Whole body

What It Is

PVNS is a condition that affects the lining of the joints (the synovium). Doctors now call it tenosynovial giant cell tumour (TGCT), because the World Health Organization classifies it as a tumour that grows in the lining of joints and tendons. The tumour is not cancer and does not spread to other parts of the body, but it can keep growing and damage the cartilage and bone around the joint (American Academy of Orthopaedic Surgeons, n.d.).

It is often characterized by swelling, pain and stiffness, as well as a build-up of iron on the inside of the joint, which comes from bleeding from the tumour (American Academy of Orthopaedic Surgeons, n.d.; Fazio et al., 2025). It occurs most often in adults between about 20 and 50 years of age and is more common in women (American Academy of Orthopaedic Surgeons, n.d.). PVNS usually only occurs in a single joint. In about 80 percent of people who have it inside a joint, the knee is affected, but the condition can also affect the hip, ankle, shoulder and elbow (American Academy of Orthopaedic Surgeons, n.d.). PVNS can occur in two different forms: localized, where there are one or more separate lumps (nodules), and diffuse, where more of the joint lining is affected. The diffuse form tends to be more aggressive and harder to treat (American Academy of Orthopaedic Surgeons, n.d.).

The cause of the condition isn't known yet. Genetic changes in a gene called CSF-1 have been identified, which lead to more inflammatory cells in the joint, but there is no known link with environmental exposures or other health conditions (American Academy of Orthopaedic Surgeons, n.d.).

This condition is rare (Fazio et al., 2025) and not very well known. An MRI scan is the best test to show it (American Academy of Orthopaedic Surgeons, n.d.).

Pigmented Villonodular Synovitis Anatomy

The knee is one of the biggest and most complex of all joints found in the body. It joins the shin bone and the thigh bone together. The smaller bone running alongside of the tibia and the kneecap are the two other bones that complete the knee joint. Tendons keep the leg muscles and knee bones connected to enable the knee joint to move. Ligaments join all of the knee bones and deliver stability to the knee.

The anterior cruciate ligament stops the shin bone (tibia) sliding too far forward under the thigh bone (femur), and the posterior cruciate ligament stops it sliding too far backward. The medial and lateral collateral ligaments control side-to-side movement of the knee.

The joint is lined by a thin layer of tissue called the synovium, which makes a small amount of fluid to lubricate the joint. In PVNS, this lining thickens and overgrows (American Academy of Orthopaedic Surgeons, n.d.).

Not a diagnosis — for more information, contact me or another trusted healthcare provider.

Treatment

Self-Care & Treatment

How Pigmented Villonodular Synovitis is Treated

Your surgeon and specialist team lead the treatment. Once your surgeon has cleared you, I can support your recovery after surgery, helping with stiffness, swelling and scar tissue and coaching exercises to rebuild movement and strength. See the My Approach tab for how I work.

Treatment usually involves surgery to remove the tumour and the damaged joint lining. For people without symptoms who do not want treatment, the doctor may instead keep a close eye on it with check-ups and MRI scans (American Academy of Orthopaedic Surgeons, n.d.).

Treatments you may want to discuss with your family doctor, nurse practitioner or specialist

Options outside my scope

Arthroscopy (keyhole surgery): the surgeon uses a small camera and small instruments passed through a few small cuts to remove the tumour and the damaged joint lining. It has fewer possible complications than open surgery, but the condition is more likely to come back afterwards, especially in the diffuse form (American Academy of Orthopaedic Surgeons, n.d.).
Open surgery: larger cuts allow the surgeon to remove the mass and the whole joint lining, which is often the best way to treat the diffuse form (American Academy of Orthopaedic Surgeons, n.d.).
Combined open surgery and arthroscopy: for diffuse PVNS of the knee, the back of the knee may be treated with open surgery and the front with arthroscopy. This decreases the size of the operation, which allows for an easier recovery (American Academy of Orthopaedic Surgeons, n.d.).
Joint replacement: if the joint has been badly damaged, replacing it with metal and plastic parts may be the best way to improve pain and function (American Academy of Orthopaedic Surgeons, n.d.).
Radiotherapy: sometimes used for the diffuse form, especially when it has come back after treatment, although there is not yet enough evidence for doctors to recommend it reliably (American Academy of Orthopaedic Surgeons, n.d.).
Targeted medicines: prescription medicines that act on the CSF-1 pathway (pexidartinib and vimseltinib) may be considered for people who cannot have surgery, or for whom surgery could cause a significant loss of function (American Academy of Orthopaedic Surgeons, n.d.).

