Clinical Results of Surgical Resection and Histopathological Evaluation of Synovial Chondromatosis in the Shoulder: A Retrospective Study and Literature Review

BACKGROUND: Synovial chondromatosis occurs rarely in the shoulder, and its details remain unclear. The purpose of this study was to clarify the clinical results of surgical resection and the histopathological findings of synovial chondromatosis in the shoulder.METHODS: Ten shoulders with synovial chondromatosis that had been operatively resected were reviewed retrospectively. Osteochondral lesions were present in the glenohumeral joint in six shoulders and in the subacromial space in four shoulders. Two patients had a history of trauma with glenohumeral dislocation without recurrent instability, and the other seven patients (eight shoulders) did not have any traumatic episodes or past illness involving the ipsilateral shoulder girdle. The occurrences of osteochondral lesions, inferior humeral osteophytes, and acromial spurs were assessed on radiographs before resection, just after resection, and at final follow-up. The Constant scores were compared before resection and at final follow-up with Wilcoxon signed-rank tests. Resected lesions were histopathologically differentiated between primary and secondary synovial chondromatosis.RESULTS: Inferior humeral osteophytes were found in five shoulders with synovial chondromatosis in the glenohumeral joint, and all four shoulders with synovial chondromatosis in the subacromial space had acromial spur formation. Osteochondral lesions appeared to have been successfully removed in all shoulders on postoperative radiographs. At the final follow-up, however, one shoulder with secondary synovial chondromatosis in the subacromial space showed recurrence of osteochondral lesions and acromial spur formation. The mean Constant score improved significantly from 53.0 points before resection to 76.0 points at a mean follow-up of 6.0 years (p = 0.002). On histopathological evaluation, one shoulder was diagnosed as having primary synovial chondromatosis, while nine shoulders had secondary synovial chondromatosis.CONCLUSIONS: The present study showed that resection of shoulder osteochondral lesions successfully relieved the clinical symptoms and that primary synovial chondromatosis is less common than secondary synovial chondromatosis in the shoulder. Although most of the present osteochondral lesions were clinically determined to be primary chondromatosis, only one case was histopathologically categorized as primary synovial chondromatosis. These results suggest that histopathological identification is needed to differentiate between primary and secondary synovial chondromatosis.

Bilateral symmetrical synovial chondromatosis of shoulder: a case report / Condromatose sinovial simétrica bilateral do ombro: relato de caso

ABSTRACT Synovial chondromatosis is a benign arthropathy rarely seen in diarthrodial joints. Extra-articular bilateral symmetrical synovial chondromatosis of shoulder is the rarest variety. The diagnosis is established with the help of imaging modalities and histopathological examinations. This report describes a case of a 39-year-old woman who presented with symmetrical, progressively increasing swelling over the bilateral shoulder region, of 12-18 months duration, with dull ache and restricted movements of the shoulder joints. Magnetic resonance imaging (MRI) and ultrasonography (USG) revealed large bilateral subacromial-subdeltoid bursal swelling with loose floating bodies. Surgical excision of extensive bilateral bursa was performed at four weeks of interval. Histopathological examination revealed synovial chondromatosis on either side. Postoperative recovery occurred without complications.

RESUMO A condromatose sinovial é uma artropatia benigna raramente vista em articulações diartrodiais. A condromatose sinovial simétrica bilateral extra-articular do ombro é a variedade mais rara. O diagnóstico é estabelecido com a ajuda de exames de imagem e histopatológicos. Este relato descreve o caso de uma paciente de 39 anos, com aumento de volume progressivo simétrico sobre a região bilateral do ombro com 12-18 meses de duração com dor entorpecido e limitação dos movimentos das articulações do ombro. A ressonância magnética e a ultrassonografia revelaram um grande aumento de volume da bursa subacromial subdeltoidea bilateral com corpos livres flutuantes. A excisão cirúrgica extensa da bursa bilateral foi feita com quatro semanas de intervalo. O exame histopatológico revelou condromatose sinovial em ambos os lados. A recuperação pós-operatória transcorreu sem complicações.

