Arthroscopic removal of loose bodies in synovial chondromatosis of shoulder joint, unusual location of rare disease: A case report and literature review

Abstract

IntroductionSynovial chondromatosis is a benign mono-articular arthropathy affecting synovial joints. It mostly affects knee joint, followed by hip, elbow and wrist and is rarely reported for shoulder joint. The exact pathogenesis is not known. Usual symptoms are pain, difficulty in movement due to mechanical obstruction. The classic treatment is arthrotomy, removal of chondromatoid loose bodies and synovectomy. With recent advances arthroscopic removal of the chondromatoid loose bodies is a good option with relatively better post op rehabilitation and faster recovery.Case presentation20 years old gentleman presented to clinic with history of pain in right shoulder for 2 years and decreased range of motion. There was no history of trauma or fever. Work up done and diagnosed with synovial chondromatosis. Arthroscopic removal of chondromatoid loose bodies and synovectomy was done. More than 120 loose bodies were removed. On two (2) years follow-up patient is pain free and having full range of motion at right shoulder joint.DiscussionSynovial chondromatosis is rare in shoulder joint. The Primary synovial chondromatosis of unknown etiology, and secondary synovial chondromatosis due to degenerative joint disease. Classic treatment is arthrotomy and synovectomy. With recent advances, arthroscopic removal of loose bodies and synovectomy is also a good option for its treatment. In literature only few cases have been reported treated with arthroscopic removal of loose bodies and synovectomy.ConclusionArthroscopic treatment of synovial chondromatosis is a good option if expertise is available. It causes less surgical trauma, better visualization during surgery, early recovery.

Primary synovial chondromatosis in children: a case report and literature review

“…The PSC, called idiopathic synovial osteochondromatosis or Reichel syndrome, usually occurs in a previously healthy joint. In contrast, secondary osteochondromatosis is a sequela of intra-articular pathology as osteochondral fracture, osteochondritis dissecans, and osteoarthritis [4,9,7,11,15,20]. In our case, the young-onset, the absence of a history of trauma, and the unremarkable results of blood tests strengthen the diagnosis of PSC.…”

“…It is a proliferation of multiple cartilaginous nodules in the synovium of joints, tendon sheaths, and bursae. These nodules may break free from the synovial membrane to become cartilaginous loose bodies in the joint space [4,10,15,[17][18][19][20].…”

Synovial chondromatosis in unusual locations treated with arthroscopy: A report of three cases

“…Contemporary case reports and series report that partial synovectomy combined with removal of loose bodies performed by arthroscopy can provide significant relief and increased range of motion. Wahab et al [6] arthroscopically removed more than 120 loose bodies from the shoulder of a 20-year-old man and performed partial synovectomy. Although there were significant degenerative changes, as in our case, the patient was pain free at two years.…”

Staged arthroscopic procedure for treating simultaneous shoulder and elbow synovial chondromatosis: A case report and literature review

“…16 We believe arthroscopy is preferable because of the associated lower morbidity, early rehabilitation, better visualization, and convenient retrieval of free bodies during surgery. 11,17,18 In this case, considering the patient's condition and risk of potential complications of shoulder and elbow arthroscopy, 19,20 such as joint stiffness, infection, and neurovascular injury, we performed a staged arthroscopy. Shoulder surgery was prioritized for the following reasons: first, the mechanical symptoms of shoulder involvement such as ROM, muscle strength loss, and snapping had started much earlier; second, a massive RCT was detected on the MRI; third, early accomplishment of shoulder rehabilitation could be beneficial to the exercise routine post elbow arthroscopy; and, finally, our experience in shoulder arthroscopic synovectomy, acromial debridement, and postoperative rehabilitation procedures in treating shoulder SC was great.…”

“… 16 We believe arthroscopy is preferable because of the associated lower morbidity, early rehabilitation, better visualization, and convenient retrieval of free bodies during surgery. 11 , 17 , 18 …”