2025年 · 第105卷第01期

A 20-year-old male went to the Sports Medicine Department of the Second Affiliated Hospital of Xi'an Jiaotong University for "pain in the left shoulder with mobility restriction for 6 months and aggravation for 5 days". Six months before admission, the patient had left shoulder pain and discomfort without obvious trigger, which was not paid attention to. After strenuous exercise, the pain worsened, and oral non-steroidal anti-inflammatory drugs could not relieve it. Specialist physical examination showed that the left shoulder was obviously aggravated by anterior flexion and abduction, and Job sign was positive. MRI of the left shoulder showed a large number of free bodies in the shoulder joint, supraspinatus tendon tear (panel A, arrow), biceps longhead tendonitis (panel B, arrow). After admission, the left shoulder joint was explored and cleared under arthroscopy. During the operation, a large number of free bodies were filled in the glenohumeral joint cavity and internodular sulcus, and synovial congestion and edema were found. Articular cartilage degeneration, partial tear of the supraspinatus muscle, and tendinitis of the longhead tendon of the biceps brachii (Figures C, D). Then the anterior and posterior approaches were combined with full shoulder arthroscopic free body removal + synovectomy, and double row fixation of supraspinatus tendon under microscope was performed. Synovial osteochondromatosis was further confirmed by postoperative pathology. Rehabilitation exercises were performed after operation, and the shoulder pain was significantly reduced and the functional activity returned to normal after half a year of follow-up. Primary synovial osteochondromatosis is a rare benign soft tissue tumor involving a single joint, especially the knee. The disease is characterized by extensive inflammation of the synovial membrane of the joint, resulting in ectopic chondrocyte masses, which can be shed into a large number of free bodies. At present, the etiology of the disease is still unclear, and the inflamed synovium should be completely removed during operation to reduce the risk of recurrence. It is necessary to cooperate with rehabilitation exercise to actively recover joint mobility and muscle strength after operation. The disease is insensitive to radiotherapy and chemotherapy.