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Phalak M, Nair A, Reddy R, Chopra S, Kumar S. A Rare Case of Synovial Chondromatosis in the Proximal Interphalangeal Joint of the Right Index Finger. Cureus 2024; 16:e68072. [PMID: 39347256 PMCID: PMC11437017 DOI: 10.7759/cureus.68072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2024] [Accepted: 08/28/2024] [Indexed: 10/01/2024] Open
Abstract
Synovial chondromatosis is a rare condition that is also known as Reichel syndrome. It is a disorder that affects the monoarticular joints. The proliferation and metaplasia of the synovial cartilage are its defining characteristics. Many tiny, intra-articular osseocartilaginous loose bodies are formed as a result of this proliferation. They are fed by the synovial fluid once they break off from the synovial surface and enter the joint cavity, where they develop into calcification and ossification. If left untreated, it usually causes the afflicted joint to malfunction severely. Large joints such as the knee, hip, elbow, and shoulder joints are frequently the sites of nodular proliferation. Smaller joints such as the hand's interphalangeal and metacarpal joints and thumb are among the more unusual locations. Although the disease usually resolves on its own, conservative management options include painkillers, activity modification, and cryotherapy. Surgical options include synovectomy, which is the gold standard procedure and involves removing the loose bodies. The following case study presents a 60-year-old female patient with a rare instance of synovial chondromatosis. She presented to the outpatient department (OPD) due to escalating pain and swelling in the proximal interphalangeal (PIP) joint of her right index finger, which significantly restricted her range of motion. On the hand X-ray, several small, uniformly sized calcified bodies were visible within the synovium. After negative results from autoimmune disease tests, the patient was recommended for surgical exploration as the patient reported a six-month increase in pain and difficulty flexing his index finger. Surgical exploration of the PIP joint and adjacent proximal and middle phalanx revealed several small, evenly sized, firm, smooth, creamy-white nodules. Post-op, the patient was given a splint cast for a span of seven days, followed by physical therapy, and the range of motion was achieved by the end of six months.
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Affiliation(s)
- Mukesh Phalak
- Orthopaedics, Dr. D.Y Patil Medical College, Hospital and Research Centre, Dr. D.Y. Patil Vidyapeeth (Deemed to be University), Pune, IND
| | - Abhishek Nair
- Orthopaedics, Dr. D.Y Patil Medical College, Hospital and Research Centre, Dr. D.Y. Patil Vidyapeeth (Deemed to be University), Pune, IND
| | - Rajeev Reddy
- Orthopaedics, Dr. D.Y Patil Medical College, Hospital and Research Centre, Dr. D.Y. Patil Vidyapeeth (Deemed to be University), Pune, IND
| | - Shubhankar Chopra
- Orthopaedics, Dr. D.Y Patil Medical College, Hospital and Research Centre, Dr. D.Y. Patil Vidyapeeth (Deemed to be University), Pune, IND
| | - Sushant Kumar
- Orthopaedics, Dr. D.Y Patil Medical College, Hospital and Research Centre, Dr. D.Y. Patil Vidyapeeth (Deemed to be University), Pune, IND
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Tang XF, Qin YG, Shen XY, Chen B, Li YZ. Arthroscopic surgery for synovial chondroma of the subacromial bursa with non-traumatic shoulder subluxation complications: Two case reports. World J Clin Cases 2022; 10:1645-1653. [PMID: 35211605 PMCID: PMC8855272 DOI: 10.12998/wjcc.v10.i5.1645] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 11/04/2021] [Accepted: 01/10/2022] [Indexed: 02/06/2023] Open
Abstract
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.
