Definition
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• Tenosynovial chondromatosis is a multinodular cartilaginous proliferation that arises from tenosynovial membranes, due to synovial metaplasia

Terminology
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• Also called tenosynovial or bursal chondromatosis

Epidemiology
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• M > F; ages 20-86 years (mean and median age are 46 years)

Sites
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• Fingers (50%), feet (20%)
• Also wrists, ankles, palm, knee, forearm

Clinical features
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• May present as painless mass, mass with mild tenderness with pressure, loss of motion of affected area

Radiology
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• Multiple calcifications; may have erosion of underlying bone

Radiology images
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Multiple calcifying nodules

Case reports
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• 23 year old man with 6 month history of pain and swelling of right middle finger (J Orthop Surg (Hong Kong) 2012;20:406)
• 48 year old woman with mass and pain in first web space of hand dorsum (Oman Med J 2012;27:316)
• 59 year old woman with pain and swelling in right ring finger (AJR Am J Roentgenol 2005;184:1223)

Treatment
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• Complete excision recommended, 24-88% recur

Clinical images
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Dorsal first web space

Multiple rice bodies within synovial sheath

Gross description
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• Bluish white subsynovial nodules, mm to cm in size, which conglomerate into lobulated mass attached to synovial membranes

Micro description
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• Multinodular cartilaginous proliferation involving tenosynovium or subsynovial connective tissue
• Cartilaginous matrix more intensely basophilic than chondroma of soft parts
• Often minute cartilaginous nodules
• May have mild or moderate atypia
• Occasionally prominent mineralization
• Rarely crystalline deposits mimic tophi (APMIS 2004;112:624)
• Rarely malignant transformation, which resembles synovial chondrosarcoma

Micro images
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Nodule surrounded by tenosynovial membrane

Differential diagnosis
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• Differential diagnosis of extra-osseous tenosynovial chondromatosis includes chondroma (periosteal or soft tissue), hemangiomatosis, tumoral calcinosis / hydroxyapatite deposition disease

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