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Cureus Nov 2023Synovial osteochondromatosis or synovial chondromatosis is a benign joint pathology characterized by the development of multiple cartilaginous nodules or loose bodies in...
Synovial osteochondromatosis or synovial chondromatosis is a benign joint pathology characterized by the development of multiple cartilaginous nodules or loose bodies in the synovial membrane that typically arise in the larger joints of the body. It usually presents as joint pain and, as seen in the present case, can occasionally be missed. Diagnosis involves a combination of clinical evaluation, imaging studies, and histopathological evaluation (which is confirmatory). Treatment depends on the severity of the disease, symptoms, and the patient's social situation, and may include monitoring for asymptomatic cases, non-surgical management (pain medications and physical therapy), or surgical intervention. Surgical intervention may include arthroscopic removal of loose bodies, synovectomy, or reconstruction/replacement in severe situations. Prognosis has a direct relationship to how early the disease is diagnosed. Early intervention with appropriate management can help alleviate symptoms; however, if left unmanaged, it can lead to joint damage and osteoarthritis or very rarely, malignant transformation into chondrosarcoma. This report describes the case of a 62-year-old female with complaints of bilateral knee pain who was originally diagnosed with osteoarthritis based on clinical exam and X-rays. Two magnetic resonance imaging (MRI) scans were done three years apart, with synovial osteochondromatosis being on the differential after the second scan. A left knee major synovectomy was conducted after the second MRI reading, where rubbery masses of tissue along with loose fragments were removed. Fluid from the tissue masses was sent to culture and pathology for interpretation. Two weeks post the surgery, the patient's pain improved tremendously, with adequate ambulation independently. Histopathology came back positive for synovial osteochondromatosis. This case report highlights the importance of keeping this joint pathology on the differential when treating patients with joint pain and interpreting imaging.
PubMed: 38073924
DOI: 10.7759/cureus.48498 -
Journal of Wrist Surgery Oct 2022The wrist is the fourth most common joint to be involved in juvenile inflammatory arthritis (JIA), which is a common rheumatological condition affecting children....
The wrist is the fourth most common joint to be involved in juvenile inflammatory arthritis (JIA), which is a common rheumatological condition affecting children. Wrist arthroscopy is well established in rheumatoid arthritis, but remains unexplored in JIA. The aim of this study is to investigate the role of wrist arthroscopy in JIA, with focus on those who are refractory to medical management. This is a prospective observational study, including consecutive patients with JIA undergoing arthroscopy between January 2016 and December 2020. Those over the age of 18 years and those with other rheumatological diagnoses were excluded. Data including pre-, intra-, and postoperative variables, demographics, and patient-reported outcomes were collated and are reported using standard measures. A total of 15 patients underwent arthroscopy ( = 20 wrists). Synovitis was noted in all wrists on arthroscopy and synovectomy was performed in all cases. Other procedures were performed as indicated during the procedure. The median follow-up duration was 11.3 (interquartile range [IQR] 8.1-24.2) months. Median reduction of 4 (IQR 2.25-6) points on the Visual Analogue Score for pain on loading was noted postoperatively. Grip strength was improved in = 11/20 wrists and functional improvement was noted in = 18/20 wrists. Restriction of range of motion was achieved with a shrinkage procedure in patients with hypermobile joints. There were no postoperative complications, and no patients were lost to follow-up. In experienced hands, wrist arthroscopy is feasible, safe, and efficacious in the management of JIA, among patients who are refractory to medical management. This is a Level II study.
PubMed: 36339079
DOI: 10.1055/s-0042-1743448 -
Cardiovascular & Hematological... 2017Hemophilic arthropathy (HA) of the ankle is prevalent in people with hemophilia (PWH). It is frequently severe and incapacitating, due to recurrent bleeding into the... (Review)
Review
BACKGROUND
Hemophilic arthropathy (HA) of the ankle is prevalent in people with hemophilia (PWH). It is frequently severe and incapacitating, due to recurrent bleeding into the ankle articulation during infancy. Around 50% of hemophilic patients suffer from ankle pain and radiological signs of HA.
OBJECTIVE
To review current treatment of HA of the ankle in PWH.
