A Rare Case of Localized Pigmented Villonodular Synovitis of the Wrist presenting as Carpal Tunnel Syndrome.

Abstract

Introduction: A form of tenosynovial giant cell tumors (GCTs) that diffusely affects the soft tissue lining of joints and tendons is called pigmented villonodular synovitis or PVNS. About equal percentages of men and women are often affected, and it typically affects young individuals. The most typical sites of PVNS are the knee and ankle, making PVNS of the wrist a rare presentation. Patients with PVNS might develop symptoms of carpal tunnel syndrome (CTS) and only a handful of cases are reported in the literature. The gold standard of treatment has traditionally been surgical excision for localized lesions and additional total synovectomy of the affected joint in cases of diffuse PVNS. The objective of this article is to present a patient with PVNS of the right wrist leading to CTS, resolved with surgical treatment which led to satisfactory results.

Case report: A 29-year-old right-hand dominant female patient arrived at our out-patient department with complaints of swelling, pain, tingling, and numbness of the right palm. The patient had similar complaints 1 year ago when carpal tunnel release surgery was done for her elsewhere. After 1 year of surgery, the symptoms persisted along with diffuse swelling. Clinical examination of the patient confirmed the presence of CTS. A tenosynovial mass around the flexor tendons located along the carpal tunnel at the level of the distal radioulnar joint was visible on magnetic resonance imaging. The median nerve's conduction velocity was found to be lowered on electrodiagnostic testing. Total lesion excision was done along with carpal tunnel release, and the mass was excised and sent for histopathology. Histopathological evaluation of the extracted material confirmed the diagnosis of PVNS. At the 5-year follow-up, there were no complaints or indications of recurrence.

Conclusion: Localized PVNS of the wrist presenting as CTS is a rare condition. To diagnose this illness, several investigations and a high index of suspicion are needed. Total excision of the lesion, along with surgical release of the carpal tunnel, should be ensured to avoid recurrence.