eMedicine Specialties > Radiology > Musculoskeletal

Synovial Osteochondromatosis

Author: Johnny U V Monu, MD, Associate Professor of Radiology, University of Rochester School of Medicine, Program Director and Co-Head of Musculoskeletal Radiology, Head of Emergency Radiology, Department of Radiology, University of Rochester Strong Memorial Medical Center
Coauthor(s): Mayumi Oka, MD, Consulting Staff, Department of Radiology, University of Rochester, Strong Memorial Hospital
Contributor Information and Disclosures

Updated: Jun 21, 2007

Introduction

Background

Synovial osteochondromatosis (SOC) is a benign condition characterized by synovial membrane proliferation and metaplasia. The entity also is termed synovial chondromatosis. The synovial lining of a joint, bursa, or tendon sheath undergoes nodular proliferation, and fragments may break off from the synovial surface into the joint. There, nourished by synovial fluid, the fragments may grow, calcify, or ossify. The intra-articular fragment may vary in size from a few millimeters to a few centimeters.

The degree of calcification varies, and calcification may be seen as a few calcific specks or as foci of frankly ossified bodies. The fragments may be found free within the joint cavity, or they may be embedded within the proliferating synovium, which may extend into the surrounding soft tissues. The natural history of SOC entails gradual progression of disease, joint deterioration, and secondary osteoarthritis. Essentially, the disease is a benign process, and although studies in the literature have reported malignant transformation, this finding is decidedly unusual.

Pathophysiology

SOC is characterized by synovial membrane metaplasia, hyperplasia, and hyaline or myxoid change. The synovial lining of a joint, bursa, or tendon sheath undergoes nodular proliferation, and fragments may break off from the synovial surface into the joint. In this location, where they are nourished by synovial fluid, the fragments may grow, calcify, or ossify.

Mortality/Morbidity

Generally, SOC is a monoarticular disease that has a benign course. Several reports in the literature describe malignant transformation. The transformations occurred after several recurrences following treatment.

Sex

SOC shows a predilection of 2- to 4-fold for males over females.

Age

Individuals of all ages can be affected, but the disease is often diagnosed in persons aged 20-50 years.

Presentation

Patients with SOC often relate a history of several years of joint pain with swelling. The affected joint frequently has an associated limitation in range of motion and/or a history of locking. SOC is almost always a monoarticular process, and the large joints are more commonly affected. These include the knee, hip, elbow, and shoulder. However, the disease process may affect any synovial surface, including the extra-articular bursa.

SOC shows a predilection for males that is 2- to 4-fold greater than that for females; most patients with SOC present in the third to fifth decades of life.

If the intra-articular fragments are adequately calcified, the diagnosis is easily made with plain radiographic examination. With noncalcified fragments, magnetic resonance imaging (MRI) scans are required to show the nature and extent of SOC.

Purists differentiate primary, or idiopathic, SOC from the secondary form. In secondary SOC, the initial predisposing factor is an unrelated articular process leading to joint disintegration, production of intra-articular fragments, synovitis, and, eventually, synovial metaplasia. The cause of primary SOC is unknown.

Preferred Examination

Radiographic findings are frequently diagnostic. Computed tomography (CT) scans and CT arthrograms also may be used, especially for demonstrating noncalcified intra-articular bodies. MRI usually helps establish the diagnosis, and the images demonstrate the true extent of the disease. Ultrasonographic examination may be used to investigate accessible joints.

Radiographs should be obtained first. MRI scans should then be obtained preoperatively. When MRI is not readily available, CT arthrography may be performed.

Limitations of Techniques

Radiographs may not demonstrate noncalcified bodies. CT scans may not demonstrate the full extent of proliferating synovial disease. SOC may be confused with pigmented villonodular synovitis (PVNS) if only MRI scans are available, and plain radiographs may help in such cases.

