Our view on the treatment of patients with chondromas of the hand bones

Chondroma is a benign tumor consisting of mature cartilage cells. It usually grows slowly and may remain asymptomatic for a long time. The course is favorable, however, degeneration into a malignant tumor (chondrosarcoma) is possible, so surgical removal is required. Treatment is carried out as planned in a hospital setting. Tumors are prone to recurrence. Mostly young patients suffer (from 10 to 30 years), the peak incidence occurs at 11-16 years. Most often, chondroma affects the bones (sternum, collarbone, phalanges of the fingers, etc.), but it can also develop in soft tissues and cartilage (chondroma of the ear, larynx). In adults, chondroma most often forms on the tubular bones of the hand, more rarely on the sternum, femur and in the area of ​​the knee joint. The affected areas of the bone tend to develop nodular deformation. If the chondroma is localized on a long tubular bone (especially in the knee joint), there is a high risk of sudden pathological fracture.

Classification

Depending on the location of chondromas, they are divided into:

• ecchondromas or peripheral (formed at the site of the natural anatomical location of cartilage);
• endochondromas or central (grow where normally there is no cartilage tissue).

Echondromas occur in the cartilages of the pelvis, larynx, pubic symphysis, trachea, and costal cartilages. Endochondromas are found on tubular bones, in the parotid, mammary and lacrimal glands, testicles, lungs, ovaries, kidneys, intermuscular tissue and subcutaneous tissue.

Chondroma: causes of development, diagnosis, treatment

Chondroma is a neoplasm consisting of cartilage cells. The formation may not show any signs of presence in the human body due to its slow growth, and symptoms begin to appear only when nearby body parts or organs are pinched. The tumor is considered benign, but may change into a malignant tumor called chondrosarcoma.

Causes

Scientists have not yet been able to discover the specific cause of chondroma. There are several factors that influence tumor development:

• Age (mostly people aged from 10 to 30 years are susceptible to chondroma, while children from 11 to 16 years old are most often affected);
• The entry of viruses into the human body, leading to inflammation of organs;
• Damage to diseases of the spine;
• Polluted environment;
• Bad habits (smoking, alcohol);
• A person’s lifestyle (lack of physical activity, poor diet, lack of sleep);
• Injuries and fractures.

Localization of chondroma

The most common places where the disease occurs are:

• Bones of fingers, hands, feet, thighs, shoulders, legs;
• Throat cartilages;
• Paranasal sinuses;
• Bones of the base of the skull.

The development of the disease in the nasal cavity is dangerous due to difficulty breathing, and if it develops on the tubular bones, it is a source of synovitis (an inflammatory process that is accompanied by the accumulation of fluid in the joint cavity). Sometimes a pathological fracture (bone damage at the site of the disease) may appear.

Classification of the disease

There are several types of chondromas, depending on the type of bone and disease:

• Enchondroma (formation develops inside the bone, and it becomes deformed);
• Echondroma (formation occurs on the plane of the bone, while growth moves closer to the soft tissues).

In addition, scientists classify the disease according to the nature of its course:

• Benign, which grows slowly and does not bother the patient, while it can grow throughout a person’s life without becoming malignant;
• Malignant, accompanied by symptoms characteristic of this disease.

Symptoms of the disease

At the onset of the disease, the patient does not experience any symptoms due to the low growth rate of the tumor. The exceptions are tumors of the paranasal sinuses (paranasal sinuses), tumors in the trachea (mainly affecting the larynx), and the lower part of the skull, where compression of nearby body parts or organs occurs.

With the development of a disease of the hand or foot, a thickening can be noticed, which does not cause the patient any discomfort. Painful sensations occur if the tumor grows large enough to begin to put pressure on the nerve fibers.

When chondroma occurs in the chest area, the ribs are usually affected. At the same time, at the early stage of tumor development, the patient does not experience any symptoms. After some time (sometimes it can be 10 years), painful sensations arise in the chest, which intensify when breathing.

As the tumor affects various parts of the human body, other ailments appear:

• joint pain;
• Aches in the wrist, hands, collarbones, knees, shoulders;
• Migraines, slight dizziness;
• Difficulty breathing air into the lungs;
• Formation of swelling at the site of chondroma;
• Painful thickening;
• Blurred vision.

What is the risk of the disease?

