Multiple Loose Bodies Research Articles

Reichel Syndrome in Children: A Case Report.

Reichel syndrome or primary synovial chondromatosis (PSC) is an uncommon benign metaplastic condition that usually affects large joints. Though shoulder involvement was scarce, there are only a few cases in the pediatric population. A 14- year-old boy was admitted to the Pediatric Orthopedics department with right shoulder pain for 14 months. Imaging revealed multiple loose bodies distributed throughout the glenohumeral joint. Upon the arthroscopic approach, we remove all cartilaginous nodules within the glenohumeral space and abarticular tendon. Histopathologic examination confirmed the diagnosis of primary synovial chondromatosis. At follow-up, the patient remains free of symptoms, and shoulder radiographs showed no recurrence of calcification. The present case illustrates the clinical patterns, imaging features, histological findings, and therapeutic management of shoulder primary synovial chondromatosis in a pediatric patient.

A Case of Baker’s Cyst with Synovial Chondromatosis of Knee

Synovial chondromatosis is a benign condition which arises from synovial membrane or bursae around the joints. Joint abnormalities in the form of arthritic or mechanical conditions such as detachment of osseocartilaginous fragments from the articular surface are its secondary associations. Rarely there maybe involvement of the Baker’s cyst. Here we report a case in which a 60-year-old female came with complaints of pain, swelling and restriction of movement of right knee joint for the past one year. After careful clinical and radiological examination, it was diagnosed as Baker’s cyst complicated by synovial chondromatosis. After the diagnosis the patient underwent the following procedures: open synovectomy, cyst removal and thorough joint debridement. Synovial chondromatosis was confirmed histopathologically. Secondary synovial chondromatosis has features of osteoarthritic changes, lack of extensive synovial proliferation and complicated Baker's cyst which is not seen in primary synovial chondromatosis.
 Synovial chondromatosis (SC) is caused by metaplasia of the synovium into chondrocytes and is a rare benign disorder.[1,2] Primary synovial chondromatosis (PSC) is a self-limited process that occurs in an otherwise normal joint.[3] When synovial chondromatosis develops in a joint previously affected with disease, often posttraumatic or degenerative osteoarthritis, it is called as secondary synovial chondromatosis.[4] SC may involve any joint, but the most common joint involved is knee joint followed by hip joint, and small joints of the hand and wrist. Least involvement is seen in elbow and shoulder joint. [5] The disease is categorised into three phases according to Milligram classification: active intrasynovial disease without any loose bodies observed in the early phase, active disease and loose bodies observed in the transitional phase, and multiple loose bodies without any intrasynovial disease observed in the late phase.
 In orthopaedic practice, popliteal cysts are common occurrence; many of them are associated with degenerative or rheumatoid arthritis. The differential diagnoses become more complex when loose bodies and calcifications are noted within the joint on a radiograph. Here in, we are presenting a case of Baker’s cyst with synovial chondromatosis of knee treated by surgical excision and confirmed by histopathology.

Synovial Chondromatosis of Wrist Joint: A Rare Case Report

Synovial chondromatosis is an uncommon and non-malignant transformation of the synovial membrane which leads to development of numerous cartilaginous bodies within the joint. Synovial chondromatosis occurs rarely in the wrist, and there have been a lack of reports of this occurrence in the literature. Hereby we reported a case of synovial chondromatosis occurred in the wrist joint treated with marginal excision. A 52-year-old male complained lump on his right wrist accompanied by mild pain. On physical examination, there was lump on ulnar side of the right wrist with normal underlying skin, palpable hard and immobile. There was slight limitation on wrist flexion and extension, whereas radial – and ulnar deviation and pronation – supination range of motion were within normal limit. The plain x-ray of the right wrist showed multiple calcified intra-articular cartilaginous loose bodies in the distal radioulnar joint. Biopsy showed multilobulated cartilage tissue that contained chondrocytes without atypia, and some cartilage tissue accompanied with mild atypia. We diagnosed the patient as primary benign soft tissue tumor at right distal radio-ulnar joint due to synovial chondromatosis and we performed marginal excision. The clinical result was reported good, but complete data could not be obtained because the patient refused to do routine follow up. The rarity of synovial chondromatosis involving the wrist joint could be an obstacle in performing diagnostic procedures and treatment for the case, but with the thoughtful application of resources and surgical principles, synovial chondromatosis of the wrist joint can be safely and effectively managed. Keywords: Synovial chondromatosis, Wrist joint, Marginal excision

Imaging evaluation of extraarticular posterior loose bodies in varus ankle osteoarthritis.

