1
|
Park JP, Marwan Y, Alfayez SM, Burman ML, Martineau PA. Arthroscopic management of synovial chondromatosis of the shoulder: a systematic review of literature. Shoulder Elbow 2022; 14:5-15. [PMID: 35845621 PMCID: PMC9284258 DOI: 10.1177/1758573220977205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Accepted: 11/09/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND Synovial chondromatosis (SC) of the shoulder is rare, with limited literature on its management. This systematic review of literature aimed to characterize common arthroscopic techniques for the treatment of shoulder SC and patient outcomes. We hypothesized that arthroscopy is an effective operative modality for the management of shoulder SC. METHODS PubMed and Embase databases were searched for articles on arthroscopic management of shoulder SC, published before 6 August 2020. All articles meeting inclusion criteria received an independent full-text review by two authors. RESULTS An initial search found 64 articles. Following duplicate removal and title, abstract, and full-text reviews, 27 articles (48 patients) remained eligible. The mean age of patients was 33.0 years, with 2:1 male-to-female ratio. The mean follow-up was 41.8 months. SC was found to affect various intra- and extra-articular locations of the shoulder. Overall, arthroscopic treatment of shoulder SC was successful in 70.8%. Treatment failure was common in SC involving the bicipital tendon sheath. Disease recurrence was seen in 14.7%. CONCLUSION Literature on arthroscopic management of shoulder SC is limited, and significant heterogeneity in arthroscopic techniques was observed. Although arthroscopic management of shoulder SC is effective, further optimization is necessary to minimize treatment failure and disease recurrence.
Collapse
Affiliation(s)
- J Patrick Park
- J Patrick Park, McGill University Health Center,
Montreal General Hospital, 1650 Cedar avenue, B5.159 Montreal, Quebec H3G 1A4, Canada.
| | | | | | | | | |
Collapse
|
2
|
Al Farii H, Doyle-Kelly C, Marwan Y, Volesky M, Turcotte R. Arthroscopic Management of Synovial Chondromatosis of the Ankle Joint: A Systematic Review of the Literature. JBJS Rev 2020; 8:e2000045. [PMID: 33151646 DOI: 10.2106/jbjs.rvw.20.00045] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND Synovial chondromatosis (SC) of the ankle is a rare disorder in which metaplastic proliferation of synovia, tendon sheaths, and/or bursae leads to the formation of loose cartilaginous bodies within the joint space. While SC itself is a benign condition, its sequelae can be chronic and debilitating if left untreated, or if there is postoperative recurrence. Arthritic degeneration and malignant transformation to chondrosarcoma are among the more serious complications in the natural history of the disease; the latter occurs in approximately 5% of cases. We performed a systematic review of the literature on the arthroscopic management of ankle SC in order to better understand recurrence patterns and suggest an alternative approach to open arthrotomy. METHODS Using predetermined inclusion and exclusion criteria, the PubMed and Embase databases were searched for relevant articles related to arthroscopic surgical management of patients with confirmed SC of the ankle. Article selection and data abstraction were performed in 3 steps by 3 independent reviewers. RESULTS The initial search retrieved 116 articles, of which 15 were included. Those studies included 22 patients (14 to 63 years of age; 77% male) who were followed for a mean of 27 months (range, 8 weeks to 12 years) postoperatively. The cases represented a mix of primary and secondary SC etiologies, and almost entirely stage-III disease. Arthroscopic synovectomy with excision of loose bodies was a consistent feature of treatment, and bursectomy, debridement of osteochondral lesions or involved tendons, and osteophyte resection were performed as indicated. All but 1 case employed an anterior approach including anteromedial and anterolateral portals, and in several cases a 4-portal technique was used, which was subsequently proposed as a necessary approach for the definitive treatment of ankle SC. On the basis of the available data, complication and recurrence rates following arthroscopic management were very low. CONCLUSIONS A growing pool of evidence is emerging to suggest favorable outcomes for arthroscopic treatment of SC of the ankle joint. However, more data on patient and surgical variables, as well as comparative studies with longer follow-up, are needed in order to draw definitive conclusions. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Collapse
Affiliation(s)
- Humaid Al Farii
- 1Division of Orthopaedic Surgery, McGill University, Montreal, Quebec, Canada
| | | | | | | | | |
Collapse
|
3
|
Xu C, Yang X. Staged arthroscopic procedure for treating simultaneous shoulder and elbow synovial chondromatosis: A case report and literature review. SAGE Open Med Case Rep 2020; 8:2050313X20951340. [PMID: 32922795 PMCID: PMC7446550 DOI: 10.1177/2050313x20951340] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 07/27/2020] [Indexed: 11/21/2022] Open
Abstract
It is extremely rare for ipsilateral shoulder and elbow synovial chondromatosis to occur simultaneously. We report a very rare case of simultaneous shoulder and elbow synovial chondromatosis in a 53-year-old woman who was treated through staged surgeries. Shoulder arthroscopic synovectomy, debridement, biceps tenodesis, and subacromial decompression were conducted first, followed by elbow arthroscopy 2 months later. Post surgery, there was no recurrence either clinically or radiologically at 2 years follow-up. Despite some loss of the range of motion of the shoulder and muscle strength, the elbow functions recovered fully, and the patient was extremely satisfied with the clinical outcome. We recommend a staged arthroscopic procedure consisting of a thorough synovectomy and joint debridement for this condition.
