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      Extra-Articular Tenosynovial Chondromatosis of the Finger: A Case Series Study of Three Cases, One Including Excessive Osseous Invasion

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          Abstract

          Background:

          Synovial chondromatosis is characterized by cartilaginous metaplasia in synovial tissues. Extra-articular tenosynovial chondromatosis is considered to be an anatomical counterpart of articular synovial chondromatosis. Extra-articular tenosynovial chondromatosis occurs preferentially in the hand, although its frequency is low.

          Results:

          We report three cases of extra-articular tenosynovial chondromatosis. A 65-year-old female presented with a history of symptoms over 40 years related to the dorsum of her index finger (Case 1), A 46-year-old female presented with a 6-month history of symptoms at the volar surface of her middle finger (Case 2), and a 66-year-old male presented with a 3-month history of symptoms in a dorsal ring finger. Case 2 had evidence of ossification, which could be classified as osteochondromatosis. Interestingly, the index finger lesions (Case 1) were accompanied by excessive bone involvement. The signal intensity of T2-weighted magnetic resonance imaging varies from low to high, possibly reflecting histological variations, such as ossification and fatty tissue changes. All lesions were resected without complications.

          Conclusion:

          Variations in anatomical sites suggest that overuse or mechanical overloading was not causative. Extensive involvement of the nearby tendon and joint capsule, as well as the bone, would require attention during the resection. Preoperative analysis of images is important, not only for the diagnosis, but also to assess the extent of the lesion, particularly given the complex anatomy of the finger.

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          MR appearance of idiopathic synovial osteochondromatosis.

          Theodore Kramer, M Recht, D Deely … (2016)
          A retrospective review of the MR examinations in 21 patients with idiopathic synovial osteochondromatosis (ISO) was performed to determine its MRI characteristics. Twenty-one patients diagnosed with ISO had undergone MRI prior to surgery. The MR images were retrospectively evaluated for configuration and extent of lesion as well as for signal characteristics. Three distinct MR patterns were seen in ISO: A--lobulated homogeneous intraarticular signal isointense to slightly hyperintense to muscle on T1-weighted images and hyperintense on T2-weighted images (n = 3); B--pattern A plus foci of signal void on all pulse sequences (n = 17); and C--features of pattern A and B plus foci of peripheral low signal surrounding central fat-like signal (n = 2). The foci of signal void in pattern B and C corresponded to areas of calcification and the foci of peripheral low signal surrounding central fat-like signal in pattern C corresponded to areas of ossification. The MR appearance of ISO appears sufficiently unique to allow its differentiation from other causes of intraarticular pathology.
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            Synovial osteochondromatosis.

            J Monu, Michael Crotty, Benjamin Pope (1996)
            Primary or idiopathic synovial osteochondromatosis is an uncommon condition probably caused by synovial metaplasia and typically resulting in multiple calcified periarticular bodies. Synovial osteochondromatosis also may occur secondary to other joint disorders. This article reviews the pathogenesis, pathologic features, clinical features, and radiologic imaging of synovial osteochondromatosis. The differentiation of synovial osteochondromatosis from other conditions associated with periarticular calcified bodies is discussed.
            Article 0 comments Cited 13 times – based on 0 reviews     Review now
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              Operative treatment of primary synovial osteochondromatosis of the hip.

              Yoon-La Choi, Seung-Lark Lim, Jee-Youn Park … (2006)
              Primary synovial osteochondromatosis of the hip, a rare benign condition characterized by multiple intra-articular osteochondral loose bodies and synovial hyperplasia, may result in mechanical symptoms and degenerative arthritis if untreated. The purpose of this study was to report the results of arthrotomy alone or combined with anterior dislocation of the hip to perform synovectomy and removal of loose bodies in patients with this condition. We retrospectively reviewed a consecutive series of twenty-one patients (twenty-one hips) with primary synovial osteochondromatosis of the hip treated with open surgical débridement. On the basis of the extent of extra-articular involvement as seen on preoperative magnetic resonance imaging, eight of the twenty-one patients underwent synovectomy and removal of loose bodies following anterior dislocation of the hip and thirteen underwent the same procedure with arthrotomy alone. At a mean of 4.4 years postoperatively, the patients were assessed clinically and radiographically with special attention to disease recurrence, osteoarthritis progression, and surgical complications. The mean Harris hip score for the entire series of patients improved from 58 points preoperatively to 91 points at the time of the latest follow-up. Eighteen of the twenty-one patients had a good or excellent clinical result, and seventeen patients were satisfied with the result of the surgery. The clinical scores, patient satisfaction scores, and radiographic grades of osteoarthritis at the time of the latest follow-up did not differ significantly between the group treated with dislocation and the group treated without dislocation. Symptomatic disease recurred in two of the thirteen hips treated with arthrotomy alone and in none of the hips that had undergone dislocation. However, the surgical complication rate was higher in the group treated with dislocation than it was in the group treated without dislocation (p = 0.042). While patients with some signs of mild osteoarthritis at the initial procedure had a higher rate of osteoarthritis progression, severe osteoarthritis requiring arthroplasty had developed in only one patient at the time of follow-up. At a mean of 4.4 years postoperatively, we found that open synovectomy and removal of loose bodies for the treatment of primary synovial osteochondromatosis of the hip is a reliable procedure that can effectively relieve symptoms. Our results also indicated that synovial osteochondromatosis may recur in patients with extensive involvement who are treated with synovectomy alone without dislocation of the hip; however, surgical complications are more likely to occur in patients managed with anterior dislocation of the hip and synovectomy.
              Article 0 comments Cited 13 times – based on 0 reviews     Review now
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                Author and article information

                Journal
                Journal ID (nlm-ta): Open Orthop J
                Journal ID (iso-abbrev): Open Orthop J
                Journal ID (publisher-id): TOORTHJ
                Title: The Open Orthopaedics Journal
                Publisher: Bentham Open
                ISSN (Electronic): 1874-3250
                Publication date (Electronic): 17 May 2017
                Publication date Collection: 2017
                Volume: 11
                Pages: 417-423
                Affiliations
                [1 ]The Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
                [2 ]Shimosone Clinic of Orthopedics and Osteoporosis, Kitakyushu, Japan.
                [3 ]The Department of Pathology and Oncology, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan.
                Author notes
                [* ]Address correspondence to this author at the Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Shogoin, Kawahara-cho 54, Sakyo-ku, Kyoto 606-8507, Japan; Tel: +81-75-751-3366; Fax: +81-75-751-8409; E-mail: akiosaka@ 123456kuhp.kyoto-u.ac.jp
                Article
                Publisher ID: TOORTHJ-11-417
                DOI: 10.2174/1874325001711010417
                PMC ID: 5447904
                SO-VID: 949d846d-1b21-46bc-8e66-ddb90982b931
                Copyright © © 2017 Sakamoto et al.
                License:

                This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: https://creativecommons.org/licenses/by/4.0/legalcode. This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                Date received : 27 January 2017
                Date revision received : 21 March 2017
                Date accepted : 16 April 2017
                Categories
                Subject: Article

                ScienceOpen disciplines: Orthopedics
                Keywords: extra-articular,tenosynovial chondromatosis,osteochondromatosis,finger,hand,bone
                Data availability:
                ScienceOpen disciplines: Orthopedics
                Keywords: extra-articular, tenosynovial chondromatosis, osteochondromatosis, finger, hand, bone

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