Bilateral subacromial bursitis with macroscopic rice bodies: ultrasound, CT and MR appearance

Bilateral Subacromial-Subdeltoid Rice Bodies in the Shoulder: A Surgical Case Report

Introduction

Rice bodies (RBs) are pale and glossy appearing small fibrinous nodules that form due to synovial or tenosynovial joint inflammation. RBs are significant as they are common in orthopedic practices causing nonspecific symptoms such as pain, swelling, range of motion limitations, crepitus, and catching sensations. These loose bodies occur often within the bursa as a symptom of chronic bursitis and are commonly associated with rheumatoid, inflammatory, or tuberculous arthritis. Reports on RBs are present; however, few bilateral cases within the shoulder appear in the literature. Case Presentation. This case demonstrates an unusual bilateral, subacromial-subdeltoid presentation of rice bodies (RBs) in a 41-year-old Caucasian female patient with a history of rheumatoid arthritis. We describe treatment with right shoulder arthroscopy to remove the loose bodies. One-year postoperative patient-reported outcomes (PROMs) show improvement in symptoms, pain, and overall function.

Conclusion

Formation of RBs occurs as a symptom of an inflammatory response in synovial joints. This provokes multiple small fibrin aggregates to collect within synovial bursae and occasionally tendon sheaths. RBs are rarely seen bilaterally. Arthroscopic removal of RBs is an appropriate treatment method for symptom improvement.

Rice bodies in a shoulder bursa: a cadaveric and histologic case report

INTRODUCTION

The subacromial/subdeltoid bursa can develop inflammation and effusion related to autoimmune, infectious, and musculoskeletal disorders. Rice bodies, or loose bodies within bursa, have been described as an uncommon complication of bursitis and have been the subject of case studies over a number of years. However, they have not been described in anatomical or physical therapy-related literature.

METHODS

A donor body dissected for a physical therapy anatomy course was found to have an enlarged subacromial/subdeltoid bursa. This bursa, along with the biceps brachii tendon sheath, and the subscapularis muscle bursa, were filled with numerous rice-like bodies. The bursal wall was well developed and thickened. Tissue specimens were obtained of the suspected rice bodies, the subacromial/subdeltoid bursal wall, and the biceps brachii tendon sheath. The tissue was embedded, sectioned, and processed with hematoxylin and eosin or Masson's Trichrome staining for blinded histologic assessment.

RESULTS

The tissue samples from within the bursa were identified as tissue similar to that in prior descriptions of rice bodies. Tissue samples from the bursal wall and tendon sheath were identified as similar to synovial membranes.

CONCLUSIONS

Rice bodies found within the cadaveric body were similar histologically to those described in rheumatology, radiology, and orthopedic literature. Anatomists teaching future health-care providers and practicing physical therapists should be familiar with rice bodies as a potential finding in cadavers, and patients.

Ultrasonographic and computed tomographic features of rice bodies in an Arabian horse with atlantal bursitis

A 19-year-old castrated Arabian male horse presented for evaluation of a firm mass at the dorsal cervical region. Ultrasonography and computed tomography revealed multiple well defined fusiform structures within the atlantal bursa. Multiple glossy smooth, white to yellowish, flattened fusiform structures were removed surgically. These structures were composed of dense fibrin with some leukocytes and red blood cells. The imaging and histopathological features of these structures were similar to chronic 'rice bodies' reported in humans with bursitis or tenosynovitis. This is the first veterinary report describing the imaging features of 'rice bodies' in a horse with atlantal bursitis.

Shoulder ultrasound imaging-integrating anatomy, biomechanics and disease processes

This article brings together the anatomy, biomechanics and the imaging of shoulder disease using ultrasound to enable a better understanding of the strengths and weaknesses of ultrasound when imaging the shoulder.

[Giant bursitis with rice bodies of the shoulder/neck region in a patient with rheumatoid arthritis without joint-connection]

Giant bursitis with rice bodies is an important clinical entity recognized in rheumatoid arthritis. Usually the bursitis is connected to a joint space. In this unusual case of a giant bursitis of the shoulder/neck region, no connection to a joint could be found. The bursitis lays directly on a rib. The clinical and radiological findings are presented and this special case is discussed in comparison to the literature.