Uncommon Primary Synovial Chondromatosis Involving Only the Infrapatellar Fat Pad in an Elderly Patient

Primary synovial chondromatosis is a rare condition of idiopathic synovial chondrometaplasia and usually occurs during the third to fifth decades of life. Conversely, secondary synovial chondromatosis results from the growth of separated particles from articular cartilage or osteophytes in patients with joint diseases, such as degenerative osteoarthritis, and occurs mostly in elderly people. We describe here a 76-year-old male histopathologically confirmed as having primary synovial chondromatosis with no calcification of the infrapatellar fat pad (IFP) of the knee joint. To our knowledge, this is the first description of primary synovial chondromatosis of the knee joint confined to the IFP in a patient >60 years old.

Sindrome de Maffucci / Maffucci’s syndrome

El síndrome de Maffucci es un raro trastorno congénito de etiología desconocida. Se caracterizapor encondromas, deformidades óseas, hemangiomas y con menor frecuencia linfangiomas. Presentamos un paciente con síndrome de Maffucci y hacemos una revisión de la patología...

Plica sinovial dolorosa asociada a condromalacia radiocapitelar: reporte de caso / Synovial wris impingement with concomitant radial-capitelar chondromalacia: case report

Las plicas sinoviales de la articulación radiocapitelar pueden causar crepitación dolorosa de la articulación del codo y se deben diferenciar de otras causas de crepitación dolorosa del codo como los cuerpos libres intraarticulares, la inestabilidad o la luxación medial de la cabeza del tríceps sobre el epicóndilo medial. El dolor sobre la cara lateral del codo, acompañado de sensación de resalto en flexión y pronación, es un hallazgo común en los pacientes con dicha patología. El tratamiento con cirugía artroscópica del codo generalmente confirma la presencia de la plica sinovial asociada a un área adyacente de sinovitis y una lesión del cartílago de la cabeza radial y el capitelo. Se presenta el caso de una paciente joven con una plica sinovial dolorosa con una condromalacia radiocapitelar asociada.

Subdeltoid Bursa Chondromatosis Associated with Osteochondral Lesion of the Proximal Humerus and a Rotator Cuff Tear / 대한정형외과학회잡지

Synovial chondromatosis involving the bursa is uncommon, and those cases synovial chondromatosis within the bursa around the shoulder are especially rare. We report here a case of a 57-year-old male who had subdeltoid bursal subdeltoid bursal chondromatosis associated with osteochondral lesion of the proximal humerus and a rotator cuff tear. We also review the relevant literatures.

Synoivial Chondromatosis of the Ankle Joint and Flexor Hallucis Longus Tendon Sheath / 대한족부족관절학회지

Synovial chondromatosis is a benign lesion forming multiple round cartilagenous nodules or osseous loose bodies in joint cavity. Predilection sites are known as knee, hip and elbow joints. However, the involvement of ankle joint was rarely reported in the literature. Moreover, extraarticular chondromatosis in synovial sheath or bursa of extremities is extremely rare. We present a case of synovial chondromatosis of the left ankle joint and flexor hallucis longus tendon sheath.

Primary synovial chondromatosis of the temporomandibular joint with temporal involvement

Synovial chondromatosis is a rare, benign, monoarticular arthropathy that is characterized by the development of highly cellular, metaplastic cartilaginous nodules in the synovial membrane. It commonly affects larger joints such as the knee, elbow, wrist, shoulder, and hip. Synovial chondromatosis of the temporomandibular joint(TMJ) is rare. Moreover, the temporal involvement of synovial chondromatosis without connection with joint is greatly rare. A 44-year-old women had experienced pain of the right TMJ area and limitation of mouth opening. MRI and CT revealed multiple calcified loose bodies and widening in right upper joint space of TMJ and osteolytic lesion in right temporal bone. Treatment consisted of removal of multiple loose bodies, resection of the osteolytic lesion through the preauricular approach. She was diagnosed with primary transitional synovial chondromatosis of TMJ with involvement of temporal bone. In spite of remaining of the loose bodies, pain and mouth opening improved and there have been no recurrence of signs and symptoms for 5 years follow up.

Tenosynovial Chondromatosis on Plantar Area: A Case Report / 대한족부족관절학회지

Tenosynovial chondromatosis is a multinodular cartilaginous proliferation that arises from the tenosynovial membranes. It is rare, benign neoplasm, most commonly affects the tendon of the wrist and hand. It is clinically important because of its high rate of recurrence with a unique histopathological pattern which not infrequently displays considerable focal cellular atypia and hypercellurality nevertheless it is benign, but it has not been well recognized because of its rarity. We report here a rare case of tenosynovial chondromatosis of the tendon sheath of flexor hallucis longus and flexor digitorum longus in plantar area.