Purpose: Multiple loose bodies (LBs) are often found in patients with varus ankle osteoarthritis (OA). This study aimed to investigate the characteristics of extra-articular posterior ankle LBs in patients with varus ankle OA. We also sought to determine whether there were variations in the characteristics of LBs according to the degree of ankle OA. Methods: We retrospectively reviewed 50 patients who had appeared posterior extraarticular LBs on preoperative ankle imaging among the patients who underwent operative treatment for varus ankle OA from March 2011 to February 2023. We categorized the entire patient cohort into four groups according to the degree of ankle arthritis (Takakura stage II, IIIA, IIIB, and IV). Size, number, and location of LBs were evaluated using preoperative computed tomography and magnetic resonance imaging. Results: 142 LBs were identified (mean size: 11.5mm); 76.8% were located within the flexor hallucis longus (FHL) tendon sheath, 20.4% in the posterior recess, and 2.8% in the flexor digitorum longus tendon sheath. Average LB size was significantly larger in Takakura stage IIIB and IV patients (p < .05), and the LB number was significantly lower in stage II patients (p = .013). Conclusion: Extra-articular posterior LBs in varus ankle OA are predominantly located within the FHL tendon sheath and were larger in Takakura stages IIIB and IV patients.Level of Evidence: Level III. Retrospective comparative study.

Synovial Chondromatosis of Shoulder Treated by Arthroscopic Synovectomy and Removal of Loose Bodies: A Case Report

Synovial Chondromatosis of the shoulder is mentioned in literature as a rare case. It is a benign neoplastic condition of the synovial membrane. Multiple osteocartilaginous loose bodies inside the joint characterize this rare monoarticular disorder. This case report describes a 32-year-old man who presented with right shoulder pain for six months. He had painful abduction and internal rotation. The condition was diagnosed as synovial chondromatosis. The patient underwent arthroscopic removal of loose bodies and synovectomy. This case illustrates the investigation and treatment of synovial chondromatosis of the shoulder. The loose bodies in synovial chondromatosis of a shoulder joint can be retrieved by arthroscopy as it provides a broader field of vision, better accessible access to the loose bodies, synovectomy, reduced hospital stay, and better rehabilitation. Keywords: Arthroscopy, Loose Bodies, Shoulder, Synovial Chondromatosis

Giant Synovial Chondromatosis of the Shoulder: The Limits of Arthroscopic Treatment and Technical Tips

Synovial chondromatosis (SC) is a rare disease. It is a chondrocytic metaplasia and is characterized by the presence of cartilaginous loose bodies in the involved joint, bursa or tendon sheath, it occurs most often in those aged 30_50 years and 3 times more in males than females, The shoulder is an exceptional location. It causes significant functional disability in young people. The clinical presentation is not specific, and the diagnosis is based on MRI. Confirmation is still anatomopathological. Classically, the mainstay treatment for SC of the shoulder has been open arthrotomy and removal of loose bodies, followed by either complete or partial synovectomy, removing the affected tissue, with recent advances in arthroscopic techniques and methods, arthroscopy becomes the gold standard. We present this case report of a 26-year-old man, who was left-hand dominant, a maintenance technician, amateur football player presented a left shoulder inflammatory pain; ; plain radiography demonstrated multiple calcific densities over the glenohumeral joint , the MRI showed multiple calcified intra-articular loose bodies around the anterior and posterior joint and axillary recess ; At arthroscopy, a large number of loose bodies were observed together with marked synovitis ,it only allowed the removal of small foreign bodies &lt; 1 cm, partial synovectomy was performed with a shaver ; anatomopathological examination confirmed the diagnosis of sc. the extraction of giant fragments &gt;2 cm was impossible so it was subsequently removed by open surgery. This was carried out one month later using a delto-pectoral approach: all foreign bodies &gt; 1 cm were successfully extracted. We report this case report in order to review the role of shoulder arthroscopy and magnetic resonance imaging (MRI) in diagnosis and treatment and to highlight the operative difficulties, technical tips of arthroscopic extraction of giant Synovial chondromatosis of the shoulder.