The most severe of all complications of chondroma is its growth into the diseased part of the bone diameter. This occurs due to the tumor being too large. As the chondroma enlarges, thick, strong bone tissue is replaced with elastic cartilaginous tissue, which causes fractures that occur on their own. A sign of such damage is acute pain and a crunching sound in the area of ​​damage.

A dangerous complication of the development of the disease at the base of the skull is compression of the human brain. This results in mild nausea and persistent headaches.

, movement control is impaired.

How is the disease diagnosed?

Testing for chondromas is carried out by oncologists or orthopedic traumatologists. Chondromas of skeletal bones, hands, feet, and cartilage can be detected using x-rays. In this case, the neoplasms look like pathological clearings.

When there is a tumor on the surface of the bone, x-rays are unable to detect the formation, so other methods are used, for example, computed tomography (a method for studying the internal structure of an object), magnetic resonance imaging (a method for obtaining images for studying internal organs and tissues), during which the location of the tumor is determined , appearance and even sizes.

Treatment of tumors

Chondromas are neoplasms, albeit benign, which is why treatment is carried out promptly in the oncology department. Tumors are removed taking into account their location and impact on nearby organs. Also, if such a need arises, plastic surgery of the defect is performed.

Formations in the area of ​​tubular bones are dangerous, as they can change into malignant ones, so in this case, doctors follow the principles of emergency care for patients.

Tumors in the skull area are removed after measuring them and examining the patient for chronic diseases and general condition.
Also, to treat chondromas in this part of the body, radiation therapy is used, which is used in preparation for surgery to reduce the tumor or after surgery to completely remove chondroma cells. Author: K.M.N., Academician of the Russian Academy of Medical Sciences M.A. Bobyr

Diagnostics

To verify the nature of the neoplasm, patients need the following examination:

• consultations with specialists (their profile depends on the location of the suspected chondroma; knowledge of a neurologist, ophthalmologist, otolaryngologist, gynecologist, etc. may be required);
• radiography of the affected area (reveals not the chondroma itself, but foci of its calcification, the degree of involvement and deformation of the bones; with endochondromas, a light round area is sometimes visualized against the background of normal bone tissue);
• CT/MRI of the affected area (detect the exact location of the chondroma, evaluate its size, shape, condition of nearby organs);
• histological analysis of the structure of the neoplasm (chondroma resembles ordinary hyaline cartilage, but with a chaotic arrangement of cells and only elastic fibers without any collagen structures).

Macroscopically, chondroma resembles a translucent nodule of gray or bluish color.

Symptoms

Symptoms of chondromas are usually poor, pain often appears only in connection with trauma and pathological fractures. Often the disease proceeds latently and the site of destruction is discovered by chance. When the hands and feet are affected, there are small, slowly increasing thickenings of the bones. When localized in the distal parts of the extremities, pathological fractures occur. If the chondroma is located in the place where the paranasal sinuses are located, then it is difficult for a person to breathe through the nose. If it is located in the cranial cavity, then due to compression of the brain, dizziness, headaches, and problems with balance and coordination when moving can occur. Symptoms such as visual disturbances and difficulty swallowing may also appear.

Treatment

Mostly surgical. For this purpose, doctors use:

• radical surgical treatment (resection of chondroma within intact tissues with possible subsequent plastic surgery);
• endoscopic removal (for example, removal through endonasal access of intracranial chondroma) is a less traumatic method with faster rehabilitation of patients;
• radiation therapy (used for chondromas of the skull base before and after their removal or in inoperable situations, it helps to destroy the remaining chondroma cells);
• stereotactic radiosurgery (elimination of chondromas with a radiation cyber knife or gamma knife that does not affect healthy tissue).

Case: Patient 60 years old

For a long time I had been bothered by pain in my left knee joint. I contacted surgeons at my place of residence. A diagnosis of arthrosis of the knee joints was made. She received treatment typical for arthrosis. At the next visit, an x-ray of the femur was performed and a tumor of the femur was suspected. Referred to an oncologist. I contacted Euroonco and was consulted by an orthopedic oncologist.