How I can help (see the My Approach tab)

Supporting your rehabilitation after surgery, once your surgeon clears you
Hands-on work for stiffness, swelling and scar tissue
Exercises to rebuild movement and strength around the joint

Tips

Postoperative physical therapy is crucial in being able to return to your normal activities. Always follow your surgical team's own instructions after an operation.
You will be given a specific set of exercises to help improve movement and regain strength (American Academy of Orthopaedic Surgeons, n.d.).
Because open surgery is more extensive, there is an increased chance of stiffness after the operation (American Academy of Orthopaedic Surgeons, n.d.).
Recovery following open surgery is often more involved and needs a longer physical therapy program. Expect a return to all your usual activities to take longer, possibly several months (American Academy of Orthopaedic Surgeons, n.d.).
Recovery from arthroscopic surgery usually needs only a short course of physical therapy before you return to normal activity (American Academy of Orthopaedic Surgeons, n.d.).
The diffuse form is more likely to come back than the localized form, so people with diffuse PVNS usually need follow-up appointments, often including MRI scans, for several years after surgery (American Academy of Orthopaedic Surgeons, n.d.).

Treatment

My Approach

PVNS is treated by your surgeon and specialist team, and massage doesn't treat the tumour itself. I can help with the stiffness, swelling and weakness that often follow surgery. Your surgical team sets the limits after an operation, and I need their okay before any hands-on treatment.

Please bring any X-ray or scan reports and notes from your medical team to your first visit. They're an important part of planning safe treatment for you.

I start by asking what you've been cleared for, then assess how the joint moves, the strength around it, and how you walk if it's a leg joint.

Early After Surgery

Easing the areas that take over, such as the other leg, hips and back, or your shoulders if you're on crutches
Gentle lymphatic drainage, with nothing on or near the incisions until they've healed
Coaching the exercises your surgical team or physiotherapist has given you

Building Back Up

Scar work once the wounds have fully closed, and gentle joint mobilisation for stiffness once your surgeon allows
Strength work around the joint, building to balance, gym-based work and the movements your daily life or sport needs

If you're being monitored rather than having surgery, I can help with tension and stiffness around the joint, keeping pressure light over the joint itself.

If the joint suddenly swells, a wound looks red or is draining, or your calf becomes painful, warm and swollen, contact your surgical team. For chest pain or sudden shortness of breath, call 911.

What to Expect

Typical Course

Typical course: Early on, visits are usually short and once or twice a week, then weekly, then spaced out. After keyhole surgery most people need only a short course of rehab, while recovery from open surgery often takes several months, following your surgical team's plan.

What I Focus On

Working Within Your Team's Limits

Compensation Relief

Swelling & Scar Care

Joint Mobility

Strength

Sources

References

American Academy of Orthopaedic Surgeons (n.d.) Tenosynovial giant cell tumor (TGCT) [formerly Pigmented villonodular synovitis (PVNS)] (OrthoInfo). Available at: https://www.orthoinfo.org/diseases--conditions/pigmented-villonodular-synovitis/ (Accessed: 7 October 2026).
Fazio, A., Mazzella, G.G., Greco, T. et al. (2025) 'Diagnosis and treatment options in pigmented villonodular synovitis of the knee: a narrative review', Journal of Clinical Medicine, 14(16), p. 5857. doi: 10.3390/jcm14165857

Massage therapy · Kitchener–WaterlooPigmented Villonodular Synovitis (PVNS)

What It Is

Pigmented Villonodular Synovitis Anatomy

Self-Care & Treatment

How Pigmented Villonodular Synovitis is Treated

Treatments you may want to discuss with your family doctor, nurse practitioner or specialist

Tips

My Approach

Early After Surgery

Building Back Up

Typical Course

References

Related Conditions

Book a session

Massage therapy · Kitchener–WaterlooPigmented Villonodular Synovitis (PVNS)

What It Is

Pigmented Villonodular Synovitis Anatomy

Self-Care & Treatment

How Pigmented Villonodular Synovitis is Treated

Treatments you may want to discuss with your family doctor, nurse practitioner or specialist

Tips

My Approach

Early After Surgery

Building Back Up

Typical Course

References

Related Conditions

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Anterior Wedge Fracture to the Vertebra

Bone Tumor

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Book a session