Synovial Chondromatosis of the Elbow: A Case Report and Discussion of Feared Complications

TL;DR

This case report discusses synovial chondromatosis of the elbow and highlights the risk of its malignant transformation.

Contribution

The paper provides a case report and literature review focusing on malignant transformation of synovial chondromatosis.

Findings

Arthroscopy and synovectomy are commonly used for first-time synovial chondromatosis cases.

Computed tomography is optimal for assessing intra-articular calcifications in synovial chondromatosis.

Magnetic resonance imaging is best for determining tissue extension in synovial chondromatosis.

Abstract

Synovial chondromatosis (SC) is a rare, benign neoplasm of synovium-lined joints that commonly presents with decreased mobility, pain, and swelling. It is believed to arise from mesenchymal cells that undergo cartilaginous metaplasia, the histological hallmark of the disease. There is a concern for malignant transformation to synovial chondrosarcoma (SCH). We report a case of SC with a subsequent literature review regarding malignant transformation. A 69-year-old male presented with a progressive history of right elbow pain and stiffness. On examination, the patient had significant limitation of range of motion (ROM) and tenderness of the elbow. X-rays and MRI showed findings suggestive of SC. This was treated operatively with removal of the loose bodies, and the patient was able to return to all his activities pain free. The Boolean search strategy of PubMed was utilized to include articles from 1980 to 2025. A total of 611 articles were identified, which were narrowed to 17 after blinded tier one and two screenings by three authors utilizing Rayyan. The extracted data included the mean patient age/number of patients, history, affected joints, procedures performed, SC size, follow-up, recurrence, timeline for malignant progression, and treatment used for SCH. Our review found that although plain radiograph is used most for initial assessment, computed tomography is the optimal modality to determine the characteristics of the intra-articular calcifications, while magnetic resonance was best suited for determining extension into surrounding tissues. Of the surgical interventions used, arthroscopy and synovectomy were most used in first-time occurrences. Those who develop recurrence or malignant transformation seek more aggressive intervention such as hemipelvectomy, laminectomy, or amputation. SC can normally be successfully treated with synovectomy. However, it is necessary to balance minimally invasive treatment and to reduce the risk of recurrence or malignant transformation.

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