After consultation, a trephine biopsy of the femur was performed. Histological conclusion: enchondroma. Surgical intervention was performed: excochleation of the femur with replacement of the defect with biocomposite material. The pain syndrome was relieved immediately after surgery. The postoperative period was 3–4 days. The patient completed a short rehabilitation course. A knee orthosis was selected. She was discharged from the hospital in satisfactory condition.

Current classification

There are several criteria by which the classification of chondromatosis is formed. First of all, this is the type of pathology by which they determine:

• congenital - heads the category of true articular dysplasia and progresses with the formation of tumors;
• postnatal – benign or malignant (chondroma/chondrosarcoma, respectively).

The second criterion for classification is the form:

• stable - occurs with a small number of formed bodies (single or multiple), after which their formation slows down greatly or stops altogether;
• progressive – the development process is accompanied by the continuous formation of tumors (the number is not limited);
• rare.

Prevention

To avoid the development of the disease, you need to follow 7 rules:

• Always warm up thoroughly before performing strenuous exercise and use warming ointments.
• Additionally protect the knee joint with elastic bandages and bandages before training.
• Avoid sudden weight gain and obesity, so as not to create increased stress on the joints.
• Wear shoes of the appropriate size, made from natural materials and with soft soles. It is advisable to give preference to models with instep supports.
• Try to avoid injuries and blows to the knee area (relevant for contact martial arts).
• Reduce the amount of salty foods in your diet to avoid salt accumulation in the joints. Additionally, you need to reduce the amount of soda, tea and coffee, and also give up alcohol (all this washes away vitamins and minerals).
• Eat more foods rich in calcium, fluoride and zinc. It is advisable to add jellied meat and dairy products to your diet, as they strengthen cartilage and bone tissue.

At the first suspicion of the development of chondromalacia, immediately contact a specialist for diagnosis.

The multidisciplinary CELT clinic employs experienced traumatologist-orthopedic surgeons and has all the necessary equipment.

Treatment. Knee-joint. Chondromalacia of knee cartilage

What is Chondromalacia Patella?

This is the destruction of the cartilage of the posterior (articular) surface of the patella. As a result, the former elasticity is lost and its loosening is observed. According to statistics, chondromalacia of the patella is in first place for the causes of pain at a young age, with the exception of the traumatic consequences of it. Most often, this pathological process occurs in athletes and people engaged in heavy physical labor. Some anatomical features of the joint structure imply a more frequent incidence in women.

A number of authors consider chondromalacia of the patellar cartilage as one of the manifestations of the autoimmune process, which currently requires a greater evidence base. Read more about the treatment of chondromalacia cartilage of the knee

Symptoms

Clinically, chondromalacia of the patella does not manifest itself for a long time; pain appears when the inflammatory process sufficiently spreads through the cartilage tissue. Swelling of the knee joint is often detected; the temperature, as a rule, is either normal physiological or low-grade.

Conservative treatment

Treatment usually begins with conservative methods:

• recreation;
• NSAIDs;
• changing your training regimen;
• After this, a rehabilitation program is prescribed, which is based on stretching the extensor muscles, the iliotibial band, the ligaments that support the patella, and the posterior thigh muscles.
• increasing the strength of the quadriceps muscle, especially the oblique part of the vastus medialis muscle, as the main limiter of patellar mobility. It is believed that due to the weakness of this muscle compared to the vastus lateralis muscle, the patella is subject to external subluxation. Low-range quadriceps strengthening exercises and straight leg raises reduce the patellofemoral joint's response to this imbalance.
• In addition to exercises, you can prescribe elastic bandaging of the knee joint, fixation of the patella with a bandage or orthopedic device.

Surgery

There are many surgical options for treating chondromalacia patella. Most of them are aimed at restoring the correct anatomical position of the femoral-patellar joint, a small part - at the regeneration of the cartilaginous lining. In severe cases, contouring of the articular surfaces and patellectomy are indicated.

Knee arthroscopy

It is not only an important diagnostic, but also a therapeutic procedure. Although the advisability of irrigating the joint cavity and removing pathological tissue during arthroscopy remains a matter of debate, the value of this examination in determining the stage of the disease and planning surgical treatment is obvious. Arthroscopic lavage temporarily reduces pain and improves function by removing dead tissue and proteoglycans produced by inflammation. But since the cause of the disease is not eliminated with this manipulation, the symptoms usually reappear. When arthroscopically staging the disease, the Outerbridge system is widely used because of its simplicity and reproducibility of results. The system is based on determining the location, shape, size and depth of the defect. This kind of minimally invasive technology has an extremely beneficial effect on the outcome of the disease, the duration of rehabilitation, etc. Treatment of chondromalacia of the cartilage of the knee joint now seems to be a simpler task that does not burden the patient, which is important.