Differential Diagnoses

Pigmented Villonodular Synovitis

Other Problems to Be Considered

Rice bodies of tuberculosis and rheumatoid arthritis 
Synovial hemangioma

More on Synovial Osteochondromatosis

Overview: Synovial Osteochondromatosis
Imaging: Synovial Osteochondromatosis
Follow-up: Synovial Osteochondromatosis
Multimedia: Synovial Osteochondromatosis
References
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References

  1. Adams ME, Saifuddin A. Characterisation of intra-articular soft tissue tumours and tumour-like lesions. Eur Radiol. Apr 2007;17(4):950-8. [Medline].

  2. Akhtar M, Mahajan S, Kott E. Synovial chondromatosis of the temporomandibular joint. J Bone Joint Surg Am. Mar 1977;59(2):266-7. [Medline].

  3. Christensen JH, Poulsen JO. Synovial chondromatosis. Acta Orthop Scand. Dec 1975;46(6):919-25. [Medline].

  4. Coles MJ, Tara HH Jr. Synovial chondromatosis: a case study and brief review. Am J Orthop. Jan 1997;26(1):37-40. [Medline].

  5. Constant E, Harebottle NH, Davis DG. Synovial chondromatosis of the hand. Case report. Plast Reconstr Surg. Sep 1974;54(3):353-8. [Medline].

  6. Crittenden JJ, Jones DM, Santarelli AG. Knee arthrogram in synovial chondromatosis. Radiology. Jan 1970;94(1):133-4. [Medline].

  7. Crotty JM, Monu JU, Pope TL Jr. Synovial osteochondromatosis. Radiol Clin North Am. Mar 1996;34(2):327-42, xi. [Medline].

  8. Dunn AW, Whisler JH. Synovial chondromatosis of the knee with associated extracapsular chondromas. J Bone Joint Surg Am. Dec 1973;55(8):1747-8. [Medline].

  9. Gilbert SR, Lachiewicz PF. Primary synovial osteochondromatosis of the hip: report of two cases with long-term follow-up after synovectomy and a review of the literature. Am J Orthop. Aug 1997;26(8):555-60. [Medline].

  10. Giustra PE, Furman RS, Roberts L, et al. Synovial osteochondromatosis involving the elbow. AJR Am J Roentgenol. Aug 1976;127(2):347-8. [Medline].

  11. Goldberg RP, Genant HK. Calcified bodies in popliteal cysts: a characteristic radiographic appearance. AJR Am J Roentgenol. Nov 1978;131(5):857-9. [Medline].

  12. Goldman RL, Lichtenstein L. Synovial Chondrosarcoma. Cancer. Oct 1964;17:1233-40. [Medline].

  13. Ishizuki M, Isobe Y, Arai T, et al. Osteochondromatosis of the finger joints. Hand. Jun 1977;9(2):198-201. [Medline].

  14. Jeffreys TE. Synovial chondromatosis. J Bone Joint Surg Br. Aug 1967;49(3):530-4. [Medline]. [Full Text].

  15. Kenan S, Abdelwahab IF, Klein MJ, et al. Case report 817: synovial chondrosarcoma secondary to synovial chondromatosis. Skeletal Radiol. Nov 1993;22(8):623-6. [Medline].

  16. Kettelkamp DB, Dolan J. Synovial chondromatosis of an interphalangeal joint of a finger. Report of a case. J Bone Joint Surg Am. Mar 1966;48(2):329-32. [Medline].

  17. King JW, Spjut HJ, Fechner RE, et al. Synovial chondrosarcoma of the knee joint. J Bone Joint Surg Am. Oct 1967;49(7):1389-96. [Medline].

  18. Kyriakos M, Totty WG, Riew KD. Synovial chondromatosis in a facet joint of a cervical vertebra. Spine. Mar 1 2000;25(5):635-40. [Medline].

  19. Lewis MM, Marshall JL, Mirra JM. Synovial chondromatosis of the thumb. A case report and review of the literature. J Bone Joint Surg Am. Jan 1974;56(1):180-3. [Medline].

