A 43-year-old man presented with persistent wrist pain and loss of range of motion after nonoperative therapy. Magnetic resonance imaging showed features consistent with pigmented villonodular synovitis (PVNS) of the scaphotrapeziotrapezoidal joint. He underwent arthroscopic excision and synovectomy. At 2 years postoperatively, he had no symptomatic recurrence. This case shows the importance of considering PVNS for chronic pain of small joints, and it highlights the viability for arthroscopic synovectomy as a treatment option.

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