Collapse
Affiliation(s)
- Caiqi Xu
- Department of Sports Medicine, Shanghai Sixth People’s Hospital, Shanghai, China
| | - Xingguang Yang
- Department of Sports Medicine, Shanghai Sixth People’s Hospital, Shanghai, China
| |
Collapse
|
4
|
Fukuda A, Uemura T, Nishimura A, Kato K, Sudo A. Arthroscopic Treatment of Primary Synovial Chondromatosis of the Subscapular Bursa: A Case Report. J Orthop Case Rep 2020; 9:40-43. [PMID: 32548026 PMCID: PMC7276592 DOI: 10.13107/jocr.2019.v09.i06.1580] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Introduction Synovial chondromatosis is a rare metaplastic disorder of the synovial membrane. Primary synovial chondromatosis of the shoulder joint is a rare localization and extra-articular localization around the shoulder is much less common. Case Report We report a rare case of a 13-year-old boy with primary synovial chondromatosis of the subscapular bursa. Computed tomography and magnetic resonance imaging showed that multiple cartilaginous loose bodies were found in the subscapular bursa and the glenohumeral joint. Arthroscopic removal of loose bodies and synovectomy of the subscapular bursa was performed through sublabral foramen. Conclusion Pre-operative investigation for the precise location of the lesions was important for the planning the operative procedure. Arthroscopic removal of loose bodies and synovectomy was useful treatment options for synovial chondromatosis of the subscapular bursa.
Collapse
Affiliation(s)
- Aki Fukuda
- Department of Orthopaedic Surgery, Suzuka Kaisei Hospital, Suzuka, Mie 513-0836, Japan
| | - Takeshi Uemura
- Department of Orthopaedic Surgery, Suzuka Kaisei Hospital, Suzuka, Mie 513-0836, Japan
| | - Akinobu Nishimura
- Department of Orthopaedic and Sports Medicine, Mie University Graduate School of Medicine, Tsu, Mie 514-8507, Japan
| | - Ko Kato
- Department of Orthopaedic Surgery, Suzuka Kaisei Hospital, Suzuka, Mie 513-0836, Japan
| | - Akihiro Sudo
- Department of Orthopaedic Surgery, Mie University Graduate School of Medicine, Tsu, Mie 514-8507, Japan
| |
Collapse
|
5
|
Mo J, Pan J, Liu Y, Feng W, Li B, Luo K, Mo W, Lin H, Liao S. Bilateral synovial chondromatosis of the elbow in an adolescent: a case report and literature review. BMC Musculoskelet Disord 2020; 21:377. [PMID: 32534572 PMCID: PMC7293777 DOI: 10.1186/s12891-020-03322-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Accepted: 04/29/2020] [Indexed: 12/18/2022] Open
Abstract
Background Primary synovial chondromatosis is a rare benign disease that occurs in the joint mucosa. Case presentation In this case report, a 14-year-old gymnast sustained pain in both elbows for 2 months with limited elbow joint activity. The initial diagnosis of bilateral elbow synovial chondromatosis was performed by physical examination and imaging report. Later, the patient was treated with open surgery on both sides of the elbow, including all loose bodies were removed out and the proliferative synovia were cut off. Histopathology reports confirmed synovial chondromatosis. Conclusions The report introduced a case about synovial chondromatosis in bilateral elbow found in a 14-year-old girl, which is rarely involved in bilateral elbow and rarely found in adolescents. This case report aims to provide a treatment option for surgeons in similar situations.
