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Pigmented Villonodular Synovitis M12.20 719.20

 

synonyms: PVNS

PVNS ICD-10

PVNS ICD-9

  • 719.20 (villonodular synovitis: site unspecified)
  • 719.21 (villonodular synovitis: shoulder region)
  • 719.22 (villonodular synovitis: upper arm)
  • 719.23 (villonodular synovitis: forearm)
  • 719.24 (villonodular synovitis: hand)
  • 719.25 (villonodular synovitis: pelvic region and thigh)
  • 719.26 (villonodular synovitis: lower leg)
  • 719.27 (villonodular synovitis: ankle and foot)
  • 719.28 (villonodular synovitis: other specified sites)
  • 719.29 (villonodular synovitis: multiple sites)

PVNS Etiology / Epidemiology / Natural History

  • Uncommon proliferative disorder of they synovium.
  • May be a neoplastic disorder with reactive synovitis.
  • Etiology unknown.
  • Generally 3rd - 4th decades. Can occur at any age.

PVNS Anatomy

PVNS Clinical Evaluation

PVNS Xray / Diagnositc Tests

  • MRI: T1 images show predominantly low signal intensiti. T2 images show low to intermediate signal. Intra-articular nodular masses; modest vascularity on gadoliunium images; "blooming" on gradient echo images (ferrous-laden tissue)
  • Diagnosis is confirmed by biopsy.

PVNS Classification / Treatment

  • Localized:
  • Diffuse:
  • Treatment: total synovectomy (open or arthroscopic) (DePonti A, Arthroscopy 2003;19:602).
  • Recurrence is common.

PVNS Associated Injuries / Differential Diagnosis

  • Hoffa's disease
  • Post traumatic inflammation
  • Patellar fat pad fibrosis
  • Chondroma

PVNS of the Knee Arthroscopic synovectomy Complications

  • Recurrence
  • Iatrogenic chondral injury
  • Hemarthrosis / hematoma
  • DVT: 9.9%, proximal DVT rate = 2.1% (Ilahi OA, Arthroscopy, 2005;21:727)
  • Stiffness / Arthrofibrosis
  • Arthritis
  • Infection
  • NVI (saphenous neuralgia)
  • Fluid Extravastion / Compartment Syndrome
  • Complex Regional Pain Syndrome: rare
  • Synovial fistula

PVNS Follow-up Care

  • WBAT with crutches as needed. Home ROM and strengthening program.

PVNS Review References

  • (DePonti A, Arthroscopy 2003;19:602)°