After the procedure the patient experienced immediate pain relief,
with reduction of the pain symptomatology from VAS 8 to VAS 3 and full articular ROM recovery both in abduction (180 °) and intrarotation (thumb at the level of the paravertebral).
Anti-inflammatory drugs were not taken in the days following the operation.
The hypothesis of surgical treatment should always be considered in symptomatic patients with recovery possibilities when the conservative treatments fail.
[4]
Arthroscopy is held to be the best therapeutic strategy in most cases: less invasive than an open treatment while allowing easy fragments’ visualization [4].
Raval et al.
Reported a case of arthroscopic retrieval of more than 100 Loose Bodies from the shoulder of an adult patient diagnosed with synovial chondromatosis.
[1].
Andrade et al.
described a case of a 20-year-old man with a history of chronic shoulder pain who later underwent arthroscopic retriveal of 42 loose bodies located in the glenohumeral joint,
with MR and radiographic imaging compatible with synovial chondromatosis [3]
In both of these cases synovectomy was performed to prevent recurrences.
The last point remains controversial because is it not clear in literature if synoviectomy with the excision of all communicating bags is to be considered as best practice.
Recurrences,
in fact,
are common regardless of the extent of excision and,
consequently,
many authors prefer the removal of all loose bodies followed by a subtotal synovectomy [5]
ADVANTAGES
Our approach is innovative and unique in literature as it is extremely non-invasive and with minimal post-intervention morbidity.
It could be considered as a valid alternative to arthroscopic treatment in those cases where a reduced number of loose bodies is found,
without association with post-traumatic glenoid rim fracture,
which necessarily requires a surgical approach [5].
A further advantage of the ultrasound approach is its feasibility with only local anesthesia and does not require admission to a day hospital regime.
LIMITS:
The limits of the percutaneous approach to the extraction of the mobile body are due to:
- large number of moving bodies
- failure to visualize the joint cavity
- impossibility of concomitant tendon repair / osteocartilage,
as in the cases reported by Neumann et Al [9] and P.
Chalasani et Al [5]
- does not allow any synovectomy to be performed.