead to a delay in treatment. We review the literature and report three additional cases of synovial chondromatosis in the hand.

Synovial osteochondromatosis of the suprapatellar bursa with an imperforate suprapatellar plica

Synovial osteochondromatosis is a rare disease characterized by cartilaginous and osseous metaplasia of the joint synovium. While it may affect practically any synovial joint, the knee is most often affected. An imperforate suprapatellar plica is also a rare finding in the knee. We report an exceptionally rare case of synovial osteochondromatosis of the knee characterized by isolated multiple loose bodies in the suprapatellar bursa caused by imperforate suprapatellar plica in a 52-year-old woman. The case was successfully treated by arthroscopic surgery. A worse-case scenario and possible diagnostic and therapeutic challenges are discussed.

Synovial chondromatosis of the metacarpophalangeal joint

We describe a case of synovial chondromatosis in a metacarpophalangeal joint with invasion of local structures. The degree of local tissue involvement was not demonstrated on the preoperative MRI scans. This case highlights that synovial chondromatosis can be invasive and that even the best preoperative imaging may not demonstrate this.

Synovial chondromatosis of the distal radioulnar joint: a case report

The most definitive method for confirming the diagnosis of synovial chondromatosis is the identification of cartilaginous metaplasia within the synovium on histologic examination. In advanced stages of the disease, plain radiographs and magnetic resonance imaging (MRI) scans demonstrate calcified and cartilaginous bodies, respectively, but in earlier stages, plain radiographic findings may be normal and MRI scans may reveal only nonspecific increased fluid. Although rare in the wrist, synovial chondromatosis must be considered in the differential diagnosis in a patient presenting with pain and swelling of the distal radioulnar joint. Surgical exploration of the joint and synovectomy, alone or in combination with removal of loose bodies, is the recommended treatment.

[Synovial chondromatosis of the temporomandibular joint with invasion into the middle cranial fossa]

Synovial chondromatosis of the temporomandibular joint is a rare occurrence. Resorption of the floor of the skull base caused by the tumour with invasion into the middle cranial fossa has only been described a few times. We report on diagnosis, histologic examination and therapy of a patient with synovial chondromatosis in the articular tubercle of the right temporomandibular joint invading the middle and cranial fossa. After tumour exstirpation the defect in the floor of the middle cranial fossa was reconstructed using a split-skull graft via an intracranial approach.