繰り返す肩関節血腫の1例

抄録

An 83-year-old male presented two years after developing pain in the right shoulder joint without apparent cause. Shoulder hemarthrosis was confirmed by arthrocentesis at a local clinic. Although hemorrhagic synovial fluid was aspirated by arthrocentesis several times, the hemarthrosis recurred repeatedly and the patient was referred to our institution. Physical examination demonstrated swelling of the right shoulder joint and a significantly restricted range of motion. Blood tests showed no coagulation abnormalities. Plain X-ray showed degenerative changes in the glenohumeral joint. MRI indicated joint effusion, proliferation of the synovium, and a massive rotator cuff tear. After preoperative transarterial embolization for control of hemorrhage, shoulder arthroscopy was performed, and this revealed proliferation of the enlarged synovium, and absence of cartilages in the humeral head and glenoid. Synovectomy was performed as far as possible. Pathological examination demonstrated chronic synovitis, but no abnormal synovial cells were found. One year postoperatively, no hemarthrosis has been evident and the pain has been relieved, although range of motion is still restricted. Non-traumatic shoulder hemarthrosis is relatively rare. The present case was diagnosed to be shoulder hemarthrosis associated with cuff tear arthropathy, based on imaging and pathologic findings. Embolization and arthroscopic synovectomy achieved a favorable treatment outcome.