Collapse
Affiliation(s)
- Jianming Mo
- Departments of Orthopedics, The First Affiliated Hospital of Guangxi Medical University, Nanning, 530021, Guangxi, China
| | - Jie Pan
- Department of Rheumatology and Immunology, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Yun Liu
- Departments of Orthopedics, The First Affiliated Hospital of Guangxi Medical University, Nanning, 530021, Guangxi, China
| | - Wenyu Feng
- Departments of Orthopedics, The First Affiliated Hospital of Guangxi Medical University, Nanning, 530021, Guangxi, China
| | - Boxiang Li
- Departments of Orthopedics, The First Affiliated Hospital of Guangxi Medical University, Nanning, 530021, Guangxi, China
| | - Kai Luo
- Department of Guangxi, Medical University, Nanning, Guangxi, China
| | - Weijia Mo
- Departments of Pathology, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Huahao Lin
- Departments of Orthopedics, The First Affiliated Hospital of Guangxi Medical University, Nanning, 530021, Guangxi, China
| | - Shijie Liao
- Departments of Orthopedics, The First Affiliated Hospital of Guangxi Medical University, Nanning, 530021, Guangxi, China.
| |
Collapse
|
6
|
Utashima D, Matsumura N, Suzuki T, Iwamoto T, Ogawa K. Clinical Results of Surgical Resection and Histopathological Evaluation of Synovial Chondromatosis in the Shoulder: A Retrospective Study and Literature Review. Clin Orthop Surg 2020; 12:68-75. [PMID: 32117541 PMCID: PMC7031439 DOI: 10.4055/cios.2020.12.1.68] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Accepted: 05/30/2019] [Indexed: 11/06/2022] Open
Abstract
Background Synovial chondromatosis occurs rarely in the shoulder, and its details remain unclear. The purpose of this study was to clarify the clinical results of surgical resection and the histopathological findings of synovial chondromatosis in the shoulder. Methods Ten shoulders with synovial chondromatosis that had been operatively resected were reviewed retrospectively. Osteochondral lesions were present in the glenohumeral joint in six shoulders and in the subacromial space in four shoulders. Two patients had a history of trauma with glenohumeral dislocation without recurrent instability, and the other seven patients (eight shoulders) did not have any traumatic episodes or past illness involving the ipsilateral shoulder girdle. The occurrences of osteochondral lesions, inferior humeral osteophytes, and acromial spurs were assessed on radiographs before resection, just after resection, and at final follow-up. The Constant scores were compared before resection and at final follow-up with Wilcoxon signed-rank tests. Resected lesions were histopathologically differentiated between primary and secondary synovial chondromatosis. Results Inferior humeral osteophytes were found in five shoulders with synovial chondromatosis in the glenohumeral joint, and all four shoulders with synovial chondromatosis in the subacromial space had acromial spur formation. Osteochondral lesions appeared to have been successfully removed in all shoulders on postoperative radiographs. At the final follow-up, however, one shoulder with secondary synovial chondromatosis in the subacromial space showed recurrence of osteochondral lesions and acromial spur formation. The mean Constant score improved significantly from 53.0 points before resection to 76.0 points at a mean follow-up of 6.0 years (p = 0.002). On histopathological evaluation, one shoulder was diagnosed as having primary synovial chondromatosis, while nine shoulders had secondary synovial chondromatosis. Conclusions The present study showed that resection of shoulder osteochondral lesions successfully relieved the clinical symptoms and that primary synovial chondromatosis is less common than secondary synovial chondromatosis in the shoulder. Although most of the present osteochondral lesions were clinically determined to be primary chondromatosis, only one case was histopathologically categorized as primary synovial chondromatosis. These results suggest that histopathological identification is needed to differentiate between primary and secondary synovial chondromatosis.
Collapse
Affiliation(s)
- Daisuke Utashima
- Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Noboru Matsumura
- Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Taku Suzuki
- Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Takuji Iwamoto
- Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Kiyohisa Ogawa
- Department of Orthopedic Surgery, Eiju General Hospital, Tokyo, Japan
| |
Collapse
|
7
|
Abstract
OBJECTIVE We aimed to identify factors that affect pain, complications, and function following elbow arthroscopy for elbow synovial chondromatosis. METHODS We retrospectively reviewed the cases of all patients with elbow synovial chondromatosis treated by arthroscopic synovectomy and loose body removal between January 2000 and January 2016 at our institution. Eleven patients were enrolled (8 male; mean age, 41.7 years). The mean duration of symptoms was 13.7 months, and all patients had a decreased range of motion (ROM) in the affected elbow. By Milgram criteria, there was 1 phase II case, and 10 cases were phase III. RESULTS All patients were followed postoperatively (mean follow-up, 65 months). The preoperatively restricted ROM of 100° flexion (range, 78°-120°) and extension of 30° (range, 15°-40°) were improved to 130° flexion (range, 120°-140°) and -5° hyperextension (range, -10°-0°). Pain, recorded as the pain subscore of the American Shoulder and Elbow Surgeons questionnaire for elbows, was significantly improved from 32 points (range, 20-50) preoperatively to 85 (range, 70-100) postoperatively (on a scale ranging from 0 [worst pain] to 100 [pain-free]). Recurrence occurred in 2 patients (18.2%) who then received arthroscopic synovectomy and loose body removal again. There were no fractures or neurovascular complications, and no patient developed an infection. CONCLUSION Arthroscopic management of synovial chondromatosis of the elbow was an effective and safe therapeutic method. After the intervention, immediate and durable improvement of elbow function can be expected.
