Pigmented Villonodular Synovitis 719.20

synonyms: PVNS

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)°