METHOD
A literature review of hemophilic ankle arthropathy in PWH was performed utilizing MEDLINE (PubMed) and the Cochrane Library.
RESULTS
Primary hematologic prophylaxis could keep away from the development of ankle HA if the level of the patient's deficient factor is prevented from dropping below 1% of normal. Recurrent articular bleeding can be prevented by the intravenous infusion of clotting factor concentrates (prophylaxis). Major articular bleeds and chronic hemophilic synovitis should be managed fiercely to prevent ankle HA. In the circumstance of advancing articular involvement, some noninvasive and invasive procedures can procure symptomatic mitigation and ameliorate the patient's function and quality of life.
CONCLUSION
The ideal treatment for the hemophilic ankle when hematologic prophylaxis fails includes physical medicine and rehabilitation, orthoses, radiosynovectomy, arthroscopic ankle debridement (in the initial stages of cartilage degeneration), and ankle distraction, ankle fusion or total ankle replacement (in advanced stages of cartilage degeneration).
Topics: Ankle; Arthrodesis; Arthroplasty, Replacement, Ankle; Bone Marrow Transplantation; Disease Management; Exercise; Hemarthrosis; Hemophilia A; Humans; Quality of Life; Synovectomy
PubMed: 28891453
DOI: 10.2174/1871529X17666170908110758 -
Der Orthopade Oct 2015Synovial tumors comprise a variety of lesions, including those with benign and aggressive neoplastic changes as well as inflammatory causes. In this article we focus on... (Review)
Review
Synovial tumors comprise a variety of lesions, including those with benign and aggressive neoplastic changes as well as inflammatory causes. In this article we focus on neoplastic tumors. Synovial tumors with other etiologies, such as sarcoidosis, granuloma, synovitis, or gouty arthritis, are not dealt with here. Through a precise differentiation between these disease entities can an optimization of treatment be achieved.
Topics: Arthroplasty; Chemoradiotherapy; Combined Modality Therapy; Evidence-Based Medicine; Humans; Radiography; Soft Tissue Neoplasms; Synovectomy; Synovial Membrane; Treatment Outcome
PubMed: 26370407
DOI: 10.1007/s00132-015-3162-4 -
Arthroscopy Techniques Sep 2020Knee arthroscopy has evolved greatly from its inception in the 20th century. Arthroscopic synovectomy is performed in the case of infection or significant synovitis. We...
Knee arthroscopy has evolved greatly from its inception in the 20th century. Arthroscopic synovectomy is performed in the case of infection or significant synovitis. We continue to develop more minimally invasive procedures, and the NanoScope (Arthrex, Naples, FL) has provided a new generation of possibilities. The system does not require the use of a standard incision or portal, and using the GraftNet (Arthrex), we can harvest tissue with a standard shaver for further evaluation. This technique provides an option to perform a synovectomy and biopsy without the use of standard arthroscopy portals through an incisionless approach.
PubMed: 33024664
DOI: 10.1016/j.eats.2020.05.002 -
The Journal of Rheumatology Mar 2018
Topics: Arthritis, Rheumatoid; Arthroscopy; Humans; Operating Rooms; Osteoarthritis, Knee; Rheumatologists; Rheumatology; Synovectomy; Synovitis; Ultrasonography
PubMed: 29496915
DOI: 10.3899/jrheum.170397 -
The Quarterly Journal of Nuclear... Dec 2022Arthritis is affecting millions of people globally, involvement and distribution depending on the type of arthritis. The most common arthritic conditions are...
Arthritis is affecting millions of people globally, involvement and distribution depending on the type of arthritis. The most common arthritic conditions are osteoarthritis (OA) and rheumatoid arthritis (RA). Despite the pathogeneses being fundamentally different, both joint diseases share the same need for local treatment of synovitis. No current treatment can stop the progression of OA. Local articulate treatment including glucocorticoid (GC) injections, radiosynoviorthesis (RSO) and surgical synovectomy are the only options to relieve pain and temporally improve movability before surgical intervention. For RA, despite effective systemic treatments, similarly need for local articulate treatment is still present, especially early in the disease, but also in case of recurrent episodes of disease flare. Current evidence supports local GC injection as first line treatment for persistent synovitis in a single or a few joints. RSO provides an evident and effective alternative for GC refractory synovitis, especially in early RA. Surgical synovectomy is an invasive alternative, but with less documented efficacy. Whether one unsuccessful intraarticular GC injection is enough to change of mode of action for local treatment is still unclear and needs to be further investigated. In conclusion persistent single joint synovitis in OA and RA is well treated with local treatment. Intra-articular GC injection is considered as first line of treatment, but RSO provides an additional treatment alternative with less side effects and better evidence of efficacy than surgical synovectomy.