Collapse
|
8
|
Chillemi C, Petrozza V, Franceschini V, Garro L, Pacchiarotti A, Porta N, Cirenza M, Salate Santone F, Castagna A. The role of tendon and subacromial bursa in rotator cuff tear pain: a clinical and histopathological study. Knee Surg Sports Traumatol Arthrosc 2016; 24:3779-3786. [PMID: 26003482 DOI: 10.1007/s00167-015-3650-4] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2014] [Accepted: 05/13/2015] [Indexed: 12/17/2022]
Abstract
PURPOSE To evaluate a possible association of shoulder pain with the clinical features and the histopathological changes occurring in the ruptured tendon and subacromial bursa of patients with rotator cuff tear. METHODS One hundred and eighty patients were clinically evaluated with the constant score and the visual analogue pain scale. Radiographs and MRI were performed. The chronology of the rupture, the muscle fatty degeneration according to Goutallier's scale and the tear size were evaluated. For each patient, a biopsy of the supraspinatus tendon and subacromial bursa was performed during arthroscopic rotator cuff tear repair and the specimens were histopathologically analysed. RESULTS Clinically, the shoulder was more painful in females, in the presence of a chronic cuff lesion and a low Goutallier's grade (P < 0.05). No association was found between pain and age of the patient and between pain and tear size. Histologically, hypertrophy and inflammation of the tendon and hypertrophy, inflammation, oedema and necrosis of the subacromial bursa were directly associated with pain (P < 0.05). Pain decreased significantly in the presence of fatty metaplasia and necrosis of the tendon (P < 0.05). CONCLUSIONS This study defines the main clinical and histopathological features of painful rotator cuff tear. In particular, a greater association of pain was observed with the histopathological changes in the bursa compared with those in the rotator cuff. Considering that the bursa plays also an essential role during the healing process, this "new" role of the subacromial bursa as pain generator has important repercussions in both pharmacological and surgical treatments of rotator cuff tears. LEVEL OF EVIDENCE IV.
Collapse
Affiliation(s)
- Claudio Chillemi
- Department of Orthopaedic Surgery, Istituto Chirurgico Ortopedico Traumatologico (ICOT), Latina, Italy.
| | - Vincenzo Petrozza
- Histology Unit, Department of Medico-Surgical Sciences and Biotechnologies, ICOT Latina, Sapienza University of Rome, Latina, Italy
| | - Vincenzo Franceschini
- Department of Orthopaedics and Traumatology, ICOT, Sapienza University of Rome, Latina, Italy
| | - Luca Garro
- Department of Orthopaedic Surgery, University of Rome Tor Vergata, Rome, Italy
| | - Alberto Pacchiarotti
- Department of Histopathology, Istituto Chirurgico Ortopedico Traumatologico (ICOT), Latina, Italy
| | - Natale Porta
- Histology Unit, Department of Medico-Surgical Sciences and Biotechnologies, ICOT Latina, Sapienza University of Rome, Latina, Italy
| | - Mirko Cirenza
- Histology Unit, Department of Medico-Surgical Sciences and Biotechnologies, ICOT Latina, Sapienza University of Rome, Latina, Italy
| | | | | |
Collapse
|
9
|
Lui TH. Endoscopic Resection of the Lateral Ankle Bursa With Synovial Chondromatosis. Arthrosc Tech 2016; 5:e489-93. [PMID: 27656367 PMCID: PMC5020423 DOI: 10.1016/j.eats.2016.01.025] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2015] [Accepted: 01/25/2016] [Indexed: 02/03/2023] Open
Abstract
Bursal chondromatosis is synovial chondromatosis of the bursae. It is a rare disease entity that can involve the adventitial bursa of the lateral ankle. Complete synovectomy, removal of loose bodies, and bursectomy comprise the treatment of choice. Detailed preoperative radiologic assessment and surgical planning are the keys to success. Any accompanying synovial chondromatosis of the ankle or subtalar joint or tenosynovial chondromatosis of the peroneal tendon sheath should be treated together with the bursectomy. Endoscopic bursectomy can be performed through the bursal portal. The proximal and distal peroneal tendoscopy portals serve as viewing portals. The resection of the diseased tissues should be performed in a step-by-step zonal manner. Complete synovectomy and removal of loose bodies should be performed before bursectomy. Internal drainage of the bursal sac into the peroneal tendon sheath may be indicated if the sac is adherent to the skin. It should only be performed after complete synovectomy and removal of loose bodies.
