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What Is Pvns In The Knee

What Are The Symptoms Of Pvns In The Knee

Pigmented Villonodular Synovitis PVNS – Everything You Need To Know – Dr. Nabil Ebraheim

Most commonly, adults ages 50 and over have symptoms of PVNS and the disease has the potential to progress rapidly. Symptoms typically include:

  • Rapid swelling of the joint
  • Moderate or mild pain in the knee
  • Pain that worsens with movement
  • Catching or locking sensation in the knee
  • Weakness in the knee, feeling like the knee will collapse
  • Warmth or tenderness over the joint

How Long Is The Recovery After Pvns Arthroscopic Surgery

Following arthroscopic synovectomy, patients can bear weight as tolerated and recovery often takes 6 weeks or more. During this recovery time, patients will be encouraged to participate in physical therapy with a qualified therapist. Physical therapy will continue to help the patient maintain full range of motion of the knee as well as to strengthen the surrounding muscles. Recovery time will vary, based on the patients age, health and type of PVNS as well as treatment. In general, most patients with a minimal treatment return to their normal work, sports and play activities within a few months.

For more resources on pigmented villonodular synovitis of the knee and the treatment options available, please contact the office of Benedict Nwachukwu, MD, orthopedic knee specialist serving Manhattan, New York City and surrounding New York boroughs.

If The Pain Comes Back What Can I Do To Feel Better

You can ease the pressure on the joint that hurts by resting it. For example, you might use crutches to keep weight off of your sore knee or hip. Or you might need to stay off of your feet. This may also let the swelling go down. You can take a medicine called ibuprofen to help with the pain and swelling. Most people with PVNS have times when they have no pain and can do their normal activities.

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How Is Pigmented Villonodular Synovitis Diagnosed

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 take some fluid from the joint and test it. He or she may also want to perform a magnetic resonance imaging scan, which takes a picture of the joint.

Pigmented Villonodular Synovitis Treatment

Pigmented villonodular synovitis of the knee in a patient ...

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.

You can ease the pressure on the affected joint by resting it. For example, you might use crutches to keep weight off your sore knee or hip. Or you might need to stay off your feet. This may also relieve swelling. You can take an over-the-counter anti-inflammatory medicine such as ibuprofen , aspirin and naproxen to ease the pain and swelling.

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Who Gets Pvns And Why

PVNS isn’t common. It usually affects people 20 to 45 years old, but it can also occur in children and people over 65 years old. It may happen slightly more often in men.

Doctors don’t know exactly what causes PVNS. It doesn’t seem to run in families. It doesn’t seem to be caused by certain jobs or activities. Some people with PVNS remember that they hurt their joint at some time in the past.

Pigmented Villonodular Synovitis: A Rare Problem And A Challenging Diagnosis

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Douglas W. Jackson, MD, asks 4 questions of Joshua S. Dines, MD, about the history of PVNS.

While it is an uncommon finding, if you do enough surgery on joints, one day you will come across pigmented villonodular synovitis . With the advent of MRI, the diagnosis and/or occurrence of this entity is usually known in advance. However, occasionally it occurs as a localized manifestation which can be an unexpected finding. For this interview I asked Joshua S. Dines, MD, to share his insights into LPVNS from his work on the Sports Medicine and Shoulder Service, at The Hospital for Special Surgery in New York, N.Y.

Douglas W. Jackson, MDChief Medical Editor

Douglas W. Jackson, MD: What is the incidence of LPVNS of the knee and how it is characterized?

Joshua S. Dines, MD: PVNS is a proliferative condition of the synovium that most often affects the knee. There are two forms described in the literature: LPVNS and diffuse . It is debatable whether LPVNS and DPVNS are discrete pathologic entities or similar processes at different ends of the same disease spectrum. Either way, it is important to distinguish between the two, as the treatment and prognosis for each process differs.

Jackson: What are some of the findings and symptoms that may raise consideration in the differential diagnosis of internal derangements? Is imaging helpful?

Joshua S. Dines

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How We Approach Pigmented Villonodular Synovitis

Dana-Farber/Childrens Hospital Cancer Center provides comprehensive medical and surgical care for children and adolescents with PVNS.

We understand that you may have a lot of questions when your child is diagnosed with an PVNS. Is it dangerous? Will it affect my child long-term? What do we do next? Weve tried to provide some answers to those questions, and our experts can explain your childs condition fully. If you have further questions during your hospital stay, our experts can answer your questions fully.

Our multidisciplinary approach to care ensures that your childs case will be given thoughtful discussion by an integrated care from a team that includes the following specialists:

  • pediatric oncologists, surgical oncologists, and radiation oncologists
  • pediatric experts from every medical subspecialty, such as orthopedics, ophthalmology, physical therapy, and radiology, among others
  • highly skilled and experienced pediatric oncology nurses
  • Child Life specialists, psychologists, social workers, and resource specialists who provide supportive care before, during, and after treatment

In addition, our cancer center offers the following services:

The commitment and compassion with which we care for all children and families is matched only by the pioneering spirit of discovery and innovation that drives us to think differently, to find answers, and to build a better tomorrow for children everywhere.

