Synovial Chondromatosis in the Metacarpophalangeal Joint

Abstract

Synovial chondromatosis (SC) is a benign proliferative metaplasia of joint synovium into cartilaginous tissue. The relative scarcity of presentation in the wrist or hands contributes to the difficulties in accurately diagnosing and obtaining the necessary treatment for SC. We present a 43-year-old man with a 10-month history of stiffness and decreased range of motion of his right first metacarpophalangeal (MCP) joint. On examination, a firm mass was palpated surrounding his MCP joint. X-rays showed only a joint effusion. Subsequent magnetic resonance imaging (MRI) showed an effusion, high signal intensity joint distension, and small erosions. Surgical exploration and complete synovectomy with excision of loose bodies was performed. The pathological diagnosis, based on the clinical examination as well as MRI, was consistent with that of tenosynovial chondromatosis. This case illustrates surgical exploration and pathological investigations may be necessary for SC diagnosis. The literature was reviewed for greater understanding of SC's presentation, diagnosis, and treatment.

Primary Distal Interphalangeal Joint Tenosynovial Chondromatosis of the Small Finger: A Case Report With Literature Review

“…1 Furthermore, there is an extremely low chance of malignant transformation to chondrosarcoma. 6 Primary synovial chondromatosis—which occurs spontaneously—and secondary synovial chondromatosis—the more common entity consisting of free articular cartilaginous fragments occurring due to trauma or degenerative disease—are difficult to distinguish and require a thorough history and physical examination to elucidate. Proper identification of primary synovial chondromatosis through narrowing of the differential diagnosis is vital to ensure prompt and appropriate patient treatment.…”

“…HAND 17 (6) DIP joint and was considered in this patient's differential diagnosis. 10 Patients can be managed nonoperatively with observation, nonsteroidal anti-inflammatory drugs, activity modification, or cryotherapy if they have mild symptoms without limitations of ROM.…”