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Affiliation(s)
- Xiong-Feng Tang
- Orthpoeadic Medical Center, Jilin University Second Hospital, Changchun 130041, Jilin Province, China
| | - Yan-Guo Qin
- Orthpoeadic Medical Center, Jilin University Second Hospital, Changchun 130041, Jilin Province, China
| | - Xian-Yue Shen
- Orthpoeadic Medical Center, Jilin University Second Hospital, Changchun 130041, Jilin Province, China
| | - Bo Chen
- Orthpoeadic Medical Center, Jilin University Second Hospital, Changchun 130041, Jilin Province, China
| | - Ying-Zhi Li
- Orthpoeadic Medical Center, Jilin University Second Hospital, Changchun 130041, Jilin Province, China
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Recurrence of Primary Synovial Chondromatosis (Reichel's Syndrome) in the Ankle Joint following Surgical Excision. Case Rep Orthop 2021; 2021:9922684. [PMID: 34527383 PMCID: PMC8437642 DOI: 10.1155/2021/9922684] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 08/15/2021] [Accepted: 08/17/2021] [Indexed: 11/17/2022] Open
Abstract
Primary synovial chondromatosis, or Reichel's syndrome, is a rare benign tumour arising from the synovial lining of a joint. We present the case of a 25-year-old male with Reichel's syndrome of the ankle, with subsequent recurrence following open retrieval of loose bodies. The initial presentation was of lateral malleolus discomfort which limited moderately strenuous exercise. Clinical examination showed a mild effusion and pain on extremes of movement. Imaging confirmed the presence of multiple loose bodies within the anterior and anterolateral recesses of the ankle. Open removal of 27 loose bodies from the joint was performed, with good postoperative recovery. He represented with pain 9 months later, with imaging of the ankle showing reaccumulation of loose bodies to a lesser extent. A trial of conservative management was opted for. Reichel's syndrome confined to the ankle is an exceedingly rare diagnosis, with few cases reported in the literature. This case saw the recurrence of the disease in a short time period despite successful surgery in the first instance. Management options to treat recurrence include repeat retrieval of foreign bodies, synovectomy, radiotherapy, or arthrodesis. While the prognosis is favourable, a low risk of malignant potential warrants adequate patient follow-up.
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Zmerly H, Mauela M, Akkawi I. Ankle synovial chondromatosis in anterior and posterior compartments. A Case report. ACTA BIO-MEDICA : ATENEI PARMENSIS 2020; 91:267-270. [PMID: 32555108 PMCID: PMC7944820 DOI: 10.23750/abm.v91i4-s.9528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 04/22/2020] [Indexed: 11/23/2022]
Abstract
Synovial chondromatosis is a rare benign disease, the aetiology of which is not clear. It can arise in the synovial membrane of joints, tendon sheaths, or bursae. Synovial chondromatosis is characterized by multiple loose bodies that can grow and cause symptoms such as pain, swelling and a limited range of motion. It can also result in joint damage. We describe the case of a 48-year-old male dancer with ankle synovial chondromatosis. Diagnosis by radiograph and MRI showed multiple lesions in anterior and posterior ankle compartments. The patient was successfully treated with arthroscopic removal of all loose bodies and partial synoviectomy. Clinical follow-ups at one, four and 12 months and again at 10 years, showed the ankle had a full range of motion without pain or swelling. Post-operative radiographs at one month and at 10 years showed no lesions. Synovial chondromatosis is a benign condition with several loose bodies that must be removed to relieve symptoms and avoid future joint damage. The ankle is a rare location for chondromatosis and arthroscopic removal is the treatment of choice with good results.
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Affiliation(s)
- Hassan Zmerly
- Orthopaedics and Traumatology Unit, San Pier Damiano Hospital , Faenza, Italy and UCM Malta - Ludes Lugano Campus, Switzerland;.
