Synovial chondromatosis of the shoulder

We describe a case of synovial chondromatosis involving the shoulder. Presenting symptoms, radiographic features, intraoperative findings, and treatment options are discussed.     

Synovial chondromatosis of the shoulder.

Articular synovial chondromatosis is a rare disease commonly affecting the knee, hip or elbow, and characterized by the formation of metaplastic cartilaginous foci in the synovium. A case of cynovial chondromatosis affecting the shoulder joint is now reported because of the extreme rarity of the disease in this situation.     

Synovial chondromatosis of the hand: Three case reports and literature review

Synovial chondromatosis is a rare condition that is probably caused by synovial connective tissue metaplasia. It is very rare in the hand and wrist and because of its low prevalence and nonspecific symptoms, synovial chondromatosis can present diagnostic difficulties for the hand surgeon and may lead to a delay in treatment. We review the literature and report three additional cases of synovial chondromatosis in the hand.     

Synovial chondromatosis of the foot: Two case reports and literature review

BACKGROUND Primary synovial chondromatosis(PSC) is a rare arthropathy of the synovial joints characterized by the formation of cartilaginous nodules, which may detach and become loose bodies within the joint and may undergo secondary proliferation. PSC of the foot and ankle is exceedingly rare, with only a few cases reported in the literature. The diagnosis may be difficult and delayed until operative treatment, when it is confirmed by histological assessment. PSC may degenerate into chondrosarcoma. Operative treatment is the gold standard aiming to minimize pain, improve function, prevent or limit progression of arthritis. Surgical treatment consists in debridement by arthrotomic or arthroscopic management, but there is no consensus in the literature about timing of surgery and surgical technique. Thus, the aim of this study is to report the outcomes of the surgical treatment of two cases, together with a literature review.CASE SUMMARY We report two cases of patients affected by PSC of the foot in stage III, according to the Milgram classification: the former PSC localized in the ankle that underwent open surgery consisted of loose bodies removal; the latter in the subtalar joint, and the choice of treatment was the arthrotomy and debridement from loose bodies, in addition to the subtalar arthrodesis. Both patients returned to complete daily and working life after surgery.CONCLUSION Synovial chondromatosis is a rare benign pathology, even rarer in the ankle joint and especially in the foot. Surgery should be minimal in patients with ankle PSC,choosing the correct timing, waiting if possible until stage III. More aggressive and early surgery should be performed in patients with PSC of the foot,particularly the subtalar joint, due to the high risk of arthritic evolution.     

Synovial chondromatosis of the shoulder: A case report

Synovial chondromatosis is a rare disease in which cartilaginous masses form in the synovial membrane. The cartilaginous foci may detach to form loose bodies within the joint, which may calcify or ossify. This condition is commonly seen in the knee, hip, or elbow, but is rare in the shoulder (Varma & Ramakrishna 1976, Volpin et al. 1980, Leo & Nocera 1985).     

Synovial chondromatosis of the ankle joint and elbow in two cases

Two male patients, aged 44 and 88 years, presented with complaints of restricted joint movement, a growing swelling, and pain in the elbow and ankle joints, respectively. Radiographs showed cartilaginous nodules in the affected joints and minimal chondral damage. Magnetic resonance findings were consistent with synovial chondromatosis. Both patients underwent removal of loose bodies by open arthrotomy and partial synovectomy. Histopathologic examination confirmed the diagnosis. No recurrences were detected within a follow-up period of at least a year.     

Synovial chondromatosis of the metacarpophalangeal joint: case report and review of the literature

Intra-articular synovial chondromatosis in the hand is rare but should be considered in the differential diagnosis of a swollen, stiff or painful joint. Other possible diagnoses include osteoarthritis, rheumatoid arthritis, gout, trauma and chronic infection, and unless enchondral ossification of loose bodies is seen the diagnosis of synovial chondromatosis may not be made preoperatively. A 69-year-old man with synovial chondromatosis of the metacarpophalangeal joint is reported. The joint was swollen and tender. He had not sustained trauma and there was no evidence of arthritis, involvement of other joints or infection. Complete synovectomy with removal of all loose bodies was successful and his symptoms resolved. Intra-articular synovial chondromatosis is a benign condition, but spontaneous resolution is the exception and surgical synovectomy remains the most effective treatment.     

Synovial chondromatosis presenting with peripheral nerve compression--a report of two cases

We report two cases of synovial chondromatosis presenting with peripheral nerve compression syndromes involving respectively the median nerve at the wrist and the posterior interosseous nerve at the elbow. Only one previous instance of nerve compression due to this condition has been described, involving the ulnar nerve at the elbow. In one of our cases the disease process was at an early stage in its natural history and in the other at an advanced stage. The occurrence of nerve compression was related to the site rather than the stage of the disease. Full recovery followed local excision with decompression of the peripheral nerve involved.     

Synovial chondrosarcoma of the hip: report of two cases and literature review

Synovial chondrosarcoma (SCH) is a rare malignant tumour. The lesion may arise de novo in intra-articular space or, more frequently, it may occur as a malignant degeneration of synovial chondromatosis (SC). The authors report two cases of SCH of the hip joint occurring on a SC diagnosed 23 years earlier in one case and 10 years earlier in another case. In both cases the SCH showed an intermediate grade of malignancy at histology (grade 2). In the first case, the patient underwent an external hemipelvectomy and he was disease-free 10 years after the operation. In the second case, the patient refused the proposed amputation and, after palliative radiation therapy, she was alive with disease 58 months after diagnosis. A review of literature reports on SCH was carried out. The knee was the most affected joint, followed by the hip. An amputation was performed in two thirds of cases. Amputation was done as primary surgery in one fifth of cases and for tumour recurrence after synovectomy in four fifth of cases. Metastatic dissemination was seen in 29% of cases. An early detection of malignant transformation of SC might improve the rate of limb salvage surgery in these patients, although no reliable clinical and imaging signs of malignant degeneration have been identified so far.     

