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Synovial chondromatosis of the interphalangeal joint of the thumb: A case report
Synovial Chondromatosis of the Interphalangeal Joint of the Thumb: A Case Report R. Malhotra, MS, New Delhi, India, S. Gaur, MS, Pondicherry, India, P. K. Dave, Amit K. Dinda, New Delhi, India
Case Report A 27-year-old woman presented with a painless, slowly enlarging mass of 6 months’ duration over the dorsum of the right thumb interphalangeal joint. There was no history of trauma. Examination showed a boggy, firm, ill-defined, nontender mass with no involvement of the skin and no limitation of interphalangeal joint motion. An x-ray film showed only soft tissue swelling (Fig. 1). Exposure through a dorsal, extensor splitting incision revealed a small tumor filled with blue-white cartilaginous fragments. It had displaced the capsule dorsally, forming a sac-like extension under the tendon, but did not involve bone, palmar plate, or capsule. It was removed with the surrounding synovium. Histologic examination showed synovial tissue with numerous foci of cartilage nodules of various size in the deep and superficial layers of synovium, apparently formed by metaplasia of the subsynovial connective tissue. There were no areas of cartilage degeneration, calcification, or ossification (Fig. 2). The patient was followed for 7 years and had no evidence of recurrence.
the thumb.’ This condition seems to have a predilection for young women in contrast to that of the larger joints (e.g., the knee), which mainly affects men. The correct diagnosis may not be considered because of the rarity of the condition, especially if there is no calcification or ossification of cartilage. Although excision of the lesion with synovectomy
Discussion Synovial chondromatosis is rare in finger joints. We have found six reported caseslm5 ; only one of them was in the interphalangeal joint of From the All India Institute of Medical Sciences, Ansari Nagar, New Delhi, and Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India. Received for publication May 29, 1992; accepted in revised form Sept. 12, 1992. No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article. Reprint requests: R. Malhotra, MS, All India Institute of Medical Sciences, Ansari Nagar. New Delhi 110029. India.
460
The Journal
of Hand
Surgery
Figure 1. View of the right thumb
showing soft tissue swelling over the dot-sum of the interphalangeal joint.
The Journal
Figure 2. Photomicrograph
original magnification
showing cartilage nodules X 800).
(C) attached
for this tumor in metacarpophalangeal joints, a more radical approach with arthrodesis has been advised for this problem in the interphalangeal joint. 4~5On the basis of the results of this case, we feel that arthrodesis may not be necessary. is recommended
References 1. Murphy FP, Dahlin DC, Sullivan R. Articular synovial chondromatosis. J Bone Joint Surg 1962;44A:77-86. 2. Lucas CL, Sponsellar PD. Synovial chondrometa-
of Hand
Surgery
to the synovium
/ Vol. 19A No. 3 May 1994
(S) (hematoxylin
461
and eosin stain.
plasia of the hand: case report and review of literature. J Hand Surg 1984;9A:269-72. 3. Lewis MM, Marshall JL, Mira JM. Synovial chondromatosis of the thumb. J Bone Joint Surg 1974:56A: 180-2. 4. Kettlekamp DB, Dolan J. Synovial chondromatosis of an interphalangeal joint of a finger. J Bone Joint Surg 1966:48A:329-32. Harvey FJ, Negrine J. Synovial chondromatosis in the distal interphalangeal joint. J Hand Surg 1990:15A: 102-5.
Case Report A 27-year-old woman presented with a painless, slowly enlarging mass of 6 months’ duration over the dorsum of the right thumb interphalangeal joint. There was no history of trauma. Examination showed a boggy, firm, ill-defined, nontender mass with no involvement of the skin and no limitation of interphalangeal joint motion. An x-ray film showed only soft tissue swelling (Fig. 1). Exposure through a dorsal, extensor splitting incision revealed a small tumor filled with blue-white cartilaginous fragments. It had displaced the capsule dorsally, forming a sac-like extension under the tendon, but did not involve bone, palmar plate, or capsule. It was removed with the surrounding synovium. Histologic examination showed synovial tissue with numerous foci of cartilage nodules of various size in the deep and superficial layers of synovium, apparently formed by metaplasia of the subsynovial connective tissue. There were no areas of cartilage degeneration, calcification, or ossification (Fig. 2). The patient was followed for 7 years and had no evidence of recurrence.
the thumb.’ This condition seems to have a predilection for young women in contrast to that of the larger joints (e.g., the knee), which mainly affects men. The correct diagnosis may not be considered because of the rarity of the condition, especially if there is no calcification or ossification of cartilage. Although excision of the lesion with synovectomy
Discussion Synovial chondromatosis is rare in finger joints. We have found six reported caseslm5 ; only one of them was in the interphalangeal joint of From the All India Institute of Medical Sciences, Ansari Nagar, New Delhi, and Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India. Received for publication May 29, 1992; accepted in revised form Sept. 12, 1992. No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article. Reprint requests: R. Malhotra, MS, All India Institute of Medical Sciences, Ansari Nagar. New Delhi 110029. India.
460
The Journal
of Hand
Surgery
Figure 1. View of the right thumb
showing soft tissue swelling over the dot-sum of the interphalangeal joint.
The Journal
Figure 2. Photomicrograph
original magnification
showing cartilage nodules X 800).
(C) attached
for this tumor in metacarpophalangeal joints, a more radical approach with arthrodesis has been advised for this problem in the interphalangeal joint. 4~5On the basis of the results of this case, we feel that arthrodesis may not be necessary. is recommended
References 1. Murphy FP, Dahlin DC, Sullivan R. Articular synovial chondromatosis. J Bone Joint Surg 1962;44A:77-86. 2. Lucas CL, Sponsellar PD. Synovial chondrometa-
of Hand
Surgery
to the synovium
/ Vol. 19A No. 3 May 1994
(S) (hematoxylin
461
and eosin stain.
plasia of the hand: case report and review of literature. J Hand Surg 1984;9A:269-72. 3. Lewis MM, Marshall JL, Mira JM. Synovial chondromatosis of the thumb. J Bone Joint Surg 1974:56A: 180-2. 4. Kettlekamp DB, Dolan J. Synovial chondromatosis of an interphalangeal joint of a finger. J Bone Joint Surg 1966:48A:329-32. Harvey FJ, Negrine J. Synovial chondromatosis in the distal interphalangeal joint. J Hand Surg 1990:15A: 102-5.