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Monestier L, Riva G, Stissi P, Latiff M, Surace MF. Synovial chondromatosis of the foot: Two case reports and literature review. World J Orthop 2019; 10:404-415. [PMID: 31840021 PMCID: PMC6908443 DOI: 10.5312/wjo.v10.i11.404] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2019] [Revised: 05/17/2019] [Accepted: 09/15/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Primary synovial chondromatosis (PSC) is a rare arthropathy of the synovial joints characterized by the formation of cartilaginous nodules, which may detach and become loose bodies within the joint and may undergo secondary proliferation. PSC of the foot and ankle is exceedingly rare, with only a few cases reported in the literature. The diagnosis may be difficult and delayed until operative treatment, when it is confirmed by histological assessment. PSC may degenerate into chondrosarcoma. Operative treatment is the gold standard aiming to minimize pain, improve function, prevent or limit progression of arthritis. Surgical treatment consists in debridement by arthrotomic or arthroscopic management, but there is no consensus in the literature about timing of surgery and surgical technique. Thus, the aim of this study is to report the outcomes of the surgical treatment of two cases, together with a literature review. CASE SUMMARY We report two cases of patients affected by PSC of the foot in stage III, according to the Milgram classification: the former PSC localized in the ankle that underwent open surgery consisted of loose bodies removal; the latter in the subtalar joint, and the choice of treatment was the arthrotomy and debridement from loose bodies, in addition to the subtalar arthrodesis. Both patients returned to complete daily and working life after surgery. CONCLUSION Synovial chondromatosis is a rare benign pathology, even rarer in the ankle joint and especially in the foot. Surgery should be minimal in patients with ankle PSC, choosing the correct timing, waiting if possible until stage III. More aggressive and early surgery should be performed in patients with PSC of the foot, particularly the subtalar joint, due to the high risk of arthritic evolution.
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Affiliation(s)
- Luca Monestier
- Orthopedic and Trauma Unit, ASST Settle Laghi, Varese 21100, Italy
| | - Giacomo Riva
- Orthopedic and Trauma Unit, ASST Settle Laghi, Varese 21100, Italy
| | - Placido Stissi
- Residency Program in Orthopedics and Trauma, University of Insubria, Varese 21100, Italy
| | - Mahfuz Latiff
- Residency Program in Orthopedics and Trauma, University of Insubria, Varese 21100, Italy
| | - Michele Francesco Surace
- Orthopedic and Trauma Unit, ASST Settle Laghi, Varese 21100, Italy
- Interdisciplinary Research Centre for Pathology and Surgery of the Musculoskeletal System, Department of Biotechnology and Life Sciences, University of Insubria, Varese 21100, Italy
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Aramberri M, Tiso G, Haeni DL. Arthroscopic and Endoscopic Technique for Subcoracoid Synovial Chondromatosis of the Shoulder Through a Medial Transpectoral Portal. Arthrosc Tech 2018; 7:e279-e283. [PMID: 29881701 PMCID: PMC5990000 DOI: 10.1016/j.eats.2017.09.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Accepted: 09/06/2017] [Indexed: 02/03/2023] Open
Abstract
Synovial chondromatosis of the shoulder is a rare disorder characterized by metaplastic synovial proliferation, causing multiple loose bodies usually localized intra-articularly. Surgical treatment with open techniques through a deltopectoral approach has been commonly used. The evolution of arthroscopy has allowed a complete joint assessment and the extraction of intra-articular loose bodies with less morbidity than open techniques. Nevertheless, this pathology occurs less frequently in the subcoracoid bursa. Access to this bursa may be more complicated when extracting loose bodies that cause pain and functional limitation in performing activities of daily living. We describe an arthroscopic and endoscopic technique for the treatment of subcoracoid synovial chondromatosis through a medial transpectoral portal, allowing safe loose body extraction under direct visualization around the coracoid process and brachial plexus. The literature was reviewed, and benefits of this endoscopic technique were analyzed.
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Affiliation(s)
- Mikel Aramberri
- Ramón y Cajal Teaching Hospital, Madrid, Spain,Alai Sports Medicine Clinic, Madrid, Spain,Address correspondence to Mikel Aramberri, M.D., Ph.D., Alai Sports Medicine Clinic, Arturo Soria 342, 28033 Madrid, Spain.
| | | | - David L. Haeni
- LEONARDO, Hirslanden Clinic Birshof, Münchenstein, Basel, Switzerland,Orthopaedic Department, University Children's Hospital Basel (UKBB), Basel, Switzerland
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