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Synovial Chondromatosis Workup

  • Author: Nicolai B Baecher, MD; Chief Editor: Harris Gellman, MD  more...
 
Updated: May 31, 2016
 

Laboratory Studies

If the physical findings suggest possible infection, order the following studies:

  • Erythrocyte sedimentation rate (ESR) 
  • C-reactive protein (CRP) level
  • Complete blood count (CBC) with differential
  • Lyme titer

Results of these tests are expected to be normal in persons with primary synovial chondromatosis, but they may be elevated in persons with secondary synovial chondromatosis due to systemic inflammation from a condition such as rheumatoid arthritis.

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Imaging Studies

Plain radiography

Plain radiography with orthogonal views of the affected joint[35, 22]  frequently yields normal findings. Between 5% and 30% of patients do not have radiographically visible calcifications.

Typical plain radiograph of knee in patient with s Typical plain radiograph of knee in patient with synovial chondromatosis. No abnormalities are noted.

If loose bodies undergo ossification, they may be visible in the joint space. The pattern of mineralization varies with size. Large nodules have large, stippled, or ringlike calcified areas. Small nodules have flecks of calcium. Secondary widening of the joint space may be noted, even if the nodules are not directly visible. In 30% of cases, no matrix mineralization is present, and loose bodies appear as foci with opacity similar to that of water.

In secondary synovial chondromatosis, changes consistent with the underlying disease process are evident.

Magnetic resonance imaging

Cartilaginous nodules have intermediate signal intensity on T1-weighted magnetic resonance imaging (MRI; see the first image below) and high signal intensity on T2-weighted images (see the second, third, fourth, and fifth images below), with decreasing intensity as the amount of calcium in the nodule decreases.[35] The addition of intra-articular gadolinium-based contrast material increases the sensitivity for detecting lesions.

Sagittal T1-weighted MRI of knee in patient with s Sagittal T1-weighted MRI of knee in patient with synovial chondromatosis.
Sagittal T2-weighted MRI through knee in adult wit Sagittal T2-weighted MRI through knee in adult with synovial chondromatosis demonstrates abnormal signal intensity in suprapatellar pouch. Also note hypertrophic synovium in intercondylar notch region and normal posterior cruciate ligament.
Sagittal T2-weighted MRI of patient with synovial Sagittal T2-weighted MRI of patient with synovial chondromatosis. Note hypertrophic synovium and normal anterior cruciate ligament.
Coronal T2-weighted MRI of patient with synovial c Coronal T2-weighted MRI of patient with synovial chondromatosis demonstrates punctate areas of low intensity within synovial fluid.
Coronal T2-weighted MRI of knee in patient with sy Coronal T2-weighted MRI of knee in patient with synovial chondromatosis.

Computed tomography

Computed tomography (CT) is useful only for identifying calcified loose bodies. Unmineralized nodules typically cannot be visualized.

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Diagnostic Procedures

Arthrocentesis is used to obtain a sample of synovial fluid if the physical findings suggest infection. Send the sample for a cell count, crystal examination, Gram staining, and cultures. All findings should be within normal limits in persons with primary synovial chondromatosis. Although interleukin (IL)-6 and vascular endothelial growth factor (VEGF)-A have been noted to be elevated in synovial fluid samples, these findings do not yet play a significant role in clinical practice.[21]

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Histologic Findings

Primary synovial chondromatosis

On hematoxylin and eosin staining, thick, villous formation to the synovial membrane with islands of clustered chondrocytes is seen. The chondrocytes in the nodules are usually arranged in loose clusters, though a nonclustered uniform distribution may occur. Discrete lobules of hyaline-type cartilage can be noted with mild cellularity and surrounded by a think fibrous layer.[22]

In two thirds of cases, the chondrocytes show mild-to-moderate nuclear atypia with pleomorphism, enlarged and open-faced nuclei, and frequent binucleation. Mitotic figures are rarely found. Osteoclast-like giant cells and chondroblasts with a dense, eosinophilic cytoplasm may rim the nodules.

If calcification occurs, it is distributed in a patchy, irregular pattern. In late stages, the nodules may undergo true ossification via vascular invasion and endochondral bone formation.

Secondary synovial chondromatosis

Foci of implanted articular cartilage with and without subchondral necrotic bone are found. The chondrocytes of implanted cartilage usually lack significant atypia or binucleation, and any calcification occurs in a zonal, ringlike fashion.

