Cubital bursitis caused by localized synovial chondromatosis of the elbow. A case report

Imaging bicipitoradial bursitis: a pictorial essay

Although bicipitoradial bursitis is not commonly seen, when it does occur, it can frequently lead to diagnostic difficulty, mimicking either a soft-tissue tumor or infection. Lack of awareness of this uncommon entity can lead to unnecessary anxiety or tissue biopsy. This pictorial essay discusses the normal anatomy of the bicipitoradial bursa and the spectrum of imaging findings of bicipital bursitis.

Arthroscopic management of elbow synovial chondromatosis

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.

A Rare Case of Multiple Rice Bodies in Glenohumeral Joint, Subscapular Recess and Along Long Head of Biceps

INTRODUCTION

Synovial chondromatosis is a rare, generally benign condition which affects the synovial membranes and commonly involves the large joints such as the knee, and hip. It is usually mono-articular and more common in males. Synovial chondromatosis is characterized by the presence of multiple cartilaginous nodules in the joint synovium. The definitive diagnosis is achieved after the pathological examination of the synovial tissue. It can be very destructive and can cause severe osteoarthritis, pain and malignant transformation. We present a rare case of primary synovial chondromatosis of the shoulder joint in a 31-year-old male patient.

CASE PRESENTATION

A 31-year-old man presented with pain and restricted movements of left shoulder for past 6 months, which was insidious in onset and gradually progressive. He had no history of trauma, fever, loss of appetite or weight loss. No tenderness or warmth over shoulder joint was observed. Restriction of movements was observed in all directions. No abnormality was detected in central nervous, cardiovascular, respiratory, genitourinary, or gastrointestinal systems. Routine pre-operative investigations (including liver function and renal function tests) were within the normal limit, serological investigation for rheumatoid arthritis was negative. Excision biopsy of loose bodies was performed. Biopsy reported histological features ofsynovial chondromatosis.

CONCLUSION

Synovial osteochondromatosis of shoulder joint, subscapular recess and along the long head of biceps is a rare case (less than 5% cases reported till date). Understanding the pathology, recognizing the radiographic and MRI appearance of primary synovial chondromatosis and differentiating it from secondary form, malignancy and other synovial pathologies are important in the diagnosis and clinical management of these patients.

Endoscopic Resection of the Bicipitoradial Bursa

The bicipitoradial bursa lies at the insertion of the biceps tendon on the radial tuberosity. It is an unusual site for chronic bursitis. It can be treated conservatively with aspiration and steroid injection. Surgical excision of the bursa is indicated in case of infection cause, failed conservative treatment with recurrence of the enlarged bursa and pain after aspiration, the presence of nerve compression with neurological impairment, mechanical limitation to flexion and extension of the elbow or biceps tendon degeneration, and/or functional impairment. Open resection through the anterior approach requires extensive dissection to expose the radial tuberosity and the radial neck, which increases the risk of neurovascular injury. Endoscopic resection is possible through distal biceps tendoscopy and endoscopy around the radial neck. It is technically demanding and should be reserved to the experienced elbow arthroscopist.

Elbow magnetic resonance imaging: imaging anatomy and evaluation

The elbow is a complex joint. Magnetic resonance imaging (MRI) is often the imaging modality of choice in the workup of elbow pain, especially in sports injuries and younger patients who often have either a history of a chronic repetitive strain such as the throwing athlete or a distinct traumatic injury. Traumatic injuries and alternative musculoskeletal pathologies can affect the ligaments, musculotendinous, cartilaginous, and osseous structures of the elbow as well as the 3 main nerves to the upper limb, and these structures are best assessed with MRI.Knowledge of the complex anatomy of the elbow joint as well as patterns of injury and disease is important for the radiologist to make an accurate diagnosis in the setting of elbow pain. This chapter will outline elbow anatomy, basic imaging parameters, compartmental pathology, and finally applications of some novel MRI techniques.

Arthroscopic treatment of synovial osteochondromatosis of the elbow. Case report and literature review

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.

Preoperative diagnosis of bicipitoradial bursitis: a case report

Inflammation of the bicipitoradial bursa is a rare condition and only few reports can be found in literature. Several causes for a cubital bursitis have been suggested in the past. The need to include a malignant lesion in the differential diagnosis has only been mentioned in one of these reports. May main objective in reporting this case is to make this pathological entity better known.

Bicipitoradial Bursitis: A Review of Clinical Presentation and Treatment

The bicipitoradial bursa lies at the insertion of the biceps tendon on the radial tuberosity. It is an unusual site for chronic bursitis and most often results from repetitive mechanical trauma or overuse. Other causes include tuberculosis, immunological complications of rheumatological disease and synovial chondromatosis. Accurate diagnosis requires imaging studies and sometimes histological study. It can be treated conservatively with aspiration and steroid injection. Surgical excision of the bursa is indicated in the case of infection cause, failed conservative treatment with recurrence of the enlarged bursa and pain after aspiration, presence of nerve compression with neurological impairment, mechanical limitation to flexion, and extension of the elbow or biceps tendon degeneration and/or functional impairment.

