Wrist synovial chondromatosis: case report and literature review

Synovial chondromatosis of the distal radioulnar joint-a rare case

Unclear wrist tumors are a common clinical presentation in patients with pain and movement restrictions of the wrist. We report a rare case of a benign tumor of the wrist in a 63-year-old female patient who presented with a ganglion-like swelling of the right hand. After examination and preoperative radiological diagnostics, the indication for an open surgery was indicated for resection of either a typical ganglion cyst or a peripheral nerve sheath tumor was made. Interestingly, the suspected diagnosis was not correct. The intraoperative finding and histological analysis revealed typical findings of synovial chondromatosis of the distal radioulnar joint. Although synovial chondromatosis is a relatively rare, and even rarer in the wrist, it is important to consider it as a differential diagnosis when a patient presents with a 'simple' wrist ganglion.

A rare case of synovial chondromatosis of distal radio-ulnar joint

INTRODUCTION

Synovial chondromatosis (SC) is a benign metaplastic proliferation of cartilaginous nodules within the synovial membrane that commonly manifests as "loose masses" in the joint space. Synovial chondromatosis affects 1.8 per 1 million individuals. The most common articulations affected are the knees, followed by the hip, elbows, and shoulder. The wrist, on the other hand, is rarely affected. Synovial chondromatosis occurs mostly in the third or fifth decade of life.

PRESENTATION OF CASE

A 30-year-old Saudi, non-married female patient presented to the outpatient orthopaedic clinic complaining of right wrist pain for 5 years. The pain started gradually with on and off pain episodes. Her magnetic resonance imagining was ordered which showed large radio ulnar joint effusion associated with synovitis with multiple low- intensity foci corresponding to subtle calcifications which are all consistent with synovial chondromatosis which was successfully treated with surgery. Eventually, the patient reported that her quality of life was hugely improved especially in terms of pain, stiffness, and range of motion.

CONCLUSION

Synovial chondromatosis in radio-ulnar joint is a very rare entity. Surgical exploration of the joint, removal of loose bodies alone or combined with synovectomy, is the recommended treatment.

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.

Extra-articular chondromatosis of flexor and extensor compartments of the hand: Case report and review of literature

Objectives:

Tenosynovial chondromatosis is an uncommon type of chondro-dysplasia of synovial and connective tissue. We report a case of a patient with a primary right wrist extra-articular chondromatosis extending to the flexor and the extensor compartments.

Methods:

Until now, there has been no study describing double surgical access for such a case.

Results:

Due to the extension, two surgical accesses are required to completely remove the neoformation.

Conclusions:

At 2 years of follow-up, the good functional-clinical results and absence of recurrence confirm the validity of our surgical strategy.

Synovial Osteochondromatosis at the Carpometacarpal Joint of the Thumb

Synovial osteochondromatosis (SOC) is a benign tumor characterized by synovial connective tissue metaplasia. SOC commonly affects major joints including the knee followed by the hip, elbow, and wrist. SOC cases in the hand are not reported as often as SOC of major joints. Particularly SOC of the carpometacarpal joint of the thumb is rare. We report on a 57-year-old female with primary SOC of the carpometacarpal joint of her left thumb. Surgical excision was performed and the patient had no symptoms with full range of motion of her left thumb. At 3 years of follow-up, there was no recurrence.

Synovial osteochondromatosis of the wrist joint: A case report

Synovial osteochondromatosis is a rare condition in which multiple cartilaginous nodules proliferate within the synovial membranes of joints, tendon sheaths or bursae. In general, a complete synovectomy is an effective method to treat this disease. Commonly involved joints are the knee, glenohumeral joint, elbow, hip and ankle, although any articulation may be affected. However, synovial osteochondromatosis occurs rarely in the wrist, and there have been a lack of reports of this occurrence in the literature. The current study presents a case of synovial osteochondromatosis in a 33-year-old man, who was admitted in 2014 with the symptom of swelling of the left wrist joint for 2 years. The swelling had become increasingly painful over the previous 2 months. Physical examination revealed local tenderness and a soft pliable mass, with no involvement of the skin and with moderate pain. X-ray, computed tomography and magnetic resonance imaging of the left wrist revealed a lump at the volar radial side of the left wrist joint without any bone erosion. The lesion was subsequently excised. Histological examination resulted in a diagnosis of osteochondromatosis, which was not considered prior to the surgery. The present case was reported with the aim of analyzing the clinical, imaging characteristic and therapeutic modalities of synovial osteochondromatosis of the wrist. While there was no evidence of recurrence for the subsequent 4 months of post-operative follow-up in the present case, the long-term efficacy of surgical excision requires extended observation.

Management of synovial osteochondromatosis of the distal radioulnar joint with imaging features consistent with malignancy

Synovial osteochondromatosis of the distal radioulnar joint is a rare entity with only 14 cases reported in the literature. Malignant transformation of synovial osteochondromatosis is the most worrisome complication of the disease. It has been described in joints such as the hip and knee but never for the distal radioulnar joint. We report a case of synovial osteochondromatosis of the distal radioulnar joint which presented with radiographic features which were worrisome for malignant transformation and required a comprehensive preoperative workup. Discussed are the preoperative management, surgical treatment, and a literature review of this rare disease.