Abstract
A 64-year-old right-handed woman presented herself with a 2-year history of pain of the right shoulder. The patient noted progressive stiffness of her shoulder. She reported no history of trauma. 2 weeks prior to admission, she developed severe painful swelling of the right shoulder. Aseptic aspiration of the subacromial space yielded 20ml of bloody fluid. MRIs showed a soft tissue mass with a low signal on both T1 and T2 images and full-thickness rotator cuff tear in the shoulder joint. Shoulder arthroscopy was perfomed in the left lateral decubitus. Arthroscopic findings included complete retracted cuff tear of supraspinatus and extensive diffuse yellow-brown synovitis involving the entire joint and subacromial space. The patient underwent arthroscopic synovectomy and the repair of rotator cuff tear using suture anchors. Histologic evaluation showed synovial proliferation with foam cells, giant cells, and areas of hemosiderin deposit consistent with pigmented villonodular synovitis (PVNS). 18 months later, the patient was pain free with almost no limitation of shoulder motion. The JOA score improved from 67 points preoperatively to 88 points postoperatively. Jaffe first introduced the term PVNS in 1941. The knee is a joint of frequent occurrence of PVNS, while the shoulder is rarely affected. Although PVNS of the shoulder have been treated by open surgery or radiotherapy, currently there are a few reports of arthroscopic treatment. We presented a rare case of diffuse PVNS of the shoulder with rotator cuff tear successfully treated by arthroscopic surgery. Arthroscopy allows a more precise exploration of the joint cavity and less invasive procedure than the open approach.
