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AJR 2005; 184:1223-1224
© American Roentgen Ray Society

Radiologic-Pathologic Conference of Brooke Army Medical Center

Tenosynovial Chondromatosis of the Ring Finger

Liem T. Bui-Mansfield1,2,3, Daniel Rohini4 and Mark Bagg5

1 Department of Radiology, Brooke Army Medical Center, 3851 Roger Brooke Dr., San Antonio, TX 78234.
2 Department of Radiology, Uniformed Service University of the Health Sciences, Bethesda, MD 20814-4799.
3 Department of Radiology, Wake Forest University School of Medicine, Medical Center Blvd., Winston-Salem, NC 27157-1088.
4 Department of Pathology, Brooke Army Medical Center, San Antonio, TX 78234.
5 Department of Surgery, Orthopedic Service, Brooke Army Medical Center, San Antonio, TX 78234.

Received August 29, 2004; accepted after revision November 15, 2004.

The opinions and assertions contained herein are those of the authors and should not be construed as official or as representing the opinions of the Department of the Army or the Department of Defense.

Address correspondence to L. T. Bui-Mansfield (liem_mansfield{at}hotmail.com).

A59-year-old woman presented with a long history of pain and swelling in her right ring finger. Radiographs showed soft-tissue swelling and a calcified body within soft tissue adjacent to the proximal interphalangeal joint of the ring finger (Figs. 1A and 1B). The patient underwent synovectomy and excision of an extracapsular calcified body adhering to the radial aspect of the flexor tendon of the ring finger. Histologic evaluation showed benign cartilaginous tissue with overlying scant synovial tissue, consistent with tenosynovial chondromatosis (Figs. 1C and 1D).



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  		Fig. 1A. —59-year-old woman with tenosynovial chondromatosis of ring finger. Anteroposterior (A) and oblique (B) radiographs of ring finger show soft-tissue swelling and calcified body (arrow) adjacent to proximal interphalangeal joint.

 


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  		Fig. 1B. —59-year-old woman with tenosynovial chondromatosis of ring finger. Anteroposterior (A) and oblique (B) radiographs of ring finger show soft-tissue swelling and calcified body (arrow) adjacent to proximal interphalangeal joint.

 


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  		Fig. 1C. —59-year-old woman with tenosynovial chondromatosis of ring finger. Photomicrograph shows cartilaginous nodule (arrowhead) under synovial membrane (arrow). (H and E, x4)

 


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  		Fig. 1D. —59-year-old woman with tenosynovial chondromatosis of ring finger. Photomicrograph shows no nuclear atypia of cartilaginous cells. (H and E, x40)

 

Differential diagnosis of a calcified soft-tissue mass of the finger includes soft-tissue chondroma, periosteal chondroma, tenosynovial chondromatosis, tumoral calcinosis, hydroxyapatite deposition disease, and foreign body.

Synovial chondromatosis is the result of synovial metaplasia. It can be either a primary (of unknown cause) or a secondary form, which may be due to a joint abnormality such as osteoarthritis (most common), an osteochondral fracture, or a neuropathic arthropathy. It may be found within the joint (intraarticular synovial chondromatosis), which is more common, or within the tendon sheath (tenosynovial chondromatosis).

Tenosynovial chondromatosis occurs most commonly in the hands and feet, although cases have also been reported in the knees, shoulders, hips, and ankles. In the hand, the flexor tendons (n = 17) are slightly more commonly involved than the extensor tendons (n = 12) [1, 2]. The mean age of patients with synovial osteochondromatosis in the hand is 50 years (age range, 13-80 years), with a slight female bias (57%) [1]. Although pain, swelling, and loss of motion are the most common presenting symptoms, many patients are asymptomatic. Trigger finger deformity or carpal tunnel syndrome may occur. The time to diagnosis may vary, ranging from 5 weeks to 18 years (median duration, {approx} 2 years) before medical intervention [3].

Fetsch et al. [3] reported that nine cases (39%) of tenosynovial chondromatosis had mineralization, ranging from mild to a marked degree. They found cortical erosion in 24% of the cases [3]. CT can show the osteocartilaginous bodies of moderate density (100-300 H) and can determine their precise location (intraarticular vs tenosynovial).

Treatment of tenosynovial osteochondromatosis in the hand and wrist is complete excision. However, the recurrence rate is high, between 24% and 88% [1, 3].

References

  1. Roulot E, Le Viet D. Primary synovial osteochondromatosis of the hand and wrist: report of a series of 21 cases and literature review. Rev Rhum Engl Ed1999; 66:256 -266[Medline]
  2. DeBenedetti MJ, Schwinn CP. Tenosynovial chondromatosis in the hand. J Bone Joint Surg Am1979; 61:898 -903[Abstract/Free Full Text]
  3. Fetsch JF, Vinh TN, Remotti F, Walker EA, Murphey MD, Sweet DE. Tenosynovial (extraarticular) chondromatosis: an analysis of 37 cases of an unrecognized clinicopathologic entity with a strong predilection for the hands and feet and a high local recurrence rate. Am J Surg Pathol 2003;27:1260 -1268[Medline]

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