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Fred Flandry, MD
LyIe A. Norwood, MD
Introduction
Pigmented villonodular synovitis is a non-neoplastic proliferation of synovial tissue. Articular involvement is usually in a weight bearing extremity, most often the knee. The articular cases occur in two forms. The localized form is characterized by isolated, sharply circumscribed, or pedunculated lesions and the diffuse form is characterized by ubiquitous synovial involvement. Articular involvement in the upper extremity other than the hand is represented in only a small percentage of reported cases. Fewer than ten cases of shoulder involvement have been reported1-5 and in only two of these reports are the cases of shoulder involvement specifically discussed.3,5 The authors report a case of diffuse pigmented villonodular synovitis of the shoulder that was discovered incidentally during reconstruction of an anterior dislocating shoulder.
Case Report
A 28-year-old right hand dominant man was examined for recurrent anterior dislocations of the right shoulder. He had undergone an unsuccessful anterior reconstruction and, later, an anterior bone block reconstruction approximately 5 and 6 years after the initial injury. He had not sustained any subsequent trauma to the shoulder.
He complained only of painful subluxations and was unable to perform overhead work because of the disability. Apprehension and anterior subluxation were present with stability testing, but his shoulder and neurovascular examinations were otherwise unremarkable.
Radiographs (Fig. 1) showed a screw projecting from the anterior- inferior glenoid rim. No remnant of the iliac crest bone block was visible.
The patient was admitted for screw removal and an anterior shoulder reconstruction. The initial approach through a deltoid-splitting incision revealed dense scarring of the subacromial and subdeltoid bursae. Arthrotomy revealed dark maroon blood and clots in the joint. The synovium was entirely involved by a villous hypertrophy. Cultures were taken and a total synovectomy was performed, followed by the screw removal and anterior reconstruction, as planned.
Histologie sections (Fig. 2) showed a synovial tissue lining that was characterized by papillary projections with subsynovial nodular proliferations. Isolated areas of hemorrhage were identified. Prussian blue stains were positive for iron pigment. No evidence of malignancy was noted. The specimens supported the intraoperative diagnosis of diffuse pigmented villonodular synovitis. All cultures were ultimately negative.
The patient was discharged on the second postoperative day. By 3 months, he had returned...