Synoviochondrometaplasia & Neuropathic Arthropathy (DRAFT) Flashcards
What are alternative names for Synoviochondrometaplasia?
(SCM) Synovial osteochondromatosis
Synovial Chondromatosis
what is SCM?
creation of osteochondral loose bodies inside the joint capsule
what are the forms of SCM?
Idiopathic: primary SCM (grows off synovial villi)
Degenerative: secondary SCM (2* to a degenerative process)
what are the pathologic features of 1* SCM?
- synovium undergoes metaplasia, forms exuberant synovial villi
- ends of villi form cartilage bodies, which can eventually ossify +/or break free
what are the pathologic features of 2* SCM?
degeneration results in cartilage flaking off. flakes act as accretion site and continue to grow
- can eventually ossify
what are the clinical features of SCM?
non-specific
- joint pain
- swelling
- crepitus
- locking
what is the #1 symptom of SCM that actually correlates ~specifically?
joint locking
what are the preferential locations of SCM?
70% knee MC
- hip
- shoulder
- elbow
- ankle
-wrist
what is the #1 cause of jt locking in the knee?
meniscal tear
what are the radiographic features of 1* SCM?
- loose bodies w/ similar size + shape (only seen if ossify)
- none-mild degenerative change (early in disease; 1* SCM can create degeneration
- 1-100s of loose bodies
what is the treatment for 1* SCM? what are the consequences and subsequent management of this treatment?
Loose body resection
Synovectomy: synovium lining must be removed to prevent recurrance
- no synovium = decrease imm. function, decrease lubrication, and increase degeneration
- lubricant injection every 6 months (glucosaminoglycan)
what are the radiographic features of 2* SCM?
- loose bodies w/ different size + shape (only seen if ossify)
- pre-exisiting moderate to severe degenerative change
- 1-10 loose bodies
what is the treatment for 2* SCM?
conservative management, NSAIDs
Arthroscopic loose body removal: vacuuming out loose bodies (degeneration isn’t of concern b/c pre-exists)
what is another name for Neuropathic Arthropathy?
(NA) Charcot Joint
What is Neuropathic Arthropathy?
progressive joint destruction secondary to a neurological disorder
what are some neurological disorders that may result in neuropathic arthropathy?
- Peripheral neuropathies (no pain sense –> stocking & glove anesthesia); eg. diabetes mellitus, alcholism, MS, Charcot-Marie-Tooth disease
- Central motor abnormalities; eg. neuro syphilis aka 3* syphilis (uncommon)
- Syringomyelia (relatively common)
- Iatrogenic cases
- Hanson disease aka Leprosy
what is the preferential location of Neuropathic Arthropathy?
weight-bearing joints MC:
- lumbar
- knee
- foot/ankle
what is the preferential location of Neuropathic Arthropathy when secondary to Syringomyelia?
shoulder & UE joints
what is the pathogenesis of neuropathic arthropathy?
- abnormal joint mechanics
- possible alterations in vascular supply
what are the 2 forms of Neuropathic arthropathy?
Hypertrophic & Atrophic
what is Hypertrophic Neuropathic Arthropathy?
rapid + severe secondary joint degeneration
- progressive articular & subchondral bone destruction is accelerated by lack of pain + proprioception
what is Atrophic Neuropathic Arthropathy?
resorption of bone
- tapered bone ends, missing parts (atrophy of bones)
what are the clinical manifestations of Neuropathic arthropathy?
- altered joint biomechanics / gait (eg. slapping or stomping)
- pain insensitivity; painless instability
- joint enlargement / swelling w/ warmth
- crepitus
- symptoms worsen over weeks, months, years
- “bag of bone” appearance
- “surgically amputated” appearance
what are some buzz word terms used in describing the clinical presentation of neuropathic arthropathy?
“Bag of bone”
“Surgically amputated”
what neumonic can be used when describing the clinical presentation of Hypertrophic NA? what is required for diagnosis?
6 D’s (3 Di words, 3 De words); require minimum of 3 D’s to diagnose
- Distension
- Dislocation
- Disorganization
- Density (subchondral sclerosing)
- Debris
- Destruction
what are the clinical presentations of Atrophic NA?
(vascualr component)
- tapered distal margins of bones: “licked candy stick” appearance
- surgically amputated appearance
what buzz word term is used exclusively in describing Atrophic NA?
“licked candy stick” appearance
- likely in diabetics (the irony lol)
what is the MC cause of neuropathic arthropathy?
diabetes
what is the most clinically significant component of Synoviochondrometaplasia?
joint locking w/ eventual joint destruction
what is the clinical significance of OPLL?
central canal stenosis w/ SC compression