Arthroscopic treatment of a case with concomitant subacromial and subdeltoid synovial chondromatosis and labrum tear

Synovial chondromatosis is a disease that seldomly seen in shoulder joint and is related to benign synovial proliferation and synchronous chondral tissue formation within the joint cavity. Patients suffer from progressive restriction of range of motion and shoulder pain. Extra-articular involvement is an extremely rare condition. Degenerative osteoarthritis, joint subluxation, and bursitis are common complications in untreated patients. Open or arthroscopic surgery is suitable while there is no consensus related to superiority of different approaches. We presented an arthroscopic treatment of a male patient, 48 years old with labrum tear and synovial chondromatosis localized in subacromial and subdeltoid region. Advantages of arthroscopic surgery in the presence of intra- and extra-articular combined pathologies are also discussed.

Synovial chondromatosis of the upper extremity

Synovial chondromatosis is a rare, benign, proliferative cartilaginous lesion arising from the synovial tissue or bursal lining of or near joints. This disease process can be classified into intra-articular and extra-articular, or tenosynovial, subtypes. Diagnosis can often be delayed due to the rarity of the disease and its nonspecific symptoms of pain, reduced range of motion, or swelling. This article reviews the literature and describes the classification, clinical course, demographics, diagnosis, histology, and treatment of synovial chondromatosis and tenosynovial chondromatosis in the upper extremity.

Primary synovial osteochondromatosis of a subdeltoid bursa

Primary synovial osteochondromatosis (SOC) is known to be intra-articular and wherever it is observed outside a synovial joint, it is associated with the involvement of the nearby joint. Primary SOC has not been reported to involve a subdeltoid bursa. We present a case of a 52-year-old woman having a large number of loose bodies in a large tumor in the subdeltoid bursa. The swelling was first noticed by the patient 2 years back. Plain roentgenogram revealed soft tissue swelling only with no areas of calcification. On MRI, multiple nonosseous loose bodies were visualized in the bursa deep to the deltoid muscle. A surgical excision of subdeltoid bursa was done. A biopsy confirmed it to be cartilaginous loose bodies in synovial lining sugestive of metaplastic transformation of the synovial tissue.

Tuberculous bicipitoradial bursitis: a case report

An 76-year-old man with an indolent soft tissue mass on the volar aspect of the left elbow was referred to our institution with a diagnosis of a soft tissue tumor. He had a history of lung tuberculosis since the age of 30. The mass was adjacent to the biceps brachi tendon. It demonstrated homogeneous low-signal intensity on T1-weighted magnetic resonance (MR) images and heterogeneous relatively high signal intensity with scattered low and high signal intensity areas on T2-weighted MR images. An excision was performed after needle biopsy with presumptive diagnosis of bicipitoradial bursitis. The histological specimen revealed an epithelioid cell granuloma with central necrosis. While the occurrence of tuberculous bicipitoradial bursitis has never been reported, this case demonstrates that it can be considered to be among the causes of a cystic lesion around the elbow joint.

Synovial osteochondromatosis of the Lisfranc joint: a case report

Synovial osteochondromatosis arising in the foot is a rare condition. We report a 69-year-old woman with synovial osteochondromatosis of the Lisfranc joint. The patient presented with a 10-year history of left foot pain. Imaging studies showed multiple calcified masses around the Lisfranc joint. We performed a synovectomy and removal of the loose bodies in the dorsal, lateral, and plantar aspects of the Lisfranc joint by dislocating the bases of the fourth and fifth metatarsal bones. To our knowledge, this is only the second case report of synovial osteochondromatosis involving the Lisfranc joint.

Sonography of Cubital Bursitis

OBJECTIVE

The purpose of our study was to describe the sonographic appearance of cubital bursitis in three patients and to illustrate the use of sonographic guidance for therapeutic injections.

CONCLUSION

Cubital bursitis, a rare but painful condition of the elbow, can be diagnosed with sonography. Cubital bursitis is seen as distention of the bicipitoradial bursa in the proximal forearm, occasionally with fluid or complex synovial debris in more severe cases. Power Doppler imaging can aid in providing information about active inflammation. Two patients in our series were treated using sonographically guided decompression of the bursa and steroid injection with good clinical results.

MRI Characteristics of Olecranon Bursitis

OBJECTIVE

Our aim was to describe the MRI characteristics of septic and nonseptic olecranon bursitis.

