Swelling of the right ankle of several months duration. Joint pain and locking, tenderness and limited range of motion.
The patient, without relevant past medical history presented with swelling of the right ankle of several months duration. She also suffered from joint pain and locking. Physical examination of the swollen ankle demonstrates tenderness and limited range of motion.
The first description of synovial osteochondromatosis (SOC) was presented by Ambroise Paré in 1558 when discussing loose cartilage bodies in the joints. SOC is more frequently seen in males and often diagnosed during 3rd to 5th decades of life. Large joints, in decreasing order of frequency: knee, elbow and ankle joint, are involved. Bilateral or even polyarticular distribution may be observed. It is generally believed that primary SOC is caused by hyperplastic chondrometaplasia of the synovium with subsequent endochondral bone formation and formation of calcified loose bodies within the joint space. Three phases of primary SOC are described. Synovial metaplasia without loose bodies, metaplasia with development of loose bodies, and an inactive phase, with loose bodies but without synovial metaplasia. The etiology of SOC remains unknown. Patients with SOC usually present with chronic pain, stiffness, swelling and limitation of motion. The radiological diagnosis of SOC is based on the demonstration of cartilaginous loose bodies of variable number that are enclosed by a thickened synovial joint capsule. Subsequently, these nodules may calcify and ossify to a variable extent. In long standing disease, cortical scalloping and bony erosions may develop secondary to pressure changes. Differential diagnosis of SOC includes synovial sarcoma, i.e. soft tissue sarcoma with calcification, intraarticular loose bodies secondary to osteoarthritis, peripheral chondrosarcoma and unusual conditions, such as synovial hemangioma or hemangiosarcoma. SOC may be complicated by degenerative osteoarthritis or, more seldomly, by malignant transformation into chondrosarcoma. Treatment of SOC consists of surgical removal of the loose bodies and complete synovectomy of the involved joint. Recurrence rates of 11% are reported following therapy.
Synovial osteochondromatosis
Based on the provided right ankle X-ray and CT images, the following main features are observed:
Based on a 26-year-old female patient presenting with right ankle swelling, pain, joint locking, and limited range of motion, and in conjunction with the radiographic findings, the following differential diagnoses should be considered:
Considering the patient's young age, chronic pain and swelling, synovial irritation symptoms (e.g., joint locking), and multiple calcified loose bodies on imaging, the most likely diagnosis is Synovial Osteochondromatosis (SOC).
If further confirmation is required, MRI can be utilized to closely assess synovial and soft tissue involvement, or a definitive diagnosis may be established through surgical exploration and pathological examination.
For a confirmed diagnosis of Synovial Osteochondromatosis, the primary treatment strategy is surgical. This may include:
Postoperatively, or for patients not undergoing surgery at the moment, the following rehabilitation/exercise prescription is recommended:
Throughout rehabilitation, carefully monitor pain and swelling, adjusting exercise intensity and frequency as needed. In the event of significant swelling or worsening pain, seek medical evaluation promptly and modify the rehabilitation plan accordingly.
This report is based solely on the provided medical history and imaging information. It aims to assist clinical reasoning and should not be considered a substitute for an in-person consultation or professional medical advice. Actual treatment and rehabilitation details must be determined under the guidance of a qualified specialist.
Synovial osteochondromatosis