Synovial Chondromatosis of the Metacarpophalangeal Joint: A Case Report / 대한정형외과학회잡지

Synovial chondromatosis is an uncommon lesion, which is characterized by cartilaginous and osseous metaplasia of the joint synovium. Synovial chondromatosis usually involves a large joint and rarely occurs in the hand. Intra-articular synovial chondromatosis during the hand should be considered in the differential diagnosis of swollen, stiff or painful joints. Other possible diagnoses include osteoarthritis, rheumatoid arthritis, gout, trauma and chronic infection. Moreover, if enchondral ossification of loose bodies is not seen a diagnosis of synovial chondromatosis can not be made preoperatively. Intra-articular synovial chondromatosis is a benign condition and surgical synovectomy remains the most effective treatment. The authors report a case of synovial chondromatosis of the fifth metacarpophalangeal joint.

Condromatose sinovial da articulação temporomandibular - Relato de um caso / Synovial chondromatosis of the emporomandibular joint - Report of a case

Condromatose Sinovial (CS) é uma condição benigna, rara, caracterizada pela formação de múltiplos nódulos metaplásicos oriundos do tecido conjuntivo sinovial e subsinovial das artilulações. Os autores relatam um caso clínico de CS em Articulação Temporomandibular, acompanhado de uma breve revisão da literatura

Osteochondroma and synovial chondromatosis of the temporomandibular joint / 대한구강악안면방사선학회지

Osteochondroma is a benign lesion of osseous and cartilagenous origin. It is a relatively common benign tumor of the skeleton, occurring most often in the metaphyseal region of long bone. However, it is rare in the facial bones. Reported foci in the mandible were the condyle, coronoid process, and symphysis region. Synovial chondromatosis is an uncommon benign condition of unknown etiology which affects the articular joints. Foci of cartilage develop through metaplasia in the underlying connective tissue of the synovial membrane. These cartilagenous foci and fragments may undergo calcification and ossification. We experienced 4 patients with abnormal appearance of mandibular condyle. This report describes 3 cases of osteocondroma and 1 case of synovial chondromatosis of the mandibular condyle with review of the literature.

Artroscopia de la rodilla en niños y adolescentes: experiencia de 38 casos / Arthroscopy of the knee in children and adolescents. Experience in 38 cases

Se revisaron los expedientes clínicos de 35 pacientes con el diagnóstico de patología de rodilla y que habían sido sometidos al procedimiento artroscópico. Posteriormente se correlacionó el diagnóstico clínico preoperatorio con el diagnóstico artroscópico, utilizando el término "correcto" cuando ambos diagnósticos coincidían y el término "incorrecto" cuando el diagnóstico artroscópico fue diferente, existieron diagnósticos adicionales y/o se encontró una lesión no sospechada. De las 38 artroscopias realizadas, el diagnóstico fue "correcto" en 26 casos, lo que da un porcentaje de veracidad de 68.4 por ciento. Unicamente se obtuvieron dos casos de menisco discoide y ninguno de osteocondritis disecante. El diagnóstico preoperatorio clínico más frecuente fue el de meniscopatía en 17 casos siendo correcto en 10 casos (58.8 por ciento). El 100 por ciento de los casos diagnosticados preoperatoriamente como condromalacia rotulina se confirmó durante la cirugía. La artroscopia es una herramienta útil en el paciente pediátrico, ya que éstos tienden a minimizar la sintomatología real así como la existencia de una barrera de comunicación médico-paciente que dificulta una adecuada historia clínica y un examen físico fidedigno

A case of Maffucci's syndrome / 대한피부과학회지

Maffucci's syndrome is a congenital, non-hereditary mesodermal d splasia manifested by multiple enchondromas and hemangiomas. Several case reports and reviews indicate that there is a tendency toward malignant transformation of the enchondroma. The incidence of malignancy may be as high as 30%. We report a case of 10-year-old female with multiple hemangiomas on the face, palms, and soles and skeletal chondromatoses of the multiple bones.