How Is Pvns Diagnosed

PVNS : Pigmented VilloNodular Synovitis.

Proper diagnosis from a skilled orthopedic specialist such as Dr. Nwachukwu is vital to receiving proper treatment. For patients in New York, PVNS is diagnosed based on MRI scans, XRs can be obtained to assess for joint status and any degeneration. If an injury has occurred and an X-ray or MRI has been ordered, periarticular erosions and/or loose bodies may be seen and treatment will need to be prescribed. A current MRI is helpful in assessing the extent of PVNS the knee and allowing appropriate decisions to be made regarding treatment.

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Disability Benefits For Pigmented Villonodular Synovitis

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Pigmented Villonodular Synovitis

Pigmented villonodular synovitis is a rare condition that by some estimates occurs in approximately 44 individuals per 100,000 in the localized form and 11 per 100,000 in the diffuse form .

In PVNS, the tissues that line the joint, called the synovium, become inflamed, much like in arthritis, and begin to form a mass that enlarges gradually. Symptoms can include pain, swelling , limitation of movement, and locking of the joint. In some cases, the normal joint structure can be destroyed. The knee is the most commonly affected joint, followed by the hip. But it can occur in other joints such as the shoulder, elbow, ankle, wrist, finger, and rarely the jaw. The average age of diagnosis for this condition is 35 years. The cause of PVNS is unknown. Treatment involves surgery to remove the tumor and damaged portions of the joint. Id.

The cause of this rare condition is not known. However, more than half of persons who develop PVNS have a history of a prior injury to the joint.

The diagnosis of PVNS is usually made by taking x-rays or performing an MRI of the involved joint. Aspiration of the joint may reveal bloody fluid inside the joint. A biopsy of the tissue will confirm the diagnosis.

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Symptoms Of Pigmented Villonodular Synovitis Of Knee Include:

  • Periods of swelling and pain that comes and goes.
  • Increasing swelling.
  • Gradual increase in pain.
  • Joint catching or locking.

Pigmented Villonodular Synovitis or PVNS of Knee is a serious condition and if not treated soon, it can spread to other tissues. An MRI scan should be taken along with synovial fluid aspiration from the knee for testing. A biopsy also helps confirm the diagnosis. Treatment for Pigmented Villonodular Synovitis or PVNS of knee involves removal of the tumor via a synovectomy to remove the inflamed lining. Some patients may have recurrence in which case radiation therapy can be used. In case of the repeated recurrence, a full knee replacement surgery can be done.

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Does Knee Pvns Come Back

If the patient is treated with joint replacement, PVNS does not typically return. Localized PVNS very rarely returns in the knee after surgery. However, diffuse PVNS has a higher risk of returning. 10 30% of patients with diffuse PVNS may need a joint replacement due to joint degeneration and recurrence. Diffuse PVNS patients will also need to follow up with Dr. Nwachukwu for several years.

Symptoms Of Knee Synovitis

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  • Pain, swelling and stiffness in the knee joint.
  • The knee may feel warm and inflamed.
  • It may appear red over the painful area.

Further investigations include taking a sample of fluid from the joint with a needle and considering further imaging to explore possible causes. In cases of arthritis, infection, or gout an MRI is unnecessary.

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What Is Knee Synovitis

Knee synovitis occurs when the synovial membrane which lines and lubricates the knee joint, becomes inflamed. Synovitis may be caused by other conditions, such as rheumatoid arthritis or gout. Or it may simply develop on its own.

All of the large joints in the body are synovial joints. These joints are surrounded by a synovial membrane which encapsulates the joint. Its purpose is to lubricate it by secreting synovial fluid.

This lining can become inflamed, causing pain and stiffness in the joint.

What Are The Treatment Options Available

Non-surgical treatment:

Pigmented villonodular synovitis is a progressive, degenerative disease this mean that PVNS will continue to worsen and usually will require surgery. It is believed that some patients with PVNS have a protein that is sometimes found in the cell lining the damaged joint called CFS-R1. Researchers are developing drug therapy that may be effective for fighting CFS-R1. Dr. Williams can explain the treatment options and can help determine if you are a good candidate for clinical trials for the drug therapy. Other non-surgical treatments may include resting the knee when there is a flare up, and using ice for pain and swelling. It is important to maintain a regular exercise routine to maintain mobility and the range of motion of the knee.

Surgical treatment:

Surgery is often very successful for localized PVNS. Surgery is performed to remove the growth or tumor that is caused by pigmented villonodular synovitis. Dr. Williams will discuss which type of surgery is suitable for you and may include one or more of the following:

  • Knee Arthroscopy with synovectomy
  • Knee arthrotomy with synovectomy
  • PVNS Lesion removal

For more information on pigmented villonodular synovitis and the treatment options available, please contact the office of Riley Williams, MD, orthopedic knee specialist serving Manhattan, Brooklyn, New York City, NY and surrounding areas.

