Hayakawa Kazuki, Kawano Yusuke, Kuroiwa Takashi, Nakajima Yukio, Suzuki Katsuji, Fujita Nobuyuki
Department of Orthopaedic Surgery, Fujita Health University School of Medicene, Aichi, Japan.
Department of Orthopaedic Surgery, Fujita Health University School of Medicene, Aichi, Japan.
Int J Surg Case Rep. 2024 Dec;125:110527. doi: 10.1016/j.ijscr.2024.110527. Epub 2024 Oct 26.
Synovial osteochondromatosis of the shoulder joint is predominantly primary, characterized by multiple osteochondral fragments, with reports of secondary synovial osteochondromatosis being rare.
The patient, a 48-year-old male, presented to our hospital with right shoulder pain persisting for several months. While there was no significant restriction in the range of motion, pain was noted during horizontal adduction and external rotation in the dependent position. Radiographs and CT scans revealed an osteochondral loose body in the glenohumeral joint and an osteophyte on the anterior margin of the glenoid cavity. A lidocaine test in the glenohumeral joint was positive, suggesting impingement by the loose body, leading to its surgical removal. Arthroscopically, the loose body was grasped and removed from the anterior aspect of the glenohumeral joint. The osteochondral fragment measured approximately 15 mm, with the total length including soft tissue being about 40 mm. Pathological findings indicated a layered arrangement of synovial cells, consistent with secondary synovial osteochondromatosis. Postoperatively, the shoulder pain improved rapidly, and follow-up was concluded six months after surgery.
In this case, arthroscopy revealed a Hill-Sachs-like lesion and labral deficiency on the glenoid, suggesting past trauma. However, no bone defect matching the size of the loose body was observed. In secondary synovial osteochondromatosis, small osteochondral fragments can grow with nourishment from the synovium, suggesting the loose body in this case might have similarly enlarged post-trauma.
The shoulder pain caused by a giant secondary synovial osteochondromatosis improved by removing the loose body arthroscopically.
肩关节滑膜骨软骨瘤病主要为原发性，其特征是有多个骨软骨碎片，继发性滑膜骨软骨瘤病的报道较为罕见。
该患者为一名48岁男性，因右肩疼痛持续数月前来我院就诊。虽然活动范围没有明显受限，但在卧位水平内收和外旋时会出现疼痛。X线片和CT扫描显示盂肱关节内有一个骨软骨游离体，肩胛盂腔前缘有一个骨赘。盂肱关节利多卡因试验呈阳性，提示游离体撞击，遂行手术切除。关节镜检查时，从盂肱关节前方抓住并取出游离体。骨软骨碎片大小约为15毫米，包括软组织在内的总长度约为40毫米。病理结果显示滑膜细胞呈分层排列，符合继发性滑膜骨软骨瘤病。术后，肩部疼痛迅速改善，术后六个月结束随访。
在本病例中，关节镜检查发现肩胛盂有类似希尔-萨克斯损伤和盂唇缺损，提示既往有创伤史。然而，未观察到与游离体大小匹配的骨缺损。在继发性滑膜骨软骨瘤病中，小的骨软骨碎片可在滑膜滋养下生长，提示本病例中的游离体可能在创伤后也有类似增大。
通过关节镜切除游离体，巨大继发性滑膜骨软骨瘤病引起的肩部疼痛得到改善。
