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Cureus May 2024Primary synovial osteochondromatosis (PSO), a seldom-seen synovial proliferative disease involving chondral metaplasia, presents a unique challenge when affecting the...
Primary synovial osteochondromatosis (PSO), a seldom-seen synovial proliferative disease involving chondral metaplasia, presents a unique challenge when affecting the ankle joint. Controversy exists regarding whether a combined posterior-anterior approach with total synovectomy is necessary to avert recurrence or malignancy. An 18-year-old Caucasian male presented to the outpatient clinic with clinical and imaging findings indicative of a stage III PSO. The surgical intervention involved a combined posterior-anterior arthroscopic approach with the removal of multiple loose bodies and complete synovectomy, resulting in complete relief of symptoms without recurrence at the 12-month follow-up. Pathological examination confirmed the diagnosis. The management of PSO in the ankle joint using a combined posterior-anterior arthroscopic approach with complete synovectomy demonstrated effectiveness in this case. Regular follow-ups are essential for monitoring long-term outcomes and detecting potential recurrence or malignant transformation.
PubMed: 38910686
DOI: 10.7759/cureus.60843 -
Cureus May 2024Synovial chondromatosis is a rare condition characterized by benign metaplasia of the synovial membrane, leading to nodular growths within the joint space. We present...
Synovial chondromatosis is a rare condition characterized by benign metaplasia of the synovial membrane, leading to nodular growths within the joint space. We present the case of a 58-year-old woman with persistent pain and stiffness in her right elbow, ultimately diagnosed with synovial chondromatosis. Examination revealed joint effusion, tenderness, and restricted range of motion, with palpable loose bodies and ulnar nerve symptomatology. X-ray confirmed the diagnosis. Open synovectomy was performed, with meticulous attention to ulnar nerve protection and decompression. Postoperative care included analgesics, anti-inflammatories, and physiotherapy. Synovial chondromatosis of the elbow requires prompt diagnosis and surgical intervention to alleviate symptoms and prevent complications. Prognosis is favorable with complete removal of the affected tissue. Ulnar nerve palsy should be carefully addressed during surgical management.
PubMed: 38846186
DOI: 10.7759/cureus.59807 -
Cureus Apr 2024Introduction Pigmented villonodular synovitis (PVNS) is a relatively rare disorder affecting the synovial membrane and tendon sheath of a joint. It rarely affects the...
Introduction Pigmented villonodular synovitis (PVNS) is a relatively rare disorder affecting the synovial membrane and tendon sheath of a joint. It rarely affects the shoulder joint. This prospective study aims to document the challenges encountered in achieving total synovectomy and assesses the clinical outcomes of arthroscopic synovectomy for PVNS in shoulder patients. Methods This is a prospective study conducted from April 2017 to September 2023. This monoarticular disease was observed among six patients (four females and two males). All patients underwent arthroscopic extensile synovectomy with biopsy and culture. The outcomes were measured using Constant score, American Shoulder and Elbow Surgeons (ASES), and University of California Los Angeles (UCLA) scores. All patients were followed up for a minimum of 36 months after arthroscopic synovectomy. Results All intraoperative findings were consistent with PVNS and confirmed with histopathological examination. All patients achieved a satisfactory, painless range of movements following surgery. The individual Constant score improved from a mean value of 64.83 to 94.50, the ASES score improved from a mean value of 81.15 to 99.73, and the UCLA score improved from a mean value of 23.16 to 34.83 post-arthroscopic intervention, proving its effectiveness. No recurrences were reported after 36 months of follow-up. Conclusion PVNS can be easily missed, and one must have a high index of suspicion to diagnose early. Delayed presentation of the disease had led to severe destruction of the joint. Early diagnosis and arthroscopic intervention prior to joint destruction are crucial for achieving a good functional outcome. Incomplete excision may lead to recurrence of the disease. Therefore, we propose extensile arthroscopic synovectomy of the shoulder, wherein by expecting and addressing the intraoperative challenges, complete excision can be achieved, thus preventing recurrence.
PubMed: 38707076
DOI: 10.7759/cureus.57492 -
International Journal of Surgery Case... Jun 2024Synovial lipomatosis is a rare disease that often results in joint discomfort, swelling, and effusion. Only a few reported cases have been documented so far.
INTRODUCTION AND IMPORTANCE
Synovial lipomatosis is a rare disease that often results in joint discomfort, swelling, and effusion. Only a few reported cases have been documented so far.
CASE PRESENTATION
We reported a 50-year-old woman with synovial lipomatosis of the ankle joint. The patient presented with left ankle pain since the least two years, accompanied by swelling and redness. Physical examination demonstrated swollen ankle with warmth palpation. Magnetic resonance imaging (MRI) demonstrated hyperintensity of the ankle joint on the posterior and anterolateral side, thickening of the synovium, and bone marrow edema around the talar bone, surrounding the sinus tarsi. Histopathological examination demonstrated fatty tissues with nonspecific inflammation, suggesting synovial lipomatosis. We performed synovectomy, and the pain did not recur at 1 year of follow-up.