Arthroscopic Synovectomy and Removal of Loose Bodies in Synovial Osteochondromatosis of the Knee

Synovial osteochondromatosis is a benign process that most commonly affects the knee joint (70%). It is characterized by proliferative metaplasia of synovial membrane into chondrocytes, resulting in the formation of multiple cartilaginous nodules, which can detach from the synovium to become multiple intra-articular loose bodies. It usually involves the anterior compartment, including infrapatellar fat pad, suprapatellar pouch, and anterior interval, and rarely involves the posterior compartment of the knee. Treatment for synovial osteochondromatosis usually involves surgery, especially in the presence of locking symptoms or decreased range of motion. Arthroscopy has gradually replaced a traditional open approach, resulting in low morbidity, low postoperative pain, better cosmetic results, early recovery of range of motion, short rehabilitation course, and an early return to previous function. In case of involvement of the posterior compartment of the knee joint, arthroscopic access may be difficult. In this Technical Note, the technical details of arthroscopic synovectomy and removal of loose bodies in synovial osteochondromatosis of the knee is described. This arthroscopic technique can deal with the disease, involving both the anterior and posterior compartments of the knee joint.

“Feeling -The -Rice- Bag” Sign: A Pathognomonic Manifestation of Synovial Osteochondromatosis

Synovial Osteochondromatosis is not rare in joint pathology.An orthopaedic surgeon may have around 30 cases in life career. The inner surface of synovium is presumably affected by inflammatory process and forms the osteochondral body. By the time this osteochondral formation detaches from synovium and becomes loose body in the joint. Synovial Osteochondromatosis is a pathological status in which there are multiple loose bodies inside the joint. Synovial Osteochondromatosis is presumably a benign disorder, but whose common complication is blockade of joint when loose body incacerated between cartilages of joint causing acute pain and joint cannot move.In medical terminology there is Osteochondromatosis who is a different pathology, a kind of benign bone tumors, not the title of this article. Multiple loose bodies can be detected by Feeling- the- Rice- Bag Sign. Place the hand over the involved joint, we can feel the loose bodies as if we feel the rice grain in the bag. More loose bodies exist, easier we feel. More superficial the joint and/or loose bodies are , easier feeling is recognized.Feeling -the -Rice- Bag Sign is pathognomonic manifestation for the Synovial Osteochondromatosis.

Incidental findings involving the temporomandibular joint on computed tomography and magnetic resonance imaging.

The temporomandibular joint (TMJ) is frequently imaged in head and neck computed tomography (CT) and magnetic resonance imaging (MRI) studies. Depending on the indication for the study, an abnormality of the TMJ may be an incidental finding. These findings encompass both intra- and extra-articular disorders. They may also be related to local, regional or systemic conditions. Familiarity with these findings along with pertinent clinical information helps narrow the list of differential diagnoses. While definitive diagnosis may not be immediately apparent, a systematic approach contributes to improved discussions between clinicians and radiologists and better patient management.