Vertebral synovial chondromatosis. Report of two cases and review of the literature

Synovial chondromatosis is an uncommon disorder characterized by the formation of multiple cartilaginous nodules within the synovium, most commonly affecting large joints. Its involvement with the spine is rare; only six cases have been reported. The authors describe two patients with synovial chondromatosis involving the cervical spine. In the first case, synovial chondromatosis arose from the left C1-2 facet joint. This patient underwent a two-stage procedure including a posterior approach for tumor resection and occipitocervical fusion as well as a transmandibular circumglossal approach to the anterior craniocervical junction to complete the tumor removal. Interestingly, on histopathological examination, scattered foci of low-grade chondrosarcoma were intermixed within the synovial chondromatosis. To the authors' knowledge, this is the first report of secondary low-grade chondrosarcoma arising in vertebral synovial chondromatosis. In the second case, synovial chondromatosis involved the left C4-5 facet joint. Tumor resection and cervical fusion were performed via a posterior approach. In this report, the authors describe the clinical presentation, radiographic findings, operative details, histopathological features, and clinicoradiological follow-up data obtained in these two patients and review the literature pertaining to this rare entity.     

Massive rotator cuff tear associated with acute traumatic posterior shoulder dislocation: report of two cases and literature review

A massive rotator cuff tear in association with acute traumatic posterior glenohumeral dislocation is rare. To our knowledge, only four documented cases have been reported in the literature. We present two additional cases of such injury secondary to the traffic accident. The first patient had an unsuccessful closed reduction due to the posterior instability while the second developed the profound shoulder weakness following the reduction. From the findings of our cases together with the previous reports, every patient had a unique injury mechanism of high-energy directed axial loading on an outstretched, adducted, and internally rotated arm. The glenohumeral capsule and rotator cuff were uniformly avulsed from the humeral attachment, and the supraspinatus and infraspinatus were always involved. However, the clinical presentations were variable based on the severity of the associated rotator cuff tear. The outcomes of operative treatment in this type of injury with the open repair were favorable.     

Renovascular hypertension associated with neurofibromatosis: two cases and review of the literature

The authors report two cases of renovascular hypertension associated with neurofibromatosis. A 19-year-old woman was admitted to our hospital with a complaint of abdominal pain and blood pressure of 180/120 mmHg. Examination revealed café-au-lait spots over her chest and extremities. Peripheral plasma renin activity (PRA) under basal conditions was 2.8 ng/ml/h and increased to 12.6 ng/ml/h after administration of 50 mg captopril. Plasma and urinary catecholamines were normal. Selective renal angiography showed left aneurysmal dilatation of the segmentary branch and right renal artery stenosis with multiple aneurysmal affecting different branches. Blood pressure was controlled by multiple drugs, including beta-blockers and angiotensin-converting enzyme inhibitor. Another patient, a 20-year-old woman, was admitted because of severe arterial hypertension, numerous café-au-lait spots, scoliosis, and mass over the right arm. PRA from the right renal vein was extremely elevated, and selective angiography demonstrated bilateral renal artery stenosis. Aortorenal bypass was performed successfully.     

滑膜软骨瘤病13例临床分析

目的 探讨滑膜软骨瘤病外科诊断和治疗经验。方法 对１９８６－１９９７年期间经治的１３骨膜罗骨瘤病的诊断、治疗及其病理进行总结、分析。结果 滑膜软骨瘤病临床多表现为间歇性关节疼痛、肿长、功能受限,活动时关节有弹响声或磨擦感,少数有关节交锁有的可及活动性人;Ｘ线片显示关节内游离体数目往往秒于关节内游离体的实际数目;术中肉眼可见病变滑膜充血、增厚、表面粗糙;镜下风 管增生、淋巴细胞聚集、滑膜囊层细胞及纤     

Simultaneous bilateral anterior shoulder dislocation: report of two cases and review of the literature

Bilateral shoulder dislocations are rare and almost always occur in the posterior direction. Simultaneous bilateral anterior shoulder dislocation is even rarer and only a few cases are stated in the literature. The most interesting part of a bilateral shoulder dislocation is about its injury mechanism as a synchronous and simultaneous force is needed to result in it. In cases of epilepsy or electrocution, the mechanism is different and the forceful contractions of the selective group of muscles result in the dislocation. This article reports two cases of bilateral simultaneous anterior shoulder joint dislocation that occurred after a road side accident and after an episode of convulsion in an epileptic patient. The dislocations were diagnosed early and reduced immediately with a proper postreduction rehabilitation. During their follow-up, both patients had satisfactory functional outcome. This article emphasizes on the importance of shoulder examination in road side accident victims and epileptic patients. All orthopedic surgeons and emergency physicians should be aware of such unusual possibilities to have an early diagnosis and treatment.An early reduction and appropriate rehabilitation can provide satisfactory functional outcome. This article also briefly discusses the injury mechanisms, diagnoses and treatments of bilateral shoulder dislocation as reported in the literature.