CLINICAL DISCUSSION
Synovial lipomatosis is a highly uncommon benign condition. Histopathologically, synovial lipomatosis is characterized by notable adipocyte infiltration into the subsynovial tissue and a villous or frond-like morphology of the synovium. It also features transversely hyperplastic synovial lining cells.
CONCLUSION
Synovial lipomatosis of the ankle joint is a rare entity. Further studies are required to investigate this disease and its management.
PubMed: 38677252
DOI: 10.1016/j.ijscr.2024.109694 -
BMC Infectious Diseases Apr 2024Non-tuberculous mycobacteria (NTM) are environmental organisms that are increasingly contributing to human infections. Mycobacterium immunogenum, a variant of NTM...
BACKGROUND
Non-tuberculous mycobacteria (NTM) are environmental organisms that are increasingly contributing to human infections. Mycobacterium immunogenum, a variant of NTM discovered in 2001, is a rapidly growing mycobacterium that exhibits multidrug resistance. Reports of infections caused by this organism, particularly tenosynovitis in the musculoskeletal system, are limited.
CASE PRESENTATION
A 71-year-old female with vesicular pemphigus, undergoing immunosuppressive therapy, presented with a progressively enlarging tumour on the dorsum of her right hand, along with erythematous papules that extended across her right forearm. The specimens of skin tissues and blood cultures revealed the presence of M. immunogenum. Magnetic resonance imaging evaluation led to the diagnosis of pyogenic extensor tenosynovitis. A multidrug regimen, comprising amikacin and clarithromycin, was initiated, followed by synovectomy. The patient underwent a course of 180 days of antimicrobial therapy and demonstrated no signs of disease recurrence one year after treatment completion.
CONCLUSION
Early diagnosis and surgical intervention are crucial to prevent the adverse prognostic implications of pyogenic extensor tenosynovitis caused by M. immunogenum. Effective management requires precise microbial identification and susceptibility testing, necessitating collaborative engagement with microbiological laboratories.
Topics: Humans; Female; Aged; Tenosynovitis; Early Diagnosis; Mycobacteriaceae; Hand; Nontuberculous Mycobacteria
PubMed: 38609847
DOI: 10.1186/s12879-024-09249-5 -
Journal of Hip Preservation Surgery Jan 2024Secondary hip osteoarthritis due to hip dysplasia is common among Japanese populations. This study aimed to investigate the number of hip preservation surgeries...
Secondary hip osteoarthritis due to hip dysplasia is common among Japanese populations. This study aimed to investigate the number of hip preservation surgeries performed in Japan and assess trends, by age and sex, from 2014 to 2019, focusing on hip arthroscopic surgery, based on the National Database of Health Insurance Claims and Specific Health Checkups of Japan (NDB). We downloaded the files 'Number of calculations by division, sex, and age group' under 'operation (code K)' from 2014 to 2019 from the NDB Open Data Japan database. Data on hip preservation surgeries were extracted, including the number for each surgical procedure and its incidence per year, calculated as the number of surgeries performed for each 10-year age group and by sex, regarding hip arthroscopic surgery. Overall, 14 891 hip preservation surgeries were performed in Japan over the study period, with pelvic osteotomy being the most common procedure. Although the incidence of hip preservation surgeries decreased from 2014 to 2019, there was a specific 1.54-fold higher incidence in hip arthroscopic procedures in 2019 compared to 2014. Hip arthroscopic labral repair was performed more frequently than synovectomy. The highest incidence of hip arthroscopic surgery was in the 40- to 49-years age group, with no difference in incidence between sexes ( = 0.951). In Japan, pelvic osteotomy was performed more often as a hip preservation surgery than hip arthroscopic surgery. Although hip arthroscopic surgery was developed in Japan, its use has not increased from 2017 to 2019.
PubMed: 38606332
DOI: 10.1093/jhps/hnad022 -
Journal of Orthopaedic Case Reports Mar 2024Synovial chondromatosis (SC) is very rare among children. We are aware of no reports of patients with SC accompanied by leg length discrepancy (LLD).
INTRODUCTION
Synovial chondromatosis (SC) is very rare among children. We are aware of no reports of patients with SC accompanied by leg length discrepancy (LLD).
CASE REPORT
We describe a case of synovial osteochondromatosis of a 7-year-old boy complicated by LLD. We performed epiphysiodesis of the distal femur and arthroscopic resection of loose bodies and total synovectomy. Three years after surgery, LLD had been corrected and there was no sign of recurrence.