The use of posteromedial portal for arthroscopic treatment of synovial chondromatosis of the knee: a case report

The synovial chondromatosis is an uncommon proliferative metaplastic process of the synovial cells that can develop in any synovial joint. An isolated primary chondromatosis of the posterior compartment of the knee is uncommon and few cases are reported in literature. Our purpose is to describe a rare case of primary chondromatosis of the knee posterior compartment and report the arthroscopic loose bodies excision through a difficult posteromedial portal, avoiding the use of the accessory posterior portal, most commonly reported for approaching this disease. We report a rare case of a 35-year-old Caucasian male patient with diagnosis of chondromatosis of the posterior knee compartment. The radiographs showed multiple loose bodies of the posterior compartment. The MRI revealed minimal synovial hypertrophy areas, multiple osteophytes in the intercondylar notch, and loose bodies in the posteromedial compartment. The CT allowed us to assess the bony structures, the morphology of the intercondylar notch, and the presence osteophytes of the medial and lateral femoral condyles. The CT images were crucial to plan how to reach the posterior compartments of the knee through a trans-notch passage. The patient underwent arthroscopic surgery using anteromedial, anterolateral, and posteromedial portals. The tunneling through the intercondylar osteophytes was performed to allow the arthroscope to pass trans-notch. To avoid additional accessory posterior portals, we used a 70° arthroscope to better explore the posterior knee compartment. The cartilage-like bodies were removed and synovectomy of the inflamed areas was performed. The clinical and radiological follow-up was 12months and the patient showed excellent clinical outcomes, returning to his activities of daily living and sport activity. Our case report highlights the importance of the arthroscopic approach to treat synovial chondromatosis, despite the involvement of the posterior compartment of the knee. An optimal preoperative imaging allows to plan for the proper surgical procedure even in patients with severe osteoarthritis. Moreover, the adoption of an intercondylar notch tunneling and a 70° arthroscope can help surgeons to better explore the posterior knee compartment, avoiding an accessory posterior trans-septal portal. Therefore, a synovectomy of the inflamed foci may be useful to prevent recurrence.

SURGICAL REMOVAL OF A LARGE LOOSE BODY IN THE SUBACROMIAL SPACE : A CASE REPORT.

Synovial chondromatosis is a rare condition characterized by the presence of osteocartilaginous loose bodies in articular joints, bursae, or tendon sheaths. Multiple case reports describe synovial chondromatosis in the knee, hip, elbow, wrist, ankle, and shoulder with the shoulder being the least common of these joints to be affected. All reports describe multiple small loose bodies but rarely describe of a single large loose body .We present a case of a 65 year old fe male patient who presented to us with with painless swelling over the right shoulder with radiological ndings of large loose body in the subacromial space and subdeltoid region. After no improvement with conservative treatment subtotal synovectomy and removal of loose body of size 2.5cm was done via anterior approach . At her 1 year follow-up examination she remained asymptomatic and there was no clinical or radiographic evidence of recurrence.

Multiple Peritoneal Loose Bodies in a Patient with Stage IV Endometriosis

A 34-year-old no history of pregnancy with suspected stage IV endometriosis presented for surgical management. Laparoscopy showed a frozen pelvis, bilateral endometriomas and dilated fallopian tubes, obliterated anterior and posterior cul-de-sacs, and diffuse diaphragmatic and omental endometriotic implants. Multiple free-floating and adherent masses with smooth yellow-brown surfaces and soft rubbery consistency were observed within the pelvis and tunneled into the peritoneum (Fig. 1), including deep within a bladder peritoneal pocket (Fig.

“Shoulder pain and limitation of motion in a young girl: think different”

