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

Hussain Wahab,Naveed Baloch,Obada Hasan,Ahmed Habib

doi:10.1016/j.amsu.2018.11.016

Hussain Wahab, Naveed Baloch + Show 2 more

Open Access

https://doi.org/10.1016/j.amsu.2018.11.016

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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.

Highlights

Synovial chondromatosis is a benign mono-articular arthropathy affecting synovial joints
The exact pathogenesis is not known but it is suggested that synovium undergoes cartilage metaplasia
Three stages for the disease process explained [1]: active disease without intra-articular loose bodies [2], transitional lesions with synovial proliferation and loose bodies, and [3] loose bodies without synovial disease [8]. We assumed this as a primary synovial chondromatosis due to the observation of almost the same ovoid shaped look of loose bodies in the arthroscopy, with no underlying joint disorders and with normal blood parameters

Summary

Introduction

Synovial chondromatosis is a benign idiopathic disease affecting lining of articular surfaces (synovium) of synovial joints. It is a rare condition causing unusual mono-articular pathology. Available data was in the form of case reports and small case series only [4,5,6,7,8,9] This case report is about a patient with primary synovial chondromatosis who underwent arthroscopic removal of more than 120 synovial chondromatoid loose bodies and partial synovectomy of shoulder joint which is unusual location of this rare disease with 2 years follow-up.

Case report

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