Collapse
Affiliation(s)
- Tun Hing Lui
- Address correspondence to Tun Hing Lui, M.B.B.S.(HK), F.R.C.S.(Edin), F.H.K.A.M., F.H.K.C.O.S., Department of Orthopaedics and Traumatology, North District Hospital, 9 Po Kin Road, Sheung Shui, NT, Hong Kong SAR, China.Department of Orthopaedics and TraumatologyNorth District Hospital9 Po Kin RoadSheung ShuiNTHong Kong SARChina
| |
Collapse
|
10
|
Guity MR, Eraghi AS. Open Rotator Cuff Tear Repair Using Deltopectoral Approach. Med Arch 2015; 69:298-301. [PMID: 26622080 PMCID: PMC4639353 DOI: 10.5455/medarh.2015.69.298-301] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2015] [Accepted: 10/05/2015] [Indexed: 12/16/2022] Open
Abstract
Background: The goal of this study was to evaluate the outcome of the open repair of rotator cuff tears via the deltopectoral approach in patients unable to afford arthroscopic repair costs. Methods: We evaluated 80 consecutive patients who were treated for full-thickness rotator cuff tears by open repair through the deltopectoral approach. There were 48 men and 32 women at a mean age of 60.1 years (range, 35-80 years). Preoperative and postoperative clinical assessments were performed with the Constant score, American Shoulder and Elbow Surgeons (ASES) score, modified University of California Los Angeles (UCLA) score, and pain visual analog scale. Results: The mean follow-up period was 30.6 months (range, 18-48 months). At final follow-up visits, the ASES, Constant score, and modified UCLA score were found to have improved significantly from 33.56, 39.24, and 13.0 to 85.64, 81.46, and 32.2, respectively (P <0.01). Pain, as measured on a visual analog scale, was improved significantly (P <0.01). The mean time for recovering the full range of motion was 2.5 months. Postoperative pain at 48 hours and at 6 weeks was relatively low. There were no cases of intractable stiffness. Conclusion: The deltopectoral approach for open rotator cuff repair produced satisfactory results and reduces rate of shoulder stiffness and postoperative pain.
Collapse
Affiliation(s)
- Mohammad Reza Guity
- Orthopaedics Department, Imam Khomeini Hospital, Tehran University of Medical sciences, Tehran, Iran
| | - Amir Sobhani Eraghi
- Orthopaedics Department, Rasoul Akram Hospital, Iran University of Medical sciences, Tehran, Iran
| |
Collapse
|
11
|
El Rassi G, Matta J, Hijjawi A, Khair OA, Fahs S. Extra-articular Synovial Chondromatosis Eroding and Penetrating the Acromion. Arthrosc Tech 2015; 4:e443-8. [PMID: 26697302 PMCID: PMC4661792 DOI: 10.1016/j.eats.2015.04.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2014] [Accepted: 04/09/2015] [Indexed: 02/03/2023] Open
Abstract
Synovial chondromatosis of the shoulder is an uncommon disorder. It usually affects the glenohumeral joint and is characterized by metaplasia of the synovium leading to the formation of osteochondral loose bodies. Few cases of extra-articular subacromial synovial chondromatosis involving the rotator cuff tendon have been reported in the literature. The treatment of previously reported cases consisted of open bursectomy and removal of loose bodies. We report a case of subacromial synovial chondromatosis without rotator cuff involvement but with severe erosion and fracture of the acromion. Treatment consisted of shoulder arthroscopy to remove all loose bodies, total bursectomy, and debridement of the acromion. Potential benefits of arthroscopy were also evaluated.
Collapse
Affiliation(s)
- George El Rassi
- Address correspondence to George El Rassi, M.D., Saint Georges Hospital, PO Box 166378, Ashrafieh, Beirut 1100 2807, Lebanon.
| | | | | | | | | |
Collapse
|