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Contributor Information and Disclosures
Author

Nicolai B Baecher, MD Orthopedic Surgeon, Inova Medical Group

Nicolai B Baecher, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Society for Surgery of the Hand, AO Foundation

Disclosure: Nothing to disclose.

Coauthor(s)

Christopher C Annunziata, MD Orthopedic Surgeon, Commonwealth Orthopedics and Rehabilitation; Assistant Clinical Professor, Department of Orthopedic Surgery, Georgetown University Medical Center; Team Physician, Washington Redskins; Orthopaedic Consultant, The Washington Ballet

Christopher C Annunziata, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Orthopaedic Surgeons, American Orthopaedic Society for Sports Medicine, Arthroscopy Association of North America, Eastern Orthopaedic Association, Phi Beta Kappa

Disclosure: Nothing to disclose.

John J Christoforetti, II, MD Orthopaedic Surgeon, TriState Orthopaedics and Sports Medicine, Inc., Clinical Instructor, Department of Orthopaedics, University of Pittsburgh School of Medicine

John J Christoforetti, II, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Orthopaedic Surgeons, American Orthopaedic Society for Sports Medicine, Arthroscopy Association of North America

Disclosure: Nothing to disclose.

Evan H Argintar, MD Attending Physician, Washington Hospital Center, Washington DC

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Ian D Dickey, MD, FRCSC Adjunct Professor, Department of Chemical and Biological Engineering, University of Maine; Consulting Staff, Adult Reconstruction, Orthopedic Oncology, Department of Orthopedics, Eastern Maine Medical Center

Ian D Dickey, MD, FRCSC is a member of the following medical societies: American Academy of Orthopaedic Surgeons, Royal College of Physicians and Surgeons of Canada, British Columbia Medical Association, Canadian Medical Association

Disclosure: Received consulting fee from Stryker Orthopaedics for consulting; Received honoraria from Cadence for speaking and teaching; Received grant/research funds from Wright Medical for research; Received honoraria from Angiotech for speaking and teaching; Received honoraria from Ferring for speaking and teaching.

Chief Editor

Harris Gellman, MD Consulting Surgeon, Broward Hand Center; Voluntary Clinical Professor of Orthopedic Surgery and Plastic Surgery, Departments of Orthopedic Surgery and Surgery, University of Miami, Leonard M Miller School of Medicine, Clinical Professor, Surgery, Nova Southeastern School of Medicine

Harris Gellman, MD is a member of the following medical societies: American Academy of Medical Acupuncture, American Academy of Orthopaedic Surgeons, American Orthopaedic Association, American Society for Surgery of the Hand, Arkansas Medical Society

Disclosure: Nothing to disclose.

References
  1. Kirchhoff C, Buhmann S, Braunstein V, Weiler V, Mutschler W, Biberthaler P. Synovial chondromatosis of the long biceps tendon sheath in a child: a case report and review of the literature. J Shoulder Elbow Surg. 2008 May-Jun. 17(3):e6-e10. [Medline].

  2. Adelani MA, Wupperman RM, Holt GE. Benign synovial disorders. J Am Acad Orthop Surg. 2008 May. 16(5):268-75. [Medline].

  3. Kerimoglu S, Aynaci O, Saraçoglu M, Cobanoglu U. Synovial chondromatosis of the subtalar joint: a case report and review of the literature. J Am Podiatr Med Assoc. 2008 Jul-Aug. 98(4):318-21. [Medline].

  4. Fuerst M, Zustin J, Lohmann C, Rüther W. [Synovial chondromatosis]. Orthopade. 2009 Jun. 38(6):511-9. [Medline].

  5. Nakanishi S, Sakamoto K, Yoshitake H, Kino K, Amagasa T, Yamaguchi A. Bone morphogenetic proteins are involved in the pathobiology of synovial chondromatosis. Biochem Biophys Res Commun. 2009 Feb 20. 379(4):914-9. [Medline].

  6. Bynum CK, Tasto J. Arthroscopic treatment of synovial disorders in the shoulder, elbow, and ankle. J Knee Surg. 2002. 15(1):57-9. [Medline].

  7. Coolican MR, Dandy DJ. Arthroscopic management of synovial chondromatosis of the knee. Findings and results in 18 cases. J Bone Joint Surg Br. 1989 May. 71(3):498-500. [Medline].

