Synovial chondromatosis of the acromioclavicular joint

Arthroscopic removal of loose bodies in synovial chondromatosis of shoulder joint, unusual location of rare disease: A case report and literature review

INTRODUCTION

Synovial chondromatosis is a benign mono-articular arthropathy affecting synovial joints. It mostly affects knee joint, followed by hip, elbow and wrist and is rarely reported for shoulder joint. The exact pathogenesis is not known. Usual symptoms are pain, difficulty in movement due to mechanical obstruction. The classic treatment is arthrotomy, removal of chondromatoid loose bodies and synovectomy. With recent advances arthroscopic removal of the chondromatoid loose bodies is a good option with relatively better post op rehabilitation and faster recovery.

CASE PRESENTATION

20 years old gentleman presented to clinic with history of pain in right shoulder for 2 years and decreased range of motion. There was no history of trauma or fever. Work up done and diagnosed with synovial chondromatosis. Arthroscopic removal of chondromatoid loose bodies and synovectomy was done. More than 120 loose bodies were removed. On two (2) years follow-up patient is pain free and having full range of motion at right shoulder joint.

DISCUSSION

Synovial chondromatosis is rare in shoulder joint. The Primary synovial chondromatosis of unknown etiology, and secondary synovial chondromatosis due to degenerative joint disease. Classic treatment is arthrotomy and synovectomy. With recent advances, arthroscopic removal of loose bodies and synovectomy is also a good option for its treatment. In literature only few cases have been reported treated with arthroscopic removal of loose bodies and synovectomy.

CONCLUSION

Arthroscopic treatment of synovial chondromatosis is a good option if expertise is available. It causes less surgical trauma, better visualization during surgery, early recovery.

Imaging of Synovial Chondromatosis with Radiologic-Pathologic Correlation

Primary synovial chondromatosis represents an uncommon benign neoplastic process with hyaline cartilage nodules in the subsynovial tissue of a joint, tendon sheath, or bursa. The nodules may enlarge and detach from the synovium. The knee, followed by the hip, in male adults are the most commonly involved sites and patient population. The pathologic appearance may simulate chondrosarcoma because of significant histologic atypia, and radiologic correlation to localize the process as synovially based is vital for correct diagnosis. Radiologic findings are frequently pathognomonic. Radiographs reveal multiple intraarticular calcifications (70%-95% of cases) of similar size and shape, distributed throughout the joint, with typical "ring-and-arc" chondroid mineralization. Extrinsic erosion of bone is seen in 20%-50% of cases. Computed tomography (CT) optimally depicts the calcified intraarticular fragments and extrinsic bone erosion. Magnetic resonance (MR) imaging findings are more variable, depending on the degree of mineralization, although the most common pattern (77% of cases) reveals low to intermediate signal intensity with T1-weighting and very high signal intensity with T2-weighting with hypointense calcifications. These signal intensity characteristics on MR images and low attenuation of the nonmineralized regions on CT scans reflect the high water content of the cartilaginous lesions. CT and MR imaging depict the extent of the synovial disease (particularly surrounding soft-tissue involvement) and lobular growth. Secondary synovial chondromatosis can be distinguished from primary disease both radiologically (underlying articular disease and fewer chondral bodies of variable size and shape) and pathologically (concentric rings of growth). Treatment of primary disease is surgical synovectomy with removal of chondral fragments; recurrence rates range from 3% to 23%. Malignant transformation to chondrosarcoma is unusual (5% of cases) and, although difficult to distinguish from benign disease, is suggested by multiple recurrences and marrow invasion. Recognizing the appearances of primary synovial chondromatosis, which reflect their underlying pathologic characteristics, improves radiologic assessment and is important to optimize patient management.

Synovial chondromatosis presented as knocking sensation of the knee in a 14-year-old girl

Knee joint is the most common site of synovial chondromatosis with the prevalence in middle-aged male. The following is the description of a 14-year-old girl presented with a knocking sensation during the motion of her joint, which is a less common occurrence at her age. Loose bodies in the left knee joint were excised as much as possible with arthroscopy. The patient was asymptomatic when moving her knee after arthroscopic synovialectomy and removal of the loose bodies. In spite of the less possibility of malignant transformation of synovial chondromatosis, long-term follow-up is still recommended in this 14-year-old girl due to the supposed genetic abnormalities.