Disclosures: Christine Koh-Pham, DO: No financial relationships or conflicts of interest

Case Diagnosis: Young female Veteran with chronic progressive anterior knee pain following patellar fracture found to have pigmented villonodular synovitis (PVNS).

Case Description: 39-year-old female Veteran with history of right patellar fracture managed conservatively presented to clinic for evaluation of her chronic right knee pain. She described progressive worsening of her pain with interval knee weakness affecting her ambulation. Right knee X-rays previously obtained revealed mild degenerative changes. A right knee MRI was ordered promptly for concern for pain out of proportion to radiologic findings which revealed extensive synovial thickening throughout the knee with multi-nodular lesions extending from the synovium. Given imaging consistent with PVNS, the patient was immediately referred to orthopedic surgery who performed a biopsy. Biopsy was consistent with diffuse-type tenosynovial giant cell tumor and patient was recommended for local resection of the tumor.

Setting: Veterans Administration Outpatient ClinicAssessment/

Results: Physiatrists are often evaluators of the knee and other joint arthralgia. Prompt advanced imaging such as an MRI should be considered in cases where patients have ongoing, severe, arthralgia in the setting of prior trauma and have failed conservative management.

Discussion: PVNS is an uncommon, benign condition of the synovium of large joints that affects approximately 1.8 million people worldwide. The etiology of PVNS is unclear. There is frequently an association with prior trauma to the region. Patients with PVNS often present with non-specific joint arthralgia mimicking arthritis. MRI is the gold standard for diagnosis and is useful for localization of the tumor. Treatment of PVNS typically involves surgical intervention and a complete synovectomy, which can be difficult with extensive disease or multi-nodular processes, is the gold standard treatment.

Conclusion: Given the aggressive and recurrent nature of PVNS, early surgical intervention is crucial and referral to orthopedic surgery should be promptly considered to avoid future complications and delay of care.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/pigmented-villonodular-synovitis-mimicking-arthritis/