  8. Milgram JW. Synovial osteochondromatosis: a histopathological study of thirty cases. J Bone Joint Surg Am. 1977 Sep. 59(6):792-801. [Medline].

  9. Perry BE, McQueen DA, Lin JJ. Synovial chondromatosis with malignant degeneration to chondrosarcoma. Report of a case. J Bone Joint Surg Am. 1988 Sep. 70(8):1259-61. [Medline].

  10. Sah AP, Geller DS, Mankin HJ, Rosenberg AE, Delaney TF, Wright CD, et al. Malignant transformation of synovial chondromatosis of the shoulder to chondrosarcoma. A case report. J Bone Joint Surg Am. 2007 Jun. 89(6):1321-8. [Medline].

  11. Galat DD, Ackerman DB, Spoon D, Turner NS, Shives TC. Synovial chondromatosis of the foot and ankle. Foot Ankle Int. 2008 Mar. 29(3):312-7. [Medline].

  12. Muramatsu K, Miyoshi T, Moriya A, Onaka H, Shigetomi M, Nakashima D, et al. Extremely rare synovial chondrosarcoma arising from the elbow joint: case report and review of the literature. J Shoulder Elbow Surg. 2012 Feb. 21(2):e7-11. [Medline].

  13. Evans S, Boffano M, Chaudhry S, Jeys L, Grimer R. Synovial chondrosarcoma arising in synovial chondromatosis. Sarcoma. 2014. 2014:647939. [Medline]. [Full Text].

  14. McCarthy C, Anderson WJ, Vlychou M, Inagaki Y, Whitwell D, Gibbons CL, et al. Primary synovial chondromatosis: a reassessment of malignant potential in 155 cases. Skeletal Radiol. 2016 Jun. 45 (6):755-62. [Medline].

  15. Abdelwahab IF, Contractor D, Bianchi S, Hermann G, Hoch B. Synovial chondromatosis of the lumbar spine with compressive myelopathy: a case report with review of the literature. Skeletal Radiol. 2008 Sep. 37(9):863-7. [Medline].

  16. Chiang CH, Jou IM, Wang PH, Chern TC, Huang MT. Synovial osteochondromatosis of the second metatarsophalangeal joint: a case report. J Foot Ankle Surg. 2011 Jul-Aug. 50(4):458-61. [Medline].

  17. Muramatsu K, Hashimoto T, Tominaga Y, Taguchi T. Large synovial osteochondromatosis arising from the interphalangeal joint of the thumb: a case report and review of the literature. Anticancer Res. 2014 Feb. 34(2):1057-60. [Medline].

  18. Littrell LA, Inwards CY, Sim FH, Wenger DE. Imaging features of synovial chondromatosis of the spine: a review of 28 cases. Skeletal Radiol. 2016 Jan. 45 (1):63-71. [Medline].

  19. Yoshida H, Tsuji K, Oshiro N, Wato M, Morita S. Preliminary report of Ki-67 reactivity in synovial chondromatosis of the temporomandibular joint: An immunohistochemical study. J Craniomaxillofac Surg. December 2011. [Medline].

  20. Nakanishi S, Sakamoto K, Yoshitake H, Kino K, Amagasa T, Yamaguchi A. Bone morphogenic proteins are involved in the pathobiology of synovial chondromatosis. Biochem Biophys Res Commun. Feb 2009. 379(4):914-9. [Medline].

  21. Wake M, Hamada Y, Kumagai K, Tanaka N, Ikeda Y, Nakatani Y, et al. Up-regulation of interleukin-6 and vascular endothelial growth factor-A in the synovial fluid of temporomandibular joints affected by synovial chondromatosis. Br J Oral Maxillofac Surg. 2012 Apr 2. [Medline].

  22. Wodajo F, Gannon F, Murphey M. Synovial Chondromatosis. Visual Guide to Musculoskeletal Tumors: A Clinical – Radiologic – Histologic Approach. Philadelphia: Saunders; 2010.

  23. Lin YC, Goldsmith JD, Gebhardt MG, Wu JS. Bursal synovial chondromatosis formation following osteochondroma resection. Skeletal Radiol. 2014 Jul. 43(7):997-1000. [Medline].

  24. Dorfmann H, De Bie B, Bonvarlet JP, Boyer T. Arthroscopic treatment of synovial chondromatosis of the knee. Arthroscopy. 1989. 5(1):48-51. [Medline].

