Pediatric primary synovial chondromatosis of the shoulder, biceps tendon sheath and subcoracoid bursa

Intermediate Outcomes of Shoulder Synovial Chondromatosis in an Adolescent Boy: A Case Report

CASE

Synovial chondromatosis is a rare condition affecting synovial joints. It occurs uncommonly in the shoulder and is rare in the pediatric population. We present a case of a 13-year-old male patient with shoulder pain who was diagnosed with synovial chondromatosis and a posterior labral tear. He was treated with arthroscopic loose body removal, synovectomy, and posterior labral repair and recovered well from the surgery. Four years after the surgery, he developed pain in the same shoulder, but the cause of the pain was not investigated per the patient's decision.

CONCLUSION

Synovial chondromatosis should be considered in pediatric patients presenting with shoulder pain and loss of function with potential for recurrence.

Primary Synovial Osteochondromatosis of the Shoulder in Pediatric Patient: Case Report and Review of the Literature

We report a primary synovial osteochondromatosis in a 6-year-old male with a 1-year history of shoulder pain and stiffness. The patient underwent surgical treatment, resulting in significant improvement in range of motion and functional status. Primary synovial osteochondromatosis of the shoulder is a rare benign condition that can result in shoulder pain, stiffness, and locking. MRI helps identify these lesions within the affected joint. Removal of loose bodies often alleviates symptoms and allows for improved range of motion with satisfactory results.

"Shoulder pain and limitation of motion in a young girl: think different"

Background

Primary Synovial Chondromatosis (PSC) is a rare benign tumor of the synovial membrane in which cartilage metaplasia produces calcific loose bodies within the articular space. Only a few cases are reported in the pediatric population and its etiology remains unknown. This condition typically affects large weight-bearing joints with pain, swelling and decrease range of motion. Due to its slow progressions, delayed diagnosis is frequent and differential diagnosis should consider other chronic arthritis and malignancies. While arthroscopic removal of loose bodies is the current treatment up to now, the association of partial or complete synovectomy is debated.

Case presentation

We report about a 14-year-old girl with a long-lasting right shoulder pain, especially during movements or exercise, localized tenderness and hypotonia of the glenohumeral joint. No previous trauma was mentioned. Blood exams, Mantoux test and plain radiography of the right shoulder were unremarkable. Ultrasound imaging revealed echogenic and calcified bodies stretching the glenohumeral joint and dislocating the long head of biceps tendon. Magnetic resonance showed a “rice-grain” pattern of the right shoulder. From an arthroscopic surgery, multiple loose white bodies were removed within the synovial membrane, and synovial chondromatosis was confirmed by histological analysis. At one month follow up visit, the patient completely recovered without pain.

Conclusion

Synovial chondromatosis is a very uncommon cause of mono articular pain in children, especially when it affects shoulder. Pediatricians should keep in mind this condition to avoid delayed diagnosis and treatment, even in consideration of the low risk of malignant transformation. Through this case, we would highlight common diagnostic pitfalls and treatment of synovial chondromatosis.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13052-022-01332-4.

Arthroscopic surgery for synovial chondroma of the subacromial bursa with non-traumatic shoulder subluxation complications: Two case reports

BACKGROUND

Synovial chondromatosis is a disease originating from the synovium and characterized by the presence of metaplastic cartilaginous nodules in synovial cavities. The exact prevalence of synovial chondromatosis remains unknown, and the involvement of the shoulder joint is very rare. Synovial chondromatosis accompanied by subluxation of the humeral head without a history of trauma is rarely encountered, and to our knowledge, no published reports describe this condition.

CASE SUMMARY

We present two cases of synovial chondromatosis in the shoulder joint, accompanied by subluxation of the humeral head, in two arthroscopically managed adult patients. We performed arthroscopic labrum fixation and removal of the loose body from the shoulder joint. To identify primary and secondary categories, pathological analysis was arranged. Clinical and radiographic evaluations at the 1-mo follow-up were satisfactory.

CONCLUSION

The biomechanical function of the shoulder joint requires attention, especially following the detection of loose bodies, as observed with synovial chondroma occurring in rare sites. Arthroscopic management is successful in patients with synovial chondromatosis combined with shoulder subluxation.

Shoulder Synovial Chondromatosis in an Adolescent Athlete: A Case Report

Introduction

Synovial chondromatosis refers to a benign proliferative disease of the synovium. Reports in children are rare and reports involving the pediatric shoulder are even more rare. In this review of the literature and case report, we provide a summary of all published cases in children and a report of a case of shoulder synovial chondromatosis in an adolescent female athlete.

Case Presentation

A 15-year-old female cheerleader presented to the clinic with gradual onset right shoulder pain with a severity of 5/10. On physician examination, the patient had tenderness over the proximal humerus, limited abduction to 160°, limited forward flexion, and a total arc of motion of <180°. Radiograph of the shoulder demonstrated multiple calcific intra-articular loose bodies consistent with synovial chondromatosis. Arthroscopic removal resulted in resolution of symptoms at the 36-week follow-up.

Conclusions

Our literature search revealed only eight case reports on shoulder synovial chondromatosis in children. The location of the chondromatosis within the shoulder joint can be intra-articular, extra-articular, within the biceps sheath, or combined. In general, for chondomatoses confined to the glenohumeral joint space, open surgery is not required. Bony erosions can occur in the setting of chondromatosis though may not need to be addressed surgically. Although rare, this diagnosis should be considered when confronted with shoulder pain that is exacerbated during long athletic events with limited range of motion on physical examination in the adolescent athlete. Arthroscopic treatment in conjunction with physical therapy and early mobilization can lead to a successful outcome.