Shoulder bursitis can be a persistent and painful condition, especially when it’s caused by unusual growths inside the shoulder’s natural cushioning structures. One rare but impactful form is when cartilage-like tissue forms in the shoulder’s bursa—the small sac that helps reduce friction under your shoulder blade. This condition is called synovial chondromatosis, and in some cases, it can lead to damage in the rotator cuff.
Let’s walk through a real-life case and explore how arthroscopic surgery provided long-term relief.
Understanding the Problem: What Was Going On in the Shoulder?
A patient came in with a four-year history of shoulder pain that slowly got worse over time. She hadn’t injured her shoulder, but everyday movements like lifting, rotating, or even reaching behind her back were causing increasing discomfort. On examination, her range of motion was clearly limited, and simple clinical tests triggered pain. These signs pointed toward subacromial bursitis, a condition where the space between the top of the arm bone and the shoulder blade becomes inflamed.
Imaging showed unusual calcium-like deposits in this space—what turned out to be loose bodies, or free-floating pieces of cartilage. These were coming from a condition called synovial chondromatosis, where the lining of the joint or bursa starts producing extra bits of cartilage that break off into the surrounding space. It’s a benign condition, but these loose bodies can press against soft tissue structures like the rotator cuff, causing pain and even tears over time.
The Diagnosis: What Made This Case Special?
This wasn’t just a routine case of bursitis. The real culprit was the proliferation of cartilage nodules in the subacromial bursa. These nodules had grown to the point of irritating and slightly tearing the outer surface of the rotator cuff—one of the most important muscle groups for shoulder motion and strength.
An MRI confirmed both the presence of these loose bodies and a partial tear in the rotator cuff, specifically on the side facing the bursa. This was enough to cause significant pain with motion but hadn’t yet developed into a full tear.
The Treatment: Arthroscopy to the Rescue
The patient underwent arthroscopic surgery, a minimally invasive technique that uses a small camera and instruments inserted through tiny incisions. She was placed on her side under general anesthesia, and three standard entry points were used to reach the shoulder’s subacromial space.
Once inside, the surgeon found:
- Multiple loose cartilage bodies, some as large as 2 centimeters
- A thickened, inflamed bursa
- A visible partial tear on the bursal side of the rotator cuff
Each of the cartilage fragments was carefully removed. The surgeon then shaved away the inflamed and overgrown bursal tissue using a specialized motorized device. To further reduce pressure in the subacromial space and support the rotator cuff’s healing, a subacromial decompression (acromioplasty) was performed. This involved smoothing the underside of the shoulder blade bone (the acromion) to prevent further friction.
After flushing the area thoroughly with saline, the surgeon confirmed that no loose fragments remained.
Recovery and Outcome
Pathological analysis of the removed tissue confirmed the diagnosis of synovial chondromatosis. After surgery, the patient participated in a rehabilitation program focused on restoring strength and range of motion. Within 14 months, she had regained full, pain-free use of her shoulder and showed no signs of recurrence.
Why Does This Condition Happen?
Synovial chondromatosis is rare and unpredictable. It often begins without a clear cause. The inner lining of joints or bursae begins to change and form cartilage, which can then break off and float freely. This can happen inside joints like the knee, elbow, or shoulder, and in rarer cases, within bursae like the one under your shoulder blade.
Although benign, the resulting loose fragments can cause a lot of trouble by irritating nearby structures. In this case, the rotator cuff—responsible for shoulder stability—was affected.
The Role of Arthroscopic Surgery
Arthroscopic techniques are especially useful for conditions like this. Unlike open surgery, arthroscopy allows your surgeon to:
- Access hard-to-reach spaces like the subacromial bursa
- Visualize and remove even small loose bodies with precision
- Perform procedures like debridement (cleaning) and acromioplasty in the same session
- Help you recover faster with less pain and scarring
In this patient’s case, thorough arthroscopic cleaning (synovectomy) and removal of debris from the subacromial space was the key to relieving her pain and preventing future damage.
What Causes the Rotator Cuff to Tear in This Case?
Rotator cuff tears can result from many causes: wear and tear, overuse, bony spurs, or trauma. But in this scenario, the rotator cuff was being mechanically irritated by the inflamed bursa and the cartilage fragments, essentially being abraded from the outside. Over time, this pressure led to a partial tear.
The good news? Because it was caught early and treated with decompression and cleaning, it healed well without requiring a full rotator cuff repair.
Key Takeaways for Patients
- Shoulder bursitis can have many causes, including rare ones like synovial chondromatosis.
- Persistent pain and limited range of motion deserve a thorough investigation, especially if symptoms worsen over time.
- Imaging tests like MRI are crucial for diagnosing hidden problems like loose bodies or rotator cuff injuries.
- Arthroscopic surgery is an excellent option for cleaning the joint, removing debris, and relieving pressure when conservative treatments fail.
- Recovery involves structured rehabilitation, but results are often excellent—especially if the problem is caught early and fully treated.
Final Thoughts
If you’re experiencing chronic shoulder pain that isn’t responding to physical therapy or injections, it’s important to consult a specialist. Even conditions that seem routine, like bursitis, may have a hidden cause. With advances in arthroscopic techniques, many of these issues can now be addressed with minimal disruption and excellent long-term outcomes.
At our practice, we believe in a careful, evidence-based approach to shoulder pain—rooted in deep understanding and precision surgery when needed. If you have questions or want to explore whether arthroscopic treatment is right for your shoulder condition, we’re here to help.
