Pigmented villonodular synovitis

Pigmented villonodular synovitis

Description, Causes and Risk Factors:

Abbreviation: PVNS.

Pigmented villonodular synovitis is a rare benign proliferative disorder of uncertain etiology that affects synovial lined joints, bursae, and tendon sheaths. The disorder results in various degrees of villous and/or nodular changes in the affected structures. Annual incidence of PVNS in the United States is estimated at 2 cases per 10,000; incidence of the localized form is 9 cases per 10,000.

PVNS can be of two types: localized and diffuse. The diffuse variant of the disorder affects the whole synovium and it generally develops in the large joints like the hip or knee. It is more destructive out of the two with the treatment being relatively more challenging.

The localized or nodular form of PVNS is rather less prevalent than the other variant and mostly occurs in the smaller joints, for example, in one's hands and feet. It generally begins as a large-sized benign tumor that develops on tendon sheaths of a joint. The tumor can damage the surrounding tissues and bones as it grows larger. Compared to the diffuse form, it is much easier to treat localized PVNS.

When you have PVNS, the lining of a joint becomes swollen and grows. This growth harms the bone around the joint. The lining also makes extra fluid that can cause swelling and make movement very painful.

Prognosis for PVNS is good with total joint replacement or synovectomy. Although the condition has a high rate of recurrence (45%), a patient might take anti-inflammatory drugs like ibuprofen and naproxen to ease the swelling and pain. For a more complete recovery, surgery needs to be combined with postoperative physical therapy and adequate resting.


The symptoms of PVNS generally manifest themselves initially as sudden, unexplained joint swellings accompanied by pain. The joint swellings are at first disproportionate to the extent of pain felt by the patient. Progression of the disorder is characterized by reduced motion, increased pain and stiffness or locking of the particular joint. Localized PVNS frequently manifests initially as painless, slow-growing palpable mass which then progresses to the other symptoms commonly associated with the condition. The swelling often feels warm to touch. A popping feeling might accompany movement of the joint. Recurrent episodes of atraumatic hemarthosis is a major hallmark of this disorder. The symptoms develop gradually and may occur sporadically.


PVNS is radiologically diagnosed by magnetic resonance imaging (MRI). The disorder is difficult to identify and is often not diagnosed for four years or more after presentation due to nonspecific symptoms or a general paucity of symptoms.

PVNS can look like arthritis and some other joint conditions. Your doctor may use tests to check for these conditions. After a physical exam, your doctor may want to take an X-ray of the affected joint.

Your doctor may also want to draw some fluid from the joint and test it. He or she may also want to perform a magnetic resonance imaging (MRI) scan, which takes a picture of the joint.


The best way to treat PVNS is to remove the lining of the joint. This can be done with traditional surgery or with arthroscopy. In arthroscopy, the doctor makes a tiny cut in the skin over your joint. Then a thin tube is put into the joint to remove the lining.

Even with treatment, PVNS comes back about half the time. If the pain comes back again and again, radiation therapy may help. Sometimes, the joint must be completely replaced.

NOTE: The above information is educational purpose. The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition.

DISCLAIMER: This information should not substitute for seeking responsible, professional medical care.


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