Arthroscopic treatment of synovial chondromatosis of the shoulder: A case report

Abstract

IntroductionSynovial chondromatosis is a mono-articular arthropathy rarely seen in diarthrodial joints. The classic treatment for synovial chondromatosis is open arthrotomy, synovectomy and complete removal of the free fragments. With recent advances in arthroscopic techniques and methods, the indications for arthroscopic treatment have been extended.Presentation of caseA 33-year old female presented with complaints of pain in the right shoulder. On the radiological examination, there were seen to be multiple calcified radio-opaque lesions filling all area of the glenohumeral joint. On computed tomography (CT) examination, again multiple radio-opaque free fragments were determined. Arthroscopy was applied to the right shoulder. The free fragments were completely removed. Approximately 33 free fragments, ranging in size from 0.5 to 1.3 cm, were removed.DiscussionCases of synovial chondromatosis in the shoulder have been rarely reported in literature. Generally the disease is self-limiting. Clinically, symptoms are generally not specific. Restrictions in the joint range of movement occur associated with the mechanical effect of the free fragments and in periods of active use, local pain and swelling may be seen in the shoulder. Simple removal of the free fragments, others have stated that removal with synovectomy is necessary to prevent recurrence of the cartilaginous metaplastic focus. Recurrence rates vary from 0 to 31%.ConclusionArthroscopic surgery can be successfully applied in the treatment of synovial chondromatosis. The advantages of the method include good visualisation during surgery, low morbidity and early healing.

Synovial Chondromatosis in the Shoulder

“…We were not able to perform a MRI on our patient because he was treated at a low-level social care facility without MRI access. The definitive treatment for SC is surgical resection, which can be done on an open or closed arthroscopic procedure [3]. The exact timing of surgical intervention has not been defined in the literature [1,10] but theoretically the loose bodies within the subacromial space can cause supraspinatus outlet impingement, acromial spurring, and bursal sided rotator cuff tears, as was in our case [1].…”

“…An articular ultrasonography (USG) was ordered finding a complete rupture of the supraspinatus tendon no other tendon or labral abnormality ( Figure 2). The differential diagnosis that should be considered are degenerative joint disease, osteochondritis dissecans, synovial sarcoma, chondrosarcoma, rheumatoid arthritis, pigmented villonodular synovitis and osteonecrosis of humeral head [3]. The patient underwent a shoulder arthroscopy on a beach chair position under general balanced anesthesia.…”

“…Most of the times it presents in just one articulation and is rarely seen in diarthrodial joints [1][2][3]. It is three times more frequent on men than in women.…”

Bilateral symmetrical synovial chondromatosis of shoulder: a case report

“…The etiology of synovial chondromatosis is not known but it is classified as primary or secondary and the secondary is due to trauma, rheumatic arthritis, tubercular arthritis, osteochondritis dissecans. 2 The clinical features of joint chondromatosis are not specific but generally restriction of the joint movement is the most common. Also may present local pain and tenderness with swelling on the joint.…”

“… 1 It is a mono-articular arthropathy rarely seen in diarthrodial joints and most commonly involved in the knee, followed by the hip, elbow, wrist, ankle and least often in the shoulder. 2 Most often seen on 30–50 years of age and three times more in males than females. 3 The exact reasons for the development of synovial chondromatosis are not known, but it is assumed that in the pathogenesis, the synovial chondroid metaplastic focus becomes peduncular then by breaking off, becomes free fragment in the joint which may undergo endochondral ossification or cause erosive damage to the joint.…”