Synovial chondromatosis is a rare type of non- malignant bone tumor that grows outside the bone^[1,2]. Most people have multiple nodules or tumors in a single joint. The most common place for nodules to form is knee. Nodules may also affect elbow, hip, or shoulder , rarely it may also affect smaller joints such as ankle, wrist, or jaw^[3,4,5]. The clinical features are difficulty in movements at affected joint associated with gritty sensation^[6,7,8]. The treatment of choice is synovectomy and removal of loose bodies.

A 43 year old female presented with chief complaints of pain over her right elbow for the past 8 months along with stiffness over the elbow joint. The pain was Insidious in onset, gradual in progression, aggravated on movements. There is no history of trauma, any medical comorbidities, previous surgeries and any significant family history. On examination a diffuse swelling was present around the elbow joint, Tenderness is present over the medial joint line, Range of movements was restricted due to stiffness and pain. There is no distal neurological deficit. X-ray right elbow (Fig. 1a and b) and magnetic resonance imaging were taken (Fig. 2a and b) and the diagnosis was confirmed as synovial chondromatosis of the right elbow. She was planned for open synovectomy with the removal of loose bodies because it is cheaper than arthroscopic procedure. Through the medial parapatellar approach, a plane of cleavage was created with deep dissection and thickened synovium with loose bodies was removed (Fig. 3), and histopathology report showed nodules of metaplastic cartilage and classified as stage 3 with multiple free osteochondral bodies. Post – operatively patient is treated with medications and physiotherapy at the elbow joint. Regular dressing were done, and the patient was said to continue the physiotherapy for 6 months and asked for serial follow-up (Fig. 4). On follow-up, the patient has improved movements at the elbow joint without pain (Fig. 5a and b).

Treatment of synovial chondromatosis of the elbow is important to improve the symptoms and range of movements^{[9, 10, 11]}. Most of this condition is benign and rarely changes into malignancy, so it should be operated as early as possible to avoid early osteoarthritis of an affected joint. Diagnosis is made clinically and radiologically^{[5, 12, 13]}. This condition is most commonly seen in middle-aged group. This study is done in such a way that all the patients with synovial chondromatosis treated with synovectomy were improved symptomatically post- operatively with significant improvement in a range of movements^{[3, 5, 6}, ^{8, 14].}

Follow up:
Patient was followed upto 18 months and last follow-up, was May 2022. During every follow- up patient has no c/o difficulty in range of movements.
Results:
Postoperatively patient’s clinical and functional outcome was good, and radiographically, no recurrence was present due to complete excision.

Synovial osteochondromatosis of the elbow joint is a uncommon begnin condition usually presents as multiple nodules of hyaline cartilage within the subsynovial connective tissue. The exact is not known. It is usually monoarticular and mostly involves knee joint to lesser extent; it may also involve the elbow, shoulder, hip joint and rarely the small joints. Clinical features of Synovial chondromatosis are pain, swelling, loss of motion, and stiffness, and on examination swelling , restriction of movements, and tenderness. The management is the removal of synovium with dead tissue. The purpose of treatment is to improve the symptoms and the range of movements. The prognosis is good and recurrence rate is low if synovium is completely removed. If not removed completely, the failure rate is high and patient compliance will be poor.

Synovial chondromatosis is benign condition which needs to be removed completely either through open or arthroscopic procedure depending on its location and surgeon’s preference for the prevention of recurrence and malignant transformation.