Clin Orthop Surg.  2015 Sep;7(3):414-417. 10.4055/cios.2015.7.3.414.

Uncalcified Synovial Chondromatosis in the Pisotriquetral Joint

• Kim HK
• Ha SH
• Lee GJ
• Yu SO
• Kim JR

• KMID: 2234101
• DOI: http://doi.org/10.4055/cios.2015.7.3.414

Abstract

Synovial chondromatosis is a rare lesion in the wrist, but some cases in the distal radioulnar joint have been reported and previous case reports emphasize joint calcifications, shown on preoperative plain radiographs. We report an extremely uncommon case of synovial chondromatosis in the pisotriquetral joint, in which radiographs and magnetic resonance imaging did not demonstrate apparent calcified bodies. In our case, for the accurate diagnosis and treatment, surgical exploration of the joint and synovectomy with removal of loose bodies was performed.

Keyword

Pisotriquetral joint; Wrist; Synovial chondromatosis; Calcification

MeSH Terms

*Chondromatosis, Synovial/diagnosis/physiopathology/surgery
Female
Humans
Middle Aged
*Wrist Joint/physiopathology/surgery

Figure

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  Fig. 1 (A) Preoperative oblique view showing soft tissue swelling around the pisotriquetral joint and widening of the pisotriquetral joint. (B) T2-weighted coronal magnetic resonance imaging (MRI) of the pisotriquetral joint. (C) Juxta-articular axial MRI of the pisiform demonstrating an intraarticular lobulated homogeneous material with surrounding high signal soft tissue.

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  Fig. 2 (A) In Guyon's canal, the ulnar nerve is not compressed by the mass of synovial chondromatosis. (B) Intraoperative findings showing the pisiform and multiple sized cartilaginous materials of the pisotriquetral joint. A few cartilaginous bodies are attached to the synovial membrane. (C) Gross specimen after surgical excision. Small bone on the left side is the pisiform removed for the treatment of flexor carpi ulnaris tendinitis, and materials on the right side are many cartilaginous loose bodies and a few osteocartilage bodies in the pisotriquetral joint.

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  Fig. 3 Low magnification (H&E, ×10) (A) and higher magnification (H&E, ×40) (B) of the representative histology of the tumor, indicating both mature and immature cartilage formation surrounded by fibrous tissue. The beginning of mild woven bone formation is seen, but there is no evidence of malignancy.

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