Rapid destruction of shoulder joint by pigmented villonodular synovitis treated by hemiarthroplasty: A case report

Localized pigmented villo-nodular synovitis of trochanteric bursa

This is the first report on a localized pigmented villo-nodular synovitis (PVNS or TSGCT) occurring in the trochanteric bursa. Bursal involvement in PVNS is extremely rare. Most often PVNS occurs either as a localized or diffuse lesion in a major synovial joint, such as the knee, ankle joint or hip joint. In principle, all synovial structures can be involved. The case reported here is remarkable regarding the long period between the occurrence of the first symptoms and the final diagnosis as well as the age of the female patient (75 yrs). Therapeutically a complete resection was performed in order to avoid recurrence. More then three years later the patient did well and there has been no evidence of recurrence yet.

Clinical outcomes of patients with pigmented villonodular synovitis of the shoulder after arthroscopic synovectomy

BACKGROUND

Shoulder pigmented villonodular synovitis (PVNS) is a severe clinical condition, while few studies have focused on this situation due to its rarity. This study was to investigate the efficacy of arthroscopic treatment of patients diagnosed with shoulder PVNS.

METHODS

From Jan 1^st, 2010 to Dec. 31^st, 2019, 6 patients (5 females and 1 male) diagnosed with shoulder PVNS underwent arthroscopic synovectomy in our hospital and combined rotator cuff repair was performed in 3 of them. The outcomes of this study include Constant score, Visual Analogue Scale (VAS), University of California, Los Angeles (UCLA) score and American Shoulder and Elbow Surgeons (ASES) score. The data were retrieved from the patients' medical records.

RESULTS

With a mean follow-up of 52.0 months (range, 28-92 months), the mean difference of Constant, VAS, UCLA and ASES scores were 27.83 ± 21.60, 2.83 ± 2.56, 11.67 ± 10.93 and 17.83 ± 25.35, respectively. Statistically significant improvements were detected in all the patient-reported outcomes except ASES score. One of the patients suffered from recurrence. Two patients suffered from mild complications after the surgeries while both of them achieved satisfactory recovery finally.

CONCLUSION

Arthroscopic synovectomy in the setting of shoulder PVNS can improve patients' function. A concurrent rotator cuff repair is recommended if it is needed. The conclusion still needs testifying by further high-quality research with larger sample size.

Pigmented Villonodular Synovitis of the Glenohumeral Joint and Biceps Tendon Sheath

A 34-year-old woman presented with paroxysmal, insidious shoulder pain with effusion. MRI demonstrated a permeative, intermediate-signal lesion on T1 and T2 sequences involving the glenohumeral joint and biceps tendon sheath. The patient was treated with arthroscopic synovectomy, debridement, and subpectoral biceps tenodesis, with histopathology demonstrating pigmented villonodular synovitis (PVNS).

PVNS is an extremely rare lesion of the glenohumeral joint and surrounding extra-articular structures. Awareness of this condition is paramount for timely diagnosis and intervention before joint destruction occurs. Arthroscopic treatment with meticulous attention to surgical technique is a feasible treatment strategy in the absence of end-stage chondral damage.