• Defects of the first degree are soft thickenings, sometimes swellings.
• Grade II is characterized by depressions and fissures with a diameter of less than 1 cm.
• Grade III damage looks like deep cracks with a diameter of more than 1 cm, reaching the bone.
• Grade IV is characterized by exposure of the subchondral bone.

Lavage and removal of dead tissue is more appropriate for injuries without evidence of patellar instability than for degenerative lesions of a nontraumatic nature. If the patella is tilted and there is minimal damage to the articular surfaces, especially the lateral facet, the lateral edge of the patella can be mobilized with arthroscopy. This intervention is only appropriate for clinically obvious patellar tilt and non-severe joint injuries. In general, arthroscopic lavage and removal of pathological tissue with or without mobilization of the lateral edge of the patella is warranted for grades I–II lesions; in grades III–IV, long-term results are usually poor.

Arthroscopic chondroplasty

For severe cartilage degeneration, arthroscopic chondroplasty is used. Methods of abrasive and microgap chondroplasty include mechanical penetration into the underlying bone with the introduction of bone marrow mesenchymal stem cells into the defects, stimulating the regeneration of fibrocartilaginous tissue. Arthroscopic chondroplasty is usually performed on people under 30 years of age with well-demarcated grade III lesions; for more severe lesions it is contraindicated. This type of surgical intervention has its positive and negative aspects and has found its application in sports medicine. Clinically, the treatment of chondromalacia is no different, but from a functional point of view, the range of motion in the joints returns fully.

Additional methods are aimed at restoring hyaline (articular) cartilage. To regenerate cartilage, implantation of one's own chondrocytes, transplantation of an osteochondral auto- or allograft, and plastic surgery with a fragmented osteochondral graft (mosaic plastic) are performed. Implantation of native chondrocytes is carried out in case of significant through defects in the cartilaginous lining of the femoral condyle, which manifest themselves clinically. First, the patient's chondrocytes are harvested, then they are cultured and placed under a periosteal flap, on the articular surface defect cleared of pathological tissue. According to long-term cooperative studies, good and excellent results were obtained in 79% of cases. The method is indicated for young (20–50 years old) active patients with isolated (2–4 cm²) traumatic defects of the cartilaginous lining of the femoral condyles. The results of filling defects in the patellar surface of the femur or patella are much worse. Contraindications include extensive osteoarthritis, instability or tilting of the patella with subluxation, and previous meniscectomy.

Transplantation of an osteochondral autograft and mosaic plastic surgery are interesting because they use their own intact cartilage to fill deep defects. However, to accurately restore the relief of the articular surface requires considerable technical skill. In addition, the number of donor areas is limited and complications at the sites of cartilage collection cannot be excluded. Osteochondral allografts are usually used for large (10 cm² or more) defects of the femoral condyles and often after failure of other methods. In fresh allografts, chondrocytes are more viable, but at the same time they are more immunogenic and increase the risk of infection transmission. Moreover, fresh allografts are difficult to handle and require the surgeon and the patient to clearly plan the timing of the intervention in a relatively short time. Fresh frozen allografts are less likely to cause immune reactions and provide greater freedom in choosing the timing of surgery, but both chondrocyte viability and long-term graft viability are lower. Patellectomy and patellar contouring are used for extensive injuries to the patella that cause significant impairment of function due to pain, and also when other treatment methods have not produced the desired effect. The results of the methods are ambiguous. Surgeries that require movement of large amounts of tissue, such as osteotomy, transfer and elevation of the tibial tuberosity, and others, will be discussed in the section on patellar tilt and subluxation.

Reasons for activating processes

Due to the peculiarities of the development of pathology, it is almost impossible to determine the exact causes of its occurrence.

There is an assumption that a congenital pathological process is formed as a result of a violation of the embryonic differentiation of articular tissues.

The acquired form is usually associated with external causes that have a negative impact and disrupt metabolic processes within the tissues of the joint.

