CASE PRESENTATION:
A 14-year-old, right-handed boy presented to the Pediatric Orthopedics
department with right shoulder pain. He complained of 14 months history
of pain and discomfort in his right shoulder. He had no trauma or family
history of osteochondroma. He reported no symptoms of weight loss,
fatigue, systemic signs, or any other arthralgia.
On physical examination, there was no obvious deformity or atrophy
involving the affected shoulder. We noted a decreased range of motion,
in comparison to the uninvolved side, with respectively: flexion to
160°, extension to 40°, abduction to 140°, adduction to 40°, internal
rotation to L4, and external rotation to 50°. Subacromial impingement
signs, as well
as rotator
cuff tear tests, were negative. The joint was stable. A neurovascular
exam revealed no deficits in the upper limb.
The laboratory results were slightly normal, particularly the calcium
and the phosphorus rate. Plain radiographs showed multiple radio-opaque
bodies distributed throughout the glenohumeral joint, without bone
defection or joint narrowing (Figure 1). Subsequent Magnetic resonance
imaging (MRI) revealed a high number of calcified intra-articular loose
bodies around the joint and the biceps tendon (Figure 2). PSC was
strongly suspected.
We choose a shoulder arthroscopy using a deltopectoral approach to
remove the tumors nodules. More than 50 shiny and solid bodies, with an
average size of 10-15 millimeters, were retrieved (Figure 3). There were
also several bodies within the coracoid process and the conjoint tendon.
The synovial tissue, bursas, and cartilages appeared intact. Upon
removing the particles, we complete a partial synovectomy to avoid the
relapse. Histology of loose bodies and synovium confirmed the diagnosis
of PSC by revealing multiple cartilaginous nodules, composed of
clustered chondrocytes and embedded in synovium (Figure 4). No sign of
malignant transformation was noted.
Postoperative shoulder X-rays did not show any densities. The patient
was discharged after the surgery using the arm sling. At six months of
follow-up, the patient remains free of symptoms, and shoulder
radiographs showed no recurrence of calcification.