BackgroundPrimary Synovial Chondromatosis (PSC) is a rare benign tumor of the synovial membrane in which cartilage metaplasia produces calcific loose bodies within the articular space. Only a few cases are reported in the pediatric population and its etiology remains unknown. This condition typically affects large weight-bearing joints with pain, swelling and decrease range of motion. Due to its slow progressions, delayed diagnosis is frequent and differential diagnosis should consider other chronic arthritis and malignancies. While arthroscopic removal of loose bodies is the current treatment up to now, the association of partial or complete synovectomy is debated.Case presentationWe report about a 14-year-old girl with a long-lasting right shoulder pain, especially during movements or exercise, localized tenderness and hypotonia of the glenohumeral joint. No previous trauma was mentioned. Blood exams, Mantoux test and plain radiography of the right shoulder were unremarkable. Ultrasound imaging revealed echogenic and calcified bodies stretching the glenohumeral joint and dislocating the long head of biceps tendon. Magnetic resonance showed a “rice-grain” pattern of the right shoulder. From an arthroscopic surgery, multiple loose white bodies were removed within the synovial membrane, and synovial chondromatosis was confirmed by histological analysis. At one month follow up visit, the patient completely recovered without pain.ConclusionSynovial chondromatosis is a very uncommon cause of mono articular pain in children, especially when it affects shoulder. Pediatricians should keep in mind this condition to avoid delayed diagnosis and treatment, even in consideration of the low risk of malignant transformation. Through this case, we would highlight common diagnostic pitfalls and treatment of synovial chondromatosis.

Arthroscopic management of synovial chondromatosis of the shoulder: A case report

Synovial chondromatosis of the shoulder is a rare entity that is generally mono-articular and uncommon in diarthrodial joints. Treatment of synovial chondromatosis of the shoulder includes open arthrotomy retrieval of loose bodies and synovectomy. With advances in arthroscopy, the same could be achieved using arthroscopic techniques. This case report describes a case report of a 35-year-old male patient who presented with complaints of pain and restriction of movement for 6 months. The MRI of the patient was suggestive of multiple loose bodies in the shoulder joint, in the subdeltoid region, and subscapularis muscle with subacromial bursitis. Arthroscopically more than 100 loose bodies were retrieved with subacromial decompression. Shoulder synovial chondromatosis has been rarely reported in the literature. The malignant transformation although rare, but it is still a possibility. The recurrence rate varies from 3.2% to 22.3%. Open arthrotomy, synovectomy, and retrieval of loose bodies cause delayed recovery and more morbidity with high chances of subscapularis insufficiency due to the need of subscapularis tenotomy. Arthroscopic treatment although have limitations such as limited visualization, limited synovectomy, and difficult interventions around the axillary recess or biceps sheath, but provides with the advantage of lesser morbidity and early rehabilitation. Synovial chondromatosis can be successfully treated arthroscopically as it provides intra-articular and extra articular access with early rehabilitation, lesser morbidity, and early recovery.

A case of synovial chondromatosis of knee joint treated with total knee arthroplasty

Synovial Chondromatosis is a rare disease of the synovial membrane characterised by formation of multiple loose bodies in a joint. Knee is the most common joint to be affected by this disease. Though, this disease can be managed by synovectomy and removal of loose bodies with a favourable functional outcome but in some cases where there is damage of articular cartilage, simple synovectomy might not be sufficient. Here, we present a case of right knee pain in a 53 year old male since 4 years with a established diagnosis of synovial chondromatosis. No other joint was affected. Pain was associated with a fixed flexion deformity and restriction of knee range of motion and multiple slipping bodies. Radiography showed multiple loose bodies in the tibio-femoral as well as in patello femoral compartment. MRI of knee revealed several damaged areas in the knee articular surface. As a result, decision was taken to perform total knee arthroplasty. Intraoperatively all the loose bodies were removed along with the affected synovium and arthroplasty was done. Patient was discharged in fourth post operative day with proper instructions and was called for follow up at 1 month, 3 month, 6 month, 1 year. Functional outcome was assessed by Tegner Lysholm knee score, Knee Society score and Visual Assessment Scale.

Anterior and Posterior Arthroscopic Treatment of Primary Synovial Chondromatosis of the Ankle.

