Education: Tumors of Tendon Sheaths, Joints, and Bursae

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The articular structures, including joint cartilage, synovia and joint capsule, and the periarticular structures—bursae, ligaments, and adjoining tendons—have a two-fold origin. The outer tissues are formed from connective tissue identical with that found in the superficial and deep fascia. On the other hand, intra-articular tissues and the ligaments, tendons, and bursae nearest the joint are derived from precartilaginous tissue capable of forming both cartilage and bone. Malignant tumors are equally rare in the fibrous structures and in those of precartilaginous origin. Benign tumors, which are not uncommon, are practically confined to the articular and periarticular structures which are developed from precartilaginous tissues. These neoplasms, including giant-cell tumor, chondroma, and osteochondroma, are similar in character and behavior to like tumors in the bone. Mesenchyme, destined to form both cartilage and bone, condenses at the site of the future skeleton in the early embryo. Strands of this primitive tissue, cutting across the future bone at right angles, persist at the site of the future joints (Fig. 1). By mucoid regression some of this tissue forms the joint cavity, the surrounding condensation forming the synovia. Other strands persist at the reflection of the joint capsule and at points of attachment of tendons and ligaments. Some of this tissue may regress at these points to form bursae.