HC Chang Orthopaedic Surgery | Singapore

PVNS Ankle as a Cause of Sudden Acute Ankle Pain

A patient consulted me for sudden acute pain in his right ankle while walking. There was no ankle sprain or injury to the right ankle. He has no history of gout.

The pain got worse after 2 days and he could no longer walk properly.

Examination of his right ankle showed tenderness over the anterolateral aspect of his right ankle. There was an effusion (swelling of the ankle joint).

A blood test showed no evidence of elevated uric acid to support a diagnosis of gout.

An MRI scan of his right ankle was done and it showed an intra-articular nodule / tumour  over the front of his right ankle. It was consistent with a pigmented villonodular synovitis (PVNS).

What is PVNS?

Pigmented villonodular synovitis (PVNS) is a joint disease characterized by inflammation and overgrowth of the joint lining. It usually affects the hip or knee. It can also occur in the shoulder, ankle, elbow, hand or foot. In PVNS the lining of the joint, called the synovium, becomes swollen and grows.

Is It Cancerous?

No.

Why the Sudden Onset of Pain?

This tumour has been growing in his right ankle for a long time. It was dormant and asymptomatic until one fine day when he caught part of the tumour between the surfaces of the joint. This caused bleeding and occasional “infarction” of the tumour. This leads to the acute onset of pain and swelling as in this case.

What Was Done?

I removed his right ankle PVNS tumour using an arthroscopic technique (keyhole surgery).

Two tiny holes were created over the front of his right ankle and an arthroscope (camera) is introduced into the right ankle to visualise the tumour and to remove it.

The patient was able to walk well without pain a few days after the keyhole surgery.

For more information of pigmented villonodular synovitis (PVNS) please contact Dr HC Chang at +65-683 666 36 or visit our website at http://www.ortho.com.sg