Primary synovial chondromatosis (PSC) is a progressive disorder of unknown etiology resulting in formation of multiple loose bodies. If left untreated, it may lead to degenerative changes or malignant transformation to chondrosarcoma. Seventeen patients who underwent combined posterior and anterior ankle arthroscopy within the same operative session and had histologically confirmed PSC were included in this retrospective study. American Orthopaedic Foot & Ankle Society (AOFAS) Ankle-Hindfoot score was used to evaluate ankle function preoperatively and at a final follow-up. A 3-question survey was used to evaluate patient's satisfaction at the final follow-up. In 14 patients, loose bodies were found in both compartments of the ankle, in 2 only in the anterior compartment, and in 1 only in the posterior compartment. All patients had evident signs of synovial inflammation in both compartments. The AOFAS Ankle-Hindfoot score increased from the preoperative median score of 65 (range, 29-90) to 95 (range, 65-100) at the final follow-up. Fourteen patients reported they were extremely satisfied with the outcome, 1 was moderately satisfied, and 2 were dissatisfied. No cases of recurrence of synovitis or loose body formation were noted, nor any signs of malignant transformation during the follow-up period. We believe the risk of recurrence of PSC, which is in close relation to malignant transformation, can be minimized by performing a complete synovectomy of the ankle. Our experience and review of literature makes us believe that ankle PSC should be regarded as a whole joint disorder. Performing a combined posterior and anterior arthroscopic procedure within the same operative session should always be considered in patients with ankle PSC. Level IV, retrospective case series.

Stones around knee joint

A 56 yrs old female consulted orthopedic OPD with complaints of pain, swelling and frequent locking of the knee joint with grating sounds. There was no history of trauma. She was postmenopausal since last three years. On examination hard masses were palpable on posterior aspect of the knee and in supra patellar area. On radiological examination, multiple loose bodies were found around the knee joint along with grade-III osteoarthritis (Figures 1 &amp; 2). On loose bodies were found around the knee joint along with grade-III osteoarthritis (Figures 1 &amp; 2). On correlation of clinical picture and radiological findings diagnosis was confirmed to be ‘synovial chondromatosis’.1

Synovial chondromatosis: a rare cause of knee pain and swelling

&lt;p&gt;Synovial chondromatosis (SC) is a rare, benign, metaplastic, monoarticular disorder of synovial membrane and bursae of large joints. It commonly affects the large joints such as the knee, hips, wrist, ankle and shoulder. Here we report a case of SC of right knee in a 60-year-old female presenting with chief complaints of pain, swelling, restriction of movement in right knee for 1 year after a fall at home. X-ray of right knee revealed multiple calcified loose bodies. The final diagnosis was established by correlating radiologic findings with the histopathology of the excised specimen. Patient was successfully treated by open partial synovectomy of knee using anterior approaches in a single step procedure.&lt;/p&gt;

Arthroscopic and Endoscopic Technique for Subcoracoid Synovial Chondromatosis of the Shoulder Through a Medial Transpectoral Portal

Synovial chondromatosis of the shoulder is a rare disorder characterized by metaplastic synovial proliferation, causing multiple loose bodies usually localized intra-articularly. Surgical treatment with open techniques through a deltopectoral approach has been commonly used. The evolution of arthroscopy has allowed a complete joint assessment and the extraction of intra-articular loose bodies with less morbidity than open techniques. Nevertheless, this pathology occurs less frequently in the subcoracoid bursa. Access to this bursa may be more complicated when extracting loose bodies that cause pain and functional limitation in performing activities of daily living. We describe an arthroscopic and endoscopic technique for the treatment of subcoracoid synovial chondromatosis through a medial transpectoral portal, allowing safe loose body extraction under direct visualization around the coracoid process and brachial plexus. The literature was reviewed, and benefits of this endoscopic technique were analyzed.

Multiple Stones in the Knee

Abstract A patient presented to the outpatient department with complaints of frequent locking and grating sensation in the knee. The radiographs of the knee revealed multiple loose bodies in the knee giving a picture of multiple “stones” in the knee. The patient was diagnosed as a case of synovial chondromatosis. Synovial chondromatosis is a rare, benign condition of the joints wherein the synovium grows abnormally and produces cartilage which may finally break off from the synovium and become loose bodies in the knee. The diagnosis is usually on the basis of clinico-radiologic findings and clinician awareness and high index of suspicion usually clinch the diagnosis.