Additionally, it is noted that joint injuries of various sizes, as well as excessive loads and previous infections can act as a risk factor.

Chondroblastomas

Chondroblastoma is a rare tumor accounting for 1–1.8% of primary bone tumors (10% of all skeletal tumors). Occurs mainly in childhood and adolescence. Favorite location is long tubular bones. It affects the epiphyses and metaphyses (proximal and distal femur, proximal tibia and humerus), less commonly, the pelvic bones and scapula.

Pain prevails, there is slight swelling, sometimes limited movement in the joint and muscle wasting. An x-ray reveals a heterogeneous focus of destruction of a round or oval shape. It is necessary to distinguish between chondroblastomas with solitary enchondroma and the lytic form of osteoblastoclastoma.

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Causes

At this stage of medical development, the causes of the disease remain unclear. There are several theories that can trigger the onset of chondroma development, these include:

• viral damage to the spine (for example: Epstein-Barr virus, herpes virus, retrovirus);
• hormonal imbalance in the body;
• hereditary predisposition;
• taking certain medications (phenacetin, immunosuppressants, estrogens, testosterone);
• long-term exposure to products of industrial origin (gasoline, asbestos, coal, arsenic, cadmium, chromium, nickel);
• long-term exposure to radiation on the body (disasters at nuclear power plants, nuclear weapons, people who work in radiation diagnostic rooms);
• bad habits (alcoholism, smoking, drug addiction).

Degrees of the disease

There are 4 degrees of chondromalacia:

• The first is characterized by thickening and softening of cartilage with the appearance of swellings. There is practically no pain syndrome. The specialist prescribes washing the internal area of ​​the joint capsule.
• The second is that cracks and depressions appear on the joint, which provoke acute pain and have a chronic form. The pathology occurs in professional athletes who train through pain. Specialists excise the inflamed area with surgical scissors and wash the internal cavity of the joint.
• Third, the depressions and cracks are larger than 1 centimeter in size, and the bone opens due to significant deformation. To eliminate the pathology, plastic surgery and the use of a graft are performed.

• The fourth is the most severe degree, which is characterized by exposure of the subchondral bone.

What is hidden under the concept of “chondromatosis of the joint”?

Chondromatosis is usually understood as the formation of tumor formations in the joint cavity, the diameter of which varies (from one millimeter to five centimeters).

Statistical data from clinical rheumatology indicate that the diagnosis in question is rarely made. Among the diagnosed cases, the vast majority of patients are men over 45 years of age. According to available information, there is evidence of the detection of congenital chondromatosis.

Large joints (hip, knee, elbow and shoulder) are most susceptible to damage. Lower risks of developing pathology in the ankle and wrist joints.

Causes

The two main causes of softening of articular cartilage are of greatest importance:

• Intense loads on the joint. Most often the knees of athletes involved in running and jumping are affected.
• Features of the structure of the knee joints. Women are more susceptible to pathology than men due to certain anatomical features.

As a result of pathological changes, articular cartilage begins to deteriorate, becomes soft and loses its elasticity. One of the main functions of cartilage – shock-absorbing – is lost.

At CELT you can get a consultation with a traumatologist-orthopedic specialist.

• Initial consultation – 3,000
• Repeated consultation – 2,000

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Symptomatic picture of chondromatosis of the joints

Knowledge of the key features of the symptomatic picture allows you to form a certain understanding, which makes it possible to promptly seek qualified medical help.

Despite the seriousness of the ongoing pathological process, the symptoms are not at all obvious. The patient may suspect arthrosis or arthritis, but in fact receive a completely different, no less comforting diagnosis.

The main symptoms of chondromatosis: pain localized in the joint, swelling and local redness of the tissues, limited mobility.

Mechanism of disease development

Pathological processes of various types provoke changes in the structure of articular tissues. A number of diseases create conditions for partial replacement of synovial membrane cells, which triggers the development of chondromatosis in the hip, knee or other joint.

At the most favorable moment for the development of pathology, the body activates a compensatory function and starts the process of partial replacement of synovial membrane cells with cartilage tissue, which separates into tumor formations that gradually increase in size.

Over time, the formations penetrate into the joint cavity and, moving freely inside, remain there. If left untreated, the surface of the particles ossifies, which leads to certain difficulties in realizing the functionality of the joint.