  25. Samson L, Mazurkiewicz S, Treder M, Wisniewski P. Outcome in the arthroscopic treatment of synovial chondromatosis of the knee. Ortop Traumatol Rehabil. 2005 Aug 30. 7(4):391-6. [Medline].

  26. Ackerman D, Lett P, Galat DD Jr, Parvizi J, Stuart MJ. Results of total hip and total knee arthroplasties in patients with synovial chondromatosis. J Arthroplasty. 2008 Apr. 23(3):395-400. [Medline].

  27. Urbach D, McGuigan FX, John M, Neumann W, Ender SA. Long-term results after arthroscopic treatment of synovial chondromatosis of the shoulder. Arthroscopy. 2008 Mar. 24(3):318-23. [Medline].

  28. Lunn JV, Castellanos-Rosas J, Walch G. Arthroscopic synovectomy, removal of loose bodies and selective biceps tenodesis for synovial chondromatosis of the shoulder. J Bone Joint Surg Br. 2007 Oct. 89(10):1329-35. [Medline].

  29. Doral MN, Uzumcugil A, Bozkurt M, Atay OA, Cil A, Leblebicioglu G, et al. Arthroscopic treatment of synovial chondromatosis of the ankle. J Foot Ankle Surg. 2007 May-Jun. 46(3):192-5. [Medline].

  30. Schoeniger R, Naudie DD, Siebenrock KA, Trousdale RT, Ganz R. Modified complete synovectomy prevents recurrence in synovial chondromatosis of the hip. Clin Orthop Relat Res. 2006 Oct. 451:195-200. [Medline].

  31. Boyer T, Dorfmann H. Arthroscopy in primary synovial chondromatosis of the hip: description and outcome of treatment. J Bone Joint Surg Br. 2008 Mar. 90(3):314-8. [Medline].

  32. Lee JB, Kang C, Lee CH, Kim PS, Hwang DS. Arthroscopic treatment of synovial chondromatosis of the hip. Am J Sports Med. 2012 Jun. 40(6):1412-8. [Medline].

  33. Marchie A, Panuncialman I, McCarthy JC. Efficacy of hip arthroscopy in the management of synovial chondromatosis. Am J Sports Med. 2011 Jul. 39 Suppl:126S-31S. [Medline].

  34. Ferro FP, Philippon MJ. Arthroscopy provides symptom relief and good functional outcomes in patients with hip synovial chondromatosis. J Hip Preserv Surg. 2015 Oct. 2 (3):265-71. [Medline]. [Full Text].

  35. McKenzie G, Raby N, Ritchie D. A pictorial review of primary synovial osteochondromatosis. Eur Radiol. 2008 Nov. 18(11):2662-9. [Medline].

  36. Chong CC, Kneebone A, Kirsh G. Radiotherapy in the management of recurrent synovial chondromatosis. Australas Radiol. 2007 Feb. 51(1):95-8. [Medline].

  37. Abolghasemian M, Gharanizadeh K, Kuzyk P, Masdari Z, Fakharian M, Safir O. Hips with synovial chondromatosis may display the features of femoroacetabular impingement. J Bone Joint Surg Am. 2014 Jan 15. 96(2):e11. [Medline].

 
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Arthroscopic appearance of synovial chondromatosis loose bodies in shoulder.
Arthroscopic shaver during attempted removal of loose bodies.
Sagittal T2-weighted MRI through knee in adult with synovial chondromatosis demonstrates abnormal signal intensity in suprapatellar pouch. Also note hypertrophic synovium in intercondylar notch region and normal posterior cruciate ligament.
Sagittal T2-weighted MRI of patient with synovial chondromatosis. Note hypertrophic synovium and normal anterior cruciate ligament.
Sagittal T1-weighted MRI of knee in patient with synovial chondromatosis.
Coronal T2-weighted MRI of patient with synovial chondromatosis demonstrates punctate areas of low intensity within synovial fluid.
Coronal T2-weighted MRI of knee in patient with synovial chondromatosis.
Typical plain radiograph of knee in patient with synovial chondromatosis. No abnormalities are noted.
Arthroscopic image of pedunculated synovial chondromatosis in knee.
Arthroscopic image of pedunculated synovial chondromatosis in knee.
 
 
 
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