抄録
Case 1: A 61-year-old woman came to us with a 6-month history of right shoulder pain and swelling due to repeated hemarthrosis. The shoulder joint had a mildly limited range of motion and she reported no history of trauma. Although an MRI examination showed a supraspinatus tendon tear, there were no significant positive signs associated with a rotator cuff tear. During surgery, pigmented synovitis and an isolated complete supraspinatus tendon tear were noted, and a synovectomy and supraspinatus tendon repair (McLaughlin's method) were performed. Histologic evaluation of the synovium did not confirm pigmented villonodular synovitis, because of a lack of nodular formation. Six years after surgery, the patient has no shoulder pain or recurrence of hemarthrosis.
Case 2: A 53-year-old woman with a 1-year history of repeated hemarthrosis of the left shoulder came to our department. Her shoulder showed remarkable swelling, though the range of motion was normal and there were no significant signs of a rotator cuff tear. She reported no history of trauma. During a glenohumeral arthrography examination, there was no leakage of contrast medium into the subacromial bursa. During surgery, remarkable localized synovitis of the subacromial bursa and a bursal side tear of the supraspinatus tendon beneath the synovitis were revealed, so a synovectomy and side to side repair of the supraspinatus tendon were performed. Histologically, nonspecific synovitis was noted. One year after surgery, no recurrence of hemarthrosis has been seen.
Discussion: Chronic hemarthrosis of the shoulder joint is a relatively rare condition, usually correlated with a rotator cuff tear that is often massive. Thus, reports of chronic hemarthrosis associated with a small or partial rotator cuff tear are scarce. Our findings in the present cases suggest that the cause of hemarthrosis is synovitis secondary to supraspinatus tendon deficiency, even when associated with only a small or partial tear.
