Synovial chondromatotis localized in the subacromail bursa has rarely been reported. We present a case of synovial chondromatosis of the subacromial bursa in a 75-year-old male, treated arthroscopically.
A 75-year old male, who had suffered long head of the right biceps tendon rupture 3 years previously, gradually became aware of his right shoulder swelling. He had no pain on motion and no restriction of the range of motion, no tenderness, or heat of his affected shoulder. Plain X-ray of the shoulder showed scalloping of the acromion, and enhanced MRI and enhanced CT scans revealed the mass of the subacromial space and subdeltoid bursa. T1-weighted images of MRI showed subacromial-subdeltoid bursa filled with multiple low-isointensed nodules. The result of culture analysis and cytology by puncture of the mass only showed the presence of leukocytes. Arthroscopic surgery was performed. We removed about 1200 free bodies by forceps and irrigation from posterolateral and anterolateral portals. Synovectomy was also performed. Histological findings supported our clinical diagnosis.
There was no complaint after surgery, and swelling of his shoulder disappeared.
We think arthroscopic treatment is less invasive, so we can reduce the postoperative pain and restriction of ROM compared to open surgery, and also arthroscopic treatment may allow a better visualization of the subacromial space. There may be remnant of free bodies and abnormal synovium, so we must keep this in mind for recurrence and malignant transformation. Long term follow up is necessary.
