Arthroscopic treatment of an unusual distal clavicle ostheochondroma causing rotator cuff impingement: case report and literature review

Abstract

Chronic shoulder impingement is one of the most common causes of shoulder pain. Intrinsic, extrinsic and secondary factors play a role in this syndrome; however the etiology of the pathology is still under debate. In rare cases, it can be caused by tumors, such as an osteochondroma. In the present study, a 49-year-old patient presented with shoulder pain for 6 months. Initially he underwent conservative treatment, without relief of symptoms. Xrays and MRI were then performed and showed the presence of an exostotic formation on the undersurface of the lateral third of the clavicle. The formation was arthroscopically removed. Histologic examination confirmed the diagnosis of osteochondroma. After surgery, the patient resumed fully activities with no symptoms within 3 months. At 1 year follow up, there are still no clinical or radiological signs of recurrence. This is, to our knowledge, the first case where an arthroscopic approach was used to remove an ostochondroma of the distal third of the clavicle.

Keywords: arthroscopic surgery; clavicle; osteochondroma; rotator cuff; subacromial impingement.

Figure 1.

X-rays, right shoulder antero-posterior view. An exostotic formation can be noticed on the undersurface of the lateral third of the clavicle.

Figure 2.

Magnetic Resonance, right shoulder, sagittal view. A layer of fluid between the osseous projection and the rotator cuff can be visualized. A thin rim of cartilage outlined the undersurface of the projection.