CONCLUSION
Physicians should be aware of synovial osteochondromatosis complicated by LLD in childhood and take radiographs of the whole length of lower legs when this condition is suspected.
PubMed: 38560319
DOI: 10.13107/jocr.2024.v14.i03.4280 -
Journal of Orthopaedic Case Reports Mar 2024Synovial chondromatosis (SC) is a relatively rare benign disorder characterized by developing many nodules composed of cartilage within the synovial cavities of joints....
INTRODUCTION
Synovial chondromatosis (SC) is a relatively rare benign disorder characterized by developing many nodules composed of cartilage within the synovial cavities of joints. It impacts several joints, with the knee joint being the most often affected. Extra-articular involvement, such as bursae or tendon sheaths, is rare. Furthermore, the coexistence of intra- and extra-articular SC is an infrequent condition. Hence, we present a rare case of SC with intra- and extra-articular involvement.
CASE PRESENTATION
The patient, a 38-year-old woman, reported experiencing progressive right knee discomfort for 2 months. In addition, a growing mass was observed on the medial aspect of the right knee that was noticeable for the past 2 months. MRI examination revealed the presence of both intra-articular and extra-articular lesions. A two-step surgical procedure, including arthroscopy synovectomy involving the debridement of the lesions and removal of the extra-articular mass through an open incision, was performed. Histopathological analysis confirmed SC. At the 1-year follow-up, the patient reported complete relief of discomfort in the right knee.
CONCLUSION
The coexistence of extra-articular and intra-articular SC is an exceedingly rare condition. Surgical removal of the loose bodies and a synovectomy performed as thoroughly as possible constitute the mainstay of treatment in managing SC.
PubMed: 38560316
DOI: 10.13107/jocr.2024.v14.i03.4298 -
Journal of Orthopaedic Case Reports Mar 2024Juvenile idiopathic arthritis ( JIA) is a persistent autoimmune-inflammatory disease that affects children younger than 16. Aggressive synovitis of the hip may cause...
INTRODUCTION
Juvenile idiopathic arthritis ( JIA) is a persistent autoimmune-inflammatory disease that affects children younger than 16. Aggressive synovitis of the hip may cause joint destruction, hip protrusion, erosion, pseudosubluxation, dysplasia, and osteoarthritis. Subluxation of the hip had been reported previously. However, dislocation of the hip in JIA is an extremely rare situation, and only two cases have been reported up to date. Reduction of the dislocated hip has to be performed in any way. However, there is no algorithm to be followed for the treatment of hip dislocations caused by JIA.
CASE PRESENTATION
In this study, we presented two cases of hip dislocation caused by JIA.: An 11-year-old boy had JIA and chronic recurrent multifocal osteomyelitis (CRMO). X-rays and computed tomography (CT) revealed a posterior dislocation of the left hip. An urgent operation was planned for the reduction of the hip. Avascular necrosis, dysplasia, or erosions were not evident at the last follow-up.: An 11-year-old girl was referred to the hospital with excessive left hip pain starting 24 h ago. A limited synovectomy with joint irrigation was performed. However, pathological examination of the synovium showed chronic inflammation consistent with JIA. On the post-operative 10th day, the patient was consulted for an increase in hip pain and deformity of the left hip. X-rays and MRI revealed posterior dislocation of the left hip with synovial hypertrophy. An urgent operation was planned. The hip could be reduced under anesthesia with mild traction, and a pelvipedal cast was applied only for 3 weeks. Avascular necrosis, dysplasia, destruction, or erosions were not evident at the last follow-up.
CONCLUSION
For early diagnosed patient reduction under anesthesia and medial soft-tissue contracture release; for late diagnosed patient medial soft-tissue contracture release, capsulotomy and synovectomy were effective to prevent destruction and early degenerative changes of the hip joint for treatment of dislocation caused by JIA.
PubMed: 38560299
DOI: 10.13107/jocr.2024.v14.i03.4288 -
Radiology Case Reports Jun 2024Lipoma arborescens is a rare and benign intra-articular lesion characterized by a lipomatous proliferation of the synovial membrane, usually affects the knee joint. It...
Lipoma arborescens is a rare and benign intra-articular lesion characterized by a lipomatous proliferation of the synovial membrane, usually affects the knee joint. It presents as an unusual cause of intermittent knee pain and joint effusion. We report a case of lipoma arborescens of the knee in a 23-year-old man that initially resembled inflammatory arthropathy. The diagnosis of Lipoma arborescens was made by magnetic resonance imaging of the knee and confirmed histologically by synovectomy. The purpose of our case is to show the imaging features enabling early diagnosis and appropriate treatment.
PubMed: 38559650
DOI: 10.1016/j.radcr.2024.02.106