  20. Lim SJ, Chung HW, Choi YL, et al. Operative treatment of primary synovial osteochondromatosis of the hip. J Bone Joint Surg Am. Nov 2006;88(11):2456-64. [Medline].

  21. Lynn MD, Lee J. Periarticular tenosynovial chondrometaplasia. Report of a case at the wrist. J Bone Joint Surg Am. Apr 1972;54(3):450-2. [Medline].

  22. McFarland EG, Neira CA. Synovial chondromatosis of the shoulder associated with osteoarthritis: conservative treatment in two cases and review of the literature. Am J Orthop. Oct 2000;29(10):785-7. [Medline].

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

  24. Milgram JW, Addison RG. Synovial osteochondromatosis of the knee. Chondromatous recurrence with possible chondrosarcomatous degeneration. J Bone Joint Surg Am. Mar 1976;58(2):264-6. [Medline].

  25. Miller AS, Harwick RD, Daley DJ. Temporomandibular joint synovial chondromatosis: report of case. J Oral Surg. Jun 1978;36(6):467-8. [Medline].

  26. Mullins F, Berard CW, Eisenberg SH. Chondrosarcoma following synovial chondromatosis. A case study. Cancer. Sep 1985;18:1180. [Medline].

  27. Murphy AF, Wilson JN. Tenosynovial osteochondroma in the hand. J Bone Joint Surg Am. Dec 1958;40-A(6):1236-40. [Medline].

  28. Murphy FP, Dahlin DC, Sullivan CR. Articular synovial chondromatosis. J Bone Joint Surg Am. 1962;44:77.

  29. Nixon JE, Frank GR, Chambers G. Synovial osteochondromatosis with report of four cases, one showing malignant change. U S Armed Forces Med J. Dec 1960;11:1434-45. [Medline].

  30. Nogueira A, Alcelay O, Pena C, et al. Synovial osteochondromatosis at the elbow producing ulnar and median nerve palsy. Case report and review of the literature. Chir Main. 1999;18(2):108-14. [Medline].

  31. Noyek AM, Holgate RC, Fireman SM, et al. The radiologic findings in synovial chondromatosis (chondrometaplasia) of the temporomandibular joint. J Otolaryngol Suppl. 1977;3:45-8. [Medline].

  32. Ontell F, Greenspan A. Chondrosarcoma complicating synovial chondromatosis: findings with magnetic resonance imaging. Can Assoc Radiol J. Aug 1994;45(4):318-23. [Medline].

  33. Paul GR, Leach RE. Synovial chondromatosis of the shoulder. Clin Orthop. Jan-Feb 1970;68:130-5. [Medline].

  34. Prager RJ, Mall JC. Arthrographic diagnosis of synovial chondromatosis. Am J Roentgenol. Aug 1976;127(2):344-6. [Medline].

  35. Resnick D. Tumors or tumor-like lesions in or about joints. In: Diagnosis of Bone and Joint Disorders. 4th ed. Philadelphia, Pa: WB Saunders Co; 2002.

  36. Ronald JB, Keller EE, Weiland LH. Synovial chondromatosis of the temporomandibular joint. J Oral Surg. Jan 1978;36(1):13-9. [Medline].

  37. Rosen PS, Pritzker PH, Greenbaum J, et al. Synovial chondromatosis affecting the temporomandibular joint. Case report and literature review. Arthritis Rheum. Mar 1977;20(2):736-40. [Medline].

  38. Sciot R, Dal Cin P, Bellemans J, et al. Synovial chondromatosis: clonal chromosome changes provide further evidence for a neoplastic disorder. Virchows Arch. Aug 1998;433(2):189-91. [Medline].

  39. Sim FH, Dahlin DC, Ivins JC. Extra-articular synovial chondromatosis. J Bone Joint Surg Am. Jun 1977;59(4):492-5. [Medline].

