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Loose Bodies

  1. Osteocartilaginous
    1. These are composed of bone & cartilage hence are detected radiologically. It may originate from
    2. Osteochondritis dessicans (most common)
    3. Osteochondral fracture
    4. Osteophyte (osteoarthritis)
    5. Synovial osteochondromatosis
  2. Cartilagenous
    Radiolucent loose bodies usually are traumahc & originate from articular surface of tibia, femur or patella.
  3. Fibrous
    Radiolucent loose bodies occur less frequently and result from hyalinized reaction originating usually from synovium secondary to trauma, or more commonly from chronic inflammatory condition, such as tuberculosis (rice bodies)
  4. Others
    1. lntraarticular tumors such as lipoma & localized nodular synovitis
    2. Bullets, needles, & broken arthroscopic instruments.
  5. Synovial Chondromatosis / Osteochondromatosis
    Synovial chondromatosis is characterized by the formation of metaplastic and multiple foci of hyaline cartilage in the intimal layers of synovial membrane of joint (most common), bursae and / or tendon sheath. The term synovial osteochondromatosis is used when the cartilage is ossified
  6. Etio-pathology
    1. Etiology is uncommon; Cytogenetic studies suggest it a clonal proliferation. Trauma is a possible stimulus of metaplasia of synovial cells into chondrocytes.
    2. Hyaline cartilage forms in stratum synovial of synovial membrane, particularly at the points of reflection.
    3. The nodule initially confined within the synovial lining gradually is extruded into joint cavity, where it is attached at first by a synovial pedicle and later on may be torn free to become a loose body.
    4. The cartilage body may remain unchanged or may become calcified or ossified particularly at center by metaplasia or by endochondral ossification. Bony center undergoes aseptic necrosis.
    5. Nutrition (so growth) carried through pedicle & synovial fluid.
    6. Malignant change to chondrosarcoma is exceedingly rare.
  7. Radiology
    1. Only calcified or ossified bodies are visible; so the number is always much greater than seen in direct film.
    2. Multiple areas of stippled calcification in and around affected joint is seen.
    3. When the lesion is cartilaginous air or double contrast radiography is necessary for visualization. However capsular distension & synovial thickening is seen.
    4. The articular surface of joint is not grossly altered, in contrast to other conditions which give rise to multiple loose bodies.
  8. Clinical Features
    1. This benign neoplasm is very rare. It usually occurs in persons >40 years old but occasionally occurs in adolescents. - It has no hereditary predisposition and patients are usually b/w 30-50 years.
    2. Large diarthroided joints especially Knee is most commonly affected. The condition is usually monoarticular but in 10% case there may be bilateral involvement.
    3. In order of decreasing frequency: Knee> Elbow >Ankle> Hip > Shoulder are involved.
    4. Average duration of symptoms before diagnosis is 4-5 years, with a range of 3-8 years
    5. Dull ache, swelling, stiffness, transient locking episode and grating sensations are usual complains. Generalized joint tenderness, thickening of soft tissues through which nodules (loose bodies) and crepitus may be palpable.
  9. Arthroscopy
    Characteristic appearance of joint full of cartilagenous loose bodies produces snow storm appearance
  10. Treatment
    Removal of loose bodies and partial synovectomy, often performed arthroscopically. Extensive and complete synovectomy is impractical and usually not necessary. The condition has definite tendency to resolve spontaneously

Pattern Of Joint Involvement




Rheumatoid Arthritis

Psoriatic Arthritis


PIP, DIP & 1st CMC (carpometacarpal) joints

PIP, MCP, wrist

DIP, PIP and any joint


MCP (metacarpophalangeal) & wrist

DIP joint

Sparing of any joint

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