IOSR Journal of Dental and Medical Sciences (IOSR-JDMS) e-ISSN: 2279-0853, p-ISSN: 2279-0861.Volume 17, Issue 11 Ver. 1 (November. 2018), PP 67-70 www.iosrjournals.org DOI: 10.9790/0853-1711016770 www.iosrjournals.org 67 | Page “Synovial chondromatosis involving small joints like ankle: A rare case report” Dr Samrat smrutiranjan Sahoo 1 , Dr Vinay Prabhat 2 , Dr Doki Sunil Kumar 3 , Dr Sandeep Velagada 4 1 (Senior Resident, A.I.I.M.S. Bhubaneswar) 2 (Assistant Professor,A.I.I.M.S. Bhubaneswar) 3 (Senior Resident, A.I.I.M.S. Bhubaneswar) 4 (Senior Resident, A.I.I.M.S. Bhubaneswar) Corresponding Author: Dr Samrat smrutiranjan Sahoo Abstract: Background: Primary synovial chondromatosis (Reichel syndrome), is a benign mono-articular disorder of unknown origin characterized metaplasia and proliferation of synovial tissue resulting in multiple intra- articular cartilaginous loose bodies of relatively similar in size usually involving larger joints commonly found in men of middle age of third to fourth decade of life. Case characteristic: A 40 year male presented with dull aching pain in the ankle joint left side since last one year which is progressively increasing in intensity along with swelling of the left ankle more towards the anterior aspect with restriction of movement. On examination, there was synovial hypotrophy and crepitation inside the joints with ROM 10 degree dorsiflexion with15 degree planter flexion .X-ray of the ankle showing multiple loose body mostly located the anterior part the ankle. MRI showing multiple intra-articular mass iso- intense to muscle in T1W and hyper-intense to muscle on T2WA containing multiple foci of low signal. Outcome: The patient underwent open arthrotomy with debridement and removal of the loose body with synovectomy, followed for one and half years without any recurrence now walking comfortably with full range of motion and regained his previous daily activity level. Conclusion: Primary synovial chondromatosis of the ankle which is an unusual rare presentation.In a patient with long standing history of pain swelling and crepitation even in a small joint clinical diagnosis of primery synovial chondromatosis should be considered and further more thorough radiological evaluation and histopathological evaluation will add to the diagnosis Keywords: Synovial chondromatosis, Loose bodies, Ankle joint, Open arthrotomy. --------------------------------------------------------------------------------------------------------------------------------------- Date of Submission: 20-10-2018 Date of acceptance: 03-11-2018 --------------------------------------------------------------------------------------------------------------------------------------- I. Introduction Primary synovial chondromatosis (Reichel syndrome) 1 , is a benign mono-articular disorder of unknown origin characterized metaplasia and proliferation of synovial tissue resulting in multiple intra-articular cartilaginous loose bodies of relatively similar in size usually involving larger joints of body most commonly involving knee joint , other joints being hip , shoulder 2,3,4 . Involvement of ankle is relatively rare 5,6 . These loose bodies under high pressure may coalesce with each other and become a large calcified body inside the joint. Commonly found in men of middle age of third to fifth decade of life, incidence being twice in males as compared to females. Abnormalities of chromosome 6 may be associated with this condition. Pain, swelling, restriction of movement are being the common presentations. We are presenting a rare case of synovial chondromatosis involving ankle joint treated by open arthrotomy and regaining back to his previous functional status. II. Case Report A 40 year male presented with dull aching pain in the ankle joint left side since last one year which is progressively increasing in intensity along with swelling of the left ankle more towards the anterior aspect with restriction of movement along with crepitation. The pain was increasing on walking and subsiding on rest. There was no history of the trauma to the ankle, fever, previous swelling or any other joint involvement. On physical examination, there is no local raise of temperature or tenderness. There was synovial hypotrophy and crepitation inside the joints with ROM 10 degree dorsi flexion and 15 degree planter flexion. There was no instability of ankle or any distal neurovascular deficit. On further evaluation, all the laboratory, hematological and biochemical parameters found to be within normal range. X-ray of the ankle showed multiple