  40. Someren A, Merritt WH. Tenosynovial chondroma of the hand: a case report with a brief review of the literature. Hum Pathol. Jul 1978;9(4):476-9. [Medline].

  41. Swan EF, Owens WF Jr. Synovial chondrometaplasia: a case report with spontaneous regression and a review of the literature. South Med J. Dec 1972;65(12):1496-500. [Medline].

  42. Symeonides P. Bursal chondromatosis. J Bone Joint Surg Br. May 1966;48(2):371-3. [Medline]. [Full Text].

  43. Szepesi J. Synovial chondromatosis of the metacarpophalangeal joint. Acta Orthop Scand. Dec 1975;46(6):926-30. [Medline].

  44. Thomas S, Van Demark RE. Synovial chondromatosis of hip: case with long-term followup. S D J Med. Sep 1977;30(9):7-10. [Medline].

  45. Trias A, Quintana O. Synovial chondrometaplasia: review of world literature and a study of 18 Canadian cases. Can J Surg. Mar 1976;19(2):151-8. [Medline].

  46. Varma BP, Ramakrishna YJ. Synovial chondromatosis of the shoulder. Aust N Z J Surg. Feb 1976;46(1):44-5. [Medline].

  47. Weiss C, Averbuch PF, Steiner GC, et al. Synovial chondromatosis and instability of the proximal tibiofibular joint. Clin Orthop Relat Res. May 1975;(108):187-90. [Medline].

  48. Zimmerman C, Sayegh V. Roentgen manifestations of synovial osteochondromatosis. Am J Roentgenol Radium Ther Nucl Med. Apr 1960;83:680-6. [Medline].

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Further Reading

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Keywords

synovial chondromatosis, SOC, synovial membrane proliferation, synovial membrane metaplasia, synovial membrane hyperplasia, pigmented villonodular synovitis, PVNS, Rice bodies, synovial hemangioma

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Contributor Information and Disclosures

Author

Johnny U V Monu, MD, Associate Professor of Radiology, University of Rochester School of Medicine, Program Director and Co-Head of Musculoskeletal Radiology, Head of Emergency Radiology, Department of Radiology, University of Rochester Strong Memorial Medical Center
Johnny U V Monu, MD is a member of the following medical societies: Radiological Society of North America
Disclosure: Nothing to disclose.

Coauthor(s)

Mayumi Oka, MD, Consulting Staff, Department of Radiology, University of Rochester, Strong Memorial Hospital
Mayumi Oka, MD is a member of the following medical societies: American College of Radiology
Disclosure: Nothing to disclose.

Medical Editor

David S Levey, MD, PhD, Orthopedic/Spine MRI TeleRadiologist, Radsource, LLC
David S Levey, MD, PhD is a member of the following medical societies: American Roentgen Ray Society, Radiological Society of North America, and Texas Medical Association
Disclosure: Nothing to disclose.

Pharmacy Editor

Bernard D Coombs, MB, ChB, PhD, Consulting Staff, Department of Specialist Rehabilitation Services, Hutt Valley District Health Board, New Zealand
Disclosure: Nothing to disclose.

Managing Editor

Javier Beltran, MD, Chair, Department of Radiology, Maimonides Medical Center
Disclosure: Nothing to disclose.

CME Editor

Robert M Krasny, MD, Consulting Staff, Department of Radiology, The Angeles Clinic and Research Institute
Robert M Krasny, MD is a member of the following medical societies: American Roentgen Ray Society and Radiological Society of North America
Disclosure: Nothing to disclose.

Chief Editor

Felix S Chew, MD, MBA, EdM, Professor, Department of Radiology, Vice Chairman for Radiology Informatics, Section Head of Musculoskeletal Radiology, University of Washington
Felix S Chew, MD, MBA, EdM is a member of the following medical societies: American Roentgen Ray Society, Association of University Radiologists, and Radiological Society of North America
Disclosure: Nothing to disclose.

 
 
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