Sahu Akash, Sable Aashiket, Yadav Sunil, Parmar Nihar, Gawankar Anuj
Department of Orthopaedics, Bharatratna Dr. Babasaheb Ambedkar Municipal General Hospital, Mumbai, Maharashtra, India.
Department of Orthopaedics, Smt Mathurabai Bhausaheb Thorat Sevabhavi Trust Hospital, Nashik, Mumbai, Maharashtra, India.
J Orthop Case Rep. 2025 Jan;15(1):155-159. doi: 10.13107/jocr.2025.v15.i01.5160.
A form of tenosynovial giant cell tumors (GCTs) that diffusely affects the soft tissue lining of joints and tendons is called pigmented villonodular synovitis or PVNS. About equal percentages of men and women are often affected, and it typically affects young individuals. The most typical sites of PVNS are the knee and ankle, making PVNS of the wrist a rare presentation. Patients with PVNS might develop symptoms of carpal tunnel syndrome (CTS) and only a handful of cases are reported in the literature. The gold standard of treatment has traditionally been surgical excision for localized lesions and additional total synovectomy of the affected joint in cases of diffuse PVNS. The objective of this article is to present a patient with PVNS of the right wrist leading to CTS, resolved with surgical treatment which led to satisfactory results.
A 29-year-old right-hand dominant female patient arrived at our out-patient department with complaints of swelling, pain, tingling, and numbness of the right palm. The patient had similar complaints 1 year ago when carpal tunnel release surgery was done for her elsewhere. After 1 year of surgery, the symptoms persisted along with diffuse swelling. Clinical examination of the patient confirmed the presence of CTS. A tenosynovial mass around the flexor tendons located along the carpal tunnel at the level of the distal radioulnar joint was visible on magnetic resonance imaging. The median nerve's conduction velocity was found to be lowered on electrodiagnostic testing. Total lesion excision was done along with carpal tunnel release, and the mass was excised and sent for histopathology. Histopathological evaluation of the extracted material confirmed the diagnosis of PVNS. At the 5-year follow-up, there were no complaints or indications of recurrence.
Localized PVNS of the wrist presenting as CTS is a rare condition. To diagnose this illness, several investigations and a high index of suspicion are needed. Total excision of the lesion, along with surgical release of the carpal tunnel, should be ensured to avoid recurrence.
一种弥漫性累及关节和肌腱软组织衬里的腱鞘巨细胞瘤（GCTs）被称为色素沉着绒毛结节性滑膜炎（PVNS）。男性和女性受影响的比例通常大致相等，且该病通常影响年轻人。PVNS最典型的发病部位是膝关节和踝关节，因此腕部PVNS较为罕见。PVNS患者可能会出现腕管综合征（CTS）的症状，而文献中仅报道了少数病例。传统上，治疗的金标准是对局限性病变进行手术切除，对于弥漫性PVNS病例则需对受影响关节进行额外的全滑膜切除术。本文的目的是介绍一名因右腕PVNS导致CTS的患者，经手术治疗后症状得到缓解，效果令人满意。
一名29岁右利手女性患者因右手掌肿胀、疼痛、刺痛和麻木前来我院门诊就诊。该患者1年前在其他地方接受过腕管松解手术，当时也有类似症状。手术后1年，症状持续存在且伴有弥漫性肿胀。对患者的临床检查证实存在CTS。磁共振成像显示在桡尺远侧关节水平的腕管内屈肌腱周围有一个腱鞘肿物。电诊断测试发现正中神经传导速度降低。进行了病变全切除及腕管松解术，切除肿物并送去做组织病理学检查。对所取材料的组织病理学评估证实为PVNS。在5年的随访中，患者无任何不适主诉，也无复发迹象。
表现为CTS的腕部局限性PVNS是一种罕见疾病。诊断此病需要进行多项检查并保持高度怀疑。应确保病变全切除以及腕管手术松解，以避免复发。
