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.