Topics: Humans; Synovitis; Anti-Inflammatory Agents; Arthritis, Rheumatoid; Injections, Intra-Articular; Treatment Outcome
PubMed: 35838028
DOI: 10.23736/S1824-4785.22.03477-X -
SICOT-J 2021Subacromial impingement syndrome (SIS) is the leading cause of shoulder pain. A systemic approach for abnormal causes of SIS is recommended to avoid misdiagnosing rare...
Subacromial impingement syndrome (SIS) is the leading cause of shoulder pain. A systemic approach for abnormal causes of SIS is recommended to avoid misdiagnosing rare or sinister pathologies. To our knowledge, only nine cases of subacromial lipoma arborescens associated with impingement syndrome have been reported in the literature. In this report, we briefly discuss histopathologic and radiological signs of an unusual case of impingement syndrome caused by subacromial "lipoma arborescens" and describe arthroscopic synovectomy after the failure of conservative management. The patient remains symptom-free five years after surgery.
PubMed: 33704057
DOI: 10.1051/sicotj/2021004 -
Revista Brasileira de Ortopedia Oct 2021Although lipomatous tumors are common, intra-articular occurrence is exceedingly rare and sparsely described in the literature. Regarding these rare entities, most are...
Although lipomatous tumors are common, intra-articular occurrence is exceedingly rare and sparsely described in the literature. Regarding these rare entities, most are benign, progressively growing tumors and often occur in the knee, yet it is crucial to distinguish the less infrequent lipoma arborescens (LA) from the rarer synovial lipoma, as they differ in presentation and pathogenesis. Magnetic resonance imaging is the exam of choice in their assessment and in differential diagnosis, playing a central role nowadays. Excision and synovectomy, either arthroscopic or by arthrotomy, provide good outcomes with low recurrence rates. By reporting two surgically treated distinct cases of intra-articular lipomatous tumors of the knee, the authors intend to review the literature and discuss their etiology, clinical and imaging aspects as well as treatment approach.
PubMed: 34733442
DOI: 10.1055/s-0040-1715517 -
Expert Review of Hematology May 2019Surgical interventions usually needed for hemophilic arthropathy include arthroscopic synovectomy, alignment osteotomy, arthroscopic joint debridement, radial head... (Review)
Review
Surgical interventions usually needed for hemophilic arthropathy include arthroscopic synovectomy, alignment osteotomy, arthroscopic joint debridement, radial head removal, arthrodesis of the ankle, and total joint arthroplasty (elbow, hip, knee, ankle). Areas covered: Whatever the surgical technique, appropriate surgical hemostasis must be achieved through infusion of concentrate of the deficient factor (factor VIII or factor IX), either in recombinant or plasma-derived form, at the correct dosage (ideally for 10-14 days). In patients with inhibitors, there are also the aPCCs (activated prothrombin complex concentrates) and rFVIIa (recombinant activated FVII). These surgical procedures are safe even in the most complex cases such as patients with inhibitors or who are human immunodeficiency virus-positive (HIV+) and hepatitis C virus-positive (HCV+). Expert opinion: The risk of bleeding in surgical procedures is higher for hemophilic patients than for other patients and there is also a greater risk of infection. Both these factors increase the risk of a poor outcome. Orthopedic surgery in hemophilia improves the patient's quality of life.
Topics: Blood Coagulation Factors; Factor IX; Factor VIII; Factor VIIa; Hemarthrosis; Hemophilia A; Humans; Orthopedic Procedures; Recombinant Proteins; Risk Factors; Synovectomy; Treatment Outcome
PubMed: 30929534
DOI: 10.1080/17474086.2019.1602035