PMC8046480_01
Significant restriction in forward flexion and internal rotation at the right shoulder joint on presentation.
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F1
Physical examination revealed stiffness and crepitus over the right shoulder joint with severe restriction of abduction, forward flexion, and internal rotation (Fig. 1).
Plain radiograph of the right shoulder joint showing multiple well defined calcific foci with central lucency.
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F2
Plain radiographs (Fig. 2) and computed tomography (including three dimensional reconstruction images) (Fig. 3) revealed multiple well-defined calcified foci with central lucency engulfing glenohumeral joint (intra- and extra-articular) anteriorly, posteriorly, superiorly, and inferiorly including biceps tendon consistent with synovial chondromatosis.
Magnetic resonance imaging showed multiple lobulated, osseocartilagenous loose bodies with moderate synovial effusion.
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F4
Magnetic resonance imaging done suggested moderate synovial effusion with synovial thickening and early degenerative changes with loose bodies which were consistent with the findings on computed tomography (Fig. 4).
Arthroscopic view (left) showing osteochondral loose bodies between glenoid and humeral head and post-excision empty axillary region of glenohumeral joint (right).
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F5
Active, intrasynovial proliferation was noted with intra-articular and extra-articular loose bodies (Fig. 5). With motorized shaver, partial synovectomy was performed using anterosuperior and anteroinferior portals and by inter-changing the portals frequently, the osteochondral loose bodies were removed with larger arthroscopic grasper (Fig. 5).
Excised loose bodies measuring 0.3-3.5 cm in size.
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F6
Approximately 20 fragments, ranging in size from 0.3 to 3.5 cm, were removed (Fig. 6) over a duration of 1 h.
Clusters of chondrocytes showing binucleation on histopathology.
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F7
The histopathological examination of the loose bodies and synovial tissue confirmed the presence of cartilaginous synovial metaplasia consistent with synovial chondromatosis (Fig. 7).
Comparison of plain radiograph of the right shoulder joint pre- and post-operatively - loose bodies around the glenohumeral joint were extracted.
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F8
Post-operative plain radiograph was done (Fig. 8).
Full range of movement at 4 weeks post-operatively.
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F9
By 4 weeks post-operatively, the patient could return to work (Fig. 9).