Synovial osteochondromatosis (SOC) is a benign proliferation of the synovium. Etiology is unknown. In this condition, cartilaginous metaplasia takes place within the synovial membrane of the joint. Metaplastic synovium organizes into nodules. With minor trauma, nodules are shed as small bodies into the joint space. In some patients the disease process may involve tendon sheaths and bursal sacs.

Cartilaginous intra-articular bodies float freely within the synovial fluid, which they require for nutrition and growth. Progressive enlargement and ossification occur with time. If they remain free, they continue to grow larger and more calcified. In severe cases, they may occupy the entire joint space or penetrate to adjacent tissues. Alternately, they can deposit in the synovial lining, reestablish a blood supply, and become replaced by bone. On occasion, synovial reattachment can lead to complete reabsorption of the cartilage fragment.

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