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What Are The Symptoms Of Pvns

There are two forms of pigmented villonodular synovitis: localized and diffuse. The localized form occurs in only one area of the knee. The diffuse form can be more difficult to treat because it involves the whole knee and is more widespread. With both localized and diffuse knee PVNS, the symptoms may come and go.

Localized PVNS symptoms:

  • Hemarthrosis

What Causes Pvns In The Knee

Pigmented villonodular synovitis (PVNS) of knee

Pigmented villonodular synovitis is caused by abnormal growth of the tissue that lines the knee joint known as the synovium. The synovium is an internal membrane within the joint that helps the joint move freely. In PVNS, the synovium grows abnormally, causing inflammation. The condition is a tumor-like growth process called neoplastic, and is a benign non-malignant growth which ultimately leads to chronic knee pain associated with joint damage and arthritis.

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Pvns: Experience And Causes


I recently got diagnosed with the fairly rare condition called Pigmented villonodular synovitis a disorder which affects joints. In my case, it was my knee joint, as is often the case.

I’m posting this to help others better identify and understand this condition, and also to explore any possible causes.

PVNS is very easily misdiagnosed by GP’s. It was misdiagnosed twice in my case, by two different doctors.

Because it’s more common in the 30’s and 40’s age group, and the symptoms are similar to arthritis, it can be misdiagnosed as the early onset of arthritis of the knee/joint in people who are in the upper end of this age bracket.

In the case of the PVNS affecting the knee joint which results in a tumour growth at the back of the knee , because the condition often arises after a trauma to the knee joint, the condition can be misdiagnosed as a simple lingering knee injury, leaking joint fluid, giving rise to a Bakers Cyst.

The symptoms of PVNS are both sporadic and very similar to both an ordinary knee injury and arthritis as the condition progresses. The joint becomes stiff and movement restricted. It’s usually painless in the early stages but as it progresses it causes mild to moderate discomfort with a persistent burning pain around the joint area.

If left untreated, PVNS in its advanced stages, can render the joint completely unusable, requiring a complete joint replacement.

Here’s my own experience of PVNS:

5 likes, 294 replies

What Is The Treatment For Pigmented Villonodular Synovitis

If you have PVNS, youâll need surgery to relieve the symptoms and prevent further damage to your joint. If your tendon has already been damaged, your surgeon will repair that during surgery, too.

Types of surgery include:

Talk to your doctor when you have recurring or intense joint swelling and pain.

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Citation Doi And Article Data

Citation:DOI:Assoc Prof Frank GaillardRevisions:see full revision historySystem:

  • Fibrous xanthoma of the synovial membrane
  • Polymorphocellular tumour of the synovial membrane
  • Sarcoma fusigiganocellulare
  • Synovial xanthoma

Pigmented villonodular synovitis is a rare benign proliferative condition affecting synovial membranes of joints, bursae or tendons resulting from possibly neoplastic synovial proliferation with villous and nodular projections and hemosiderin deposition. PVNS is most commonly monoarticular but occasionally it can be oligoarticular. The histology of PVNS can look similar to some aggressive neoplasms and imaging, therefore, has a crucial role in guiding the pathologist.

Radiographs show non-specific features such as joint effusion and bone erosions, CT and ultrasound can also demonstrate the hypertrophic synovium as a slightly hyperdense/echogenic soft tissue mass. MRI is the best approach showing the mass-like synovial proliferation with lobulated margins, with low signal intensity and blooming artifact on gradient echo due to hemosiderin deposition.

What Is Pigmented Villonodular Synovitis


Pigmented villonodular synovitis is a joint problem that usually affects the hip or knee. It also can occur in the shoulder, ankle, elbow, hand or foot.

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.

PVNS isnt common. It can affect anyone, but it is most common in people 20 to 45 years old. It may happen slightly more often in men.

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Pigmented Villonodular Synovitis Facts*

*Pigmented villonodular synovitis facts written by Charles P. Davis, MD, PhD

  • Pigmented villonodular synovitis is a disease where the tissue lining the joints and tendons grow abnormally to produce a noncancerous mass or tumor. There are two types: local and diffuse. Local involves one area of the joint lining while diffuse involves the entire lining of the joint. It most often affects the knee joint.
  • PVNS symptoms and signs may include swelling, joint effusion, pain, limited joint movement, and/or locking of the joint some individuals experience joint destruction.
  • The exact cause of PVNS is unknown researchers speculate it may be related to arthritis, joint trauma, or specific genetic changes.
  • Medical professionals diagnose PVNS by taking X-rays, an MRI, andCT scans sometimes it may be necessary to perform a joint aspiration and/or biopsy.
  • Physicians use surgery to remove abnormal tissue from the joint if surgery cannot be done or if the disease recurs, radiation therapy may be necessary.
  • PVNS is a rare disease .

Combined Open And Arthroscopic Surgery

If the surgeon cant completely remove the tumor through a small incision, or the tumor is in your knee, you may have a combination of open surgery and arthroscopy.

In open surgery, the surgeon removes the tumor through the back of your knee. In arthroscopy, the joint lining from the front of your knee is removed.

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