MATERIALS AND METHODS

MRI contrast-enhanced examinations (n = 19) of 35 patients with olecranon bursitis (septic, n = 14; nonseptic, n = 21) were jointly reviewed by two musculoskeletal radiologists. We evaluated bursa size, extent of marginal lobulation, septation, concomitant elbow joint effusion, soft-tissue edema, rim enhancement, soft-tissue enhancement, degree of fluid complexity, definition of bursa margins, presence of edema, thickening of the triceps tendon, and bone marrow edema.

RESULTS

Comparison of septic and nonseptic bursitis yielded the following results: marginal lobulation, 79% (11/14) versus 48% (10/21), p = 0.14; bursa septation, 64% (9/14) versus 57% (12/21), p = 1.0; moderate or marked complexity of bursa fluid, 64% (9/14) versus 29% (6/21), p = 0.15; poorly defined margins, 64% (9/14) versus 67% (14/21), p = 1.0; elbow joint effusion, 86% (12/14) versus 52% (11/21), p = 0.12; moderate to marked soft-tissue edema, 64% (9/14) versus 33% (7/21), p = 0.1; edema of the triceps, 57% (8/14) versus 48% (10/21), p = 0.73; thickening of the triceps, 43% (6/14) versus 14% (3/21), p = 0.21; bone marrow edema, 29% (4/14) versus 5% (1/21), p = 0.13; rim enhancement, 100% (11/11) versus 75% (6/8), p = 0.31; soft-tissue enhancement, 100% (11/11) versus 63% (5/8), p = 0.1.

CONCLUSION

Septic and nonseptic olecranon bursitis present with a considerable overlap of MRI findings without statistically significant differences. Septic olecranon bursitis can be excluded in the absence of bursal and soft-tissue enhancement.

Synovial chondromatosis in the quadriceps tendon

We present a case of synovial chondromatosis originating from the quadriceps tendon sheath, which caused a complete quadriceps tendon rupture. The patient was treated using marginal excision. The ruptured quadriceps tendon was repaired. This is the first description of a quadriceps tendon rupture associated with synovial chondromatosis.

Bicipital radial bursitis: CT and MR appearance

The authors present two cases of bicipital radial bursitis in the elbow. In these two cases, different CT and MR imaging patterns were observed. In the first case, postcontrast CT inhomogeneously enhanced the entire lesion. T1-weighted MR images showed the lesion with iso-signal intensity with muscle. T2-weighted images demonstrated the lesion with inhomogeneous high signal intensity, with internal, linear hypointensity. Histologically, the lesion consisted of hypertrophic synovia. In the second case, postcontrast CT failed to enhance the lesion. T2-weighted MR images showed the lesion with homogeneous, marked high signal intensity. Histologically, the lesion consisted of a monocystic bursa lined by thin synovial lining layers.

Synovial osteochondromatosis at the elbow producing ulnar and median nerve palsy. Case report and review of the literature

The authors present the case of a 53-year-old woman suffering from synovial osteochondromatosis of her right elbow responsible for ulnar and median nerve entrapment neuropathy. This condition is characterised by the formation of multiple cartilaginous nodules in the metaplastic synovium of otherwise normal joints, bursae or tendon sheaths. Treatment consisted of partial synovectomy, removal of loose bodies and microscopic nerve release. Synovial osteochondromatosis complicated by nerve compression syndromes has been rarely reported, usually with ulnar tunnel syndrome at the elbow. The literature on this subject is reviewed.

Bicipitoradial bursitis: MR imaging findings in eight patients and anatomic data from contrast material opacification of bursae followed by routine radiography and MR imaging in cadavers

PURPOSE

To use radiography and magnetic resonance (MR) imaging after contrast material opacification of the bursae in cadaveric specimens to demonstrate the anatomy of the bicipitoradial bursa and to report MR imaging findings in patients with bicipitoradial bursitis.

MATERIALS AND METHODS

Bicipitoradial bursa in eight cadaveric elbows were injected with a solution containing gadodiamide, iodinated contrast agent, and gelatin. Radiographs and MR images were obtained in each specimen, with both supination and pronation of the forearm. The morphology and relationships of the bursa were studied. Anatomic sections subsequently were obtained. MR imaging studies in eight patients with bicipitoradial bursitis were also evaluated.

RESULTS

The bicipitoradial bursa revealed a smooth outline and a wide base along the superficial aspect of the radius. The mean volume of contrast material that could be injected before extravasation was 4 mL. The mean size of the bursa was 1.8 x 2.5 cm. The bicipitoradial bursa enveloped the biceps tendon, with internal septation seen in two cases. Displacement of the superficial branch of the radial nerve by the bursa was found in two specimens. Communication between the bicipitoradial bursa and elbow joint was not observed. In patients, MR imaging demonstrated fluid collections in the bicipitoradial bursa in all cases, with compression of branches of the radial nerve in two cases.

CONCLUSION

The anatomy of the bicipitoradial bursa is demonstrated with radiography and MR imaging of bursae. MR imaging allows accurate diagnosis of bicipitoradial bursitis and its effects on adjacent structures.