The "rice" in the shoulder joint - rice body bursitis

Author: Liu Kunyu Harbin Fifth Hospital

Liu Qianqi The First Affiliated Hospital of Harbin Medical University

Reviewer: Fang Yuli, Chief Physician, Harbin Fifth Hospital

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Aunt Tang is an ordinary farmer with a cheerful personality. Her biggest pleasure on weekdays is to go square dancing. One year ago, Aunt Tang developed swelling and pain in her right shoulder after square dancing. She thought it was a strain on her right shoulder and that she would feel better after a few days of rest. However, after more than half a year of recuperation, the pain in her right shoulder not only did not improve, but symptoms of limited shoulder joint movement gradually appeared. During this period, she visited many hospitals and was diagnosed with "periarthritis of the shoulder", saying that it would get better after recuperation. Three months ago, Aunt Tang's symptoms worsened again. In order to make a clear diagnosis, Aunt Tang underwent a comprehensive shoulder joint examination. The X-ray only showed swelling of the right shoulder joint and degenerative changes in the joint. But when the MRI film came out, Aunt Tang was shocked. The results of the MRI examination of the right shoulder showed a large amount of fluid in the shoulder joint, which was filled with many granular substances.

In order to help Aunt Tang relieve her pain as soon as possible and recover soon, we chose shoulder arthroscopy for her. During the operation, we found that Aunt Tang's shoulder was filled with a large number of yellow-brown loose bodies the size of rice grains. The postoperative pathological diagnosis was rice body bursitis.

Preoperative imaging

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Intraoperative findings

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1. What is Rice Body Bursitis

Rice body bursitis is a rare disease. The earliest report on rice body bursitis can be traced back to 1895. Riese first proposed the concept of rice body bursitis in a case of tuberculous knee arthritis. That is, a large number of granules with fiber structures are similar to polished white rice, which exist in the bursa in a free or embedded form, causing joint swelling and pain. Rice body bursitis is more common in the knee and shoulder joints. It occurs in all age groups, and the incidence rate in women is higher than that in men.

2. Causes of rice body formation

The cause of rice body formation is still controversial. Currently, most scholars believe that rice body bursitis is related to nonspecific inflammatory response. Rice bodies originate from synovial cells of ischemic infarction in chronic joint inflammation. As the infarction progresses, synovial cells fall off and absorb nutrients from the joint fluid or synovial fluid, and then are wrapped by the surrounding fibrous components, gradually forming a tumor with a shiny surface similar to polished rice grains. Rice body formation is most common in rheumatoid arthritis accompanied by abundant pannus hyperplasia, followed by trauma, tuberculosis and suppurative arthritis.

Clinical manifestations of rice body bursitis

The symptoms of rice body bursitis are mainly local swelling and pain, which are often dull and occasionally severe. In the early stage, when the number of rice bodies is small, joint swelling is often manifested; as the disease progresses, the number of rice bodies gradually increases, and some patients gradually develop body masses accompanied by joint pain; in the late stage, they can invade and destroy the tissues around the joints. Affected by pain and tissue damage, joint function and range of motion may be limited to varying degrees.

Treatment of Rice Body Bursitis

1. Conservative treatment: Suitable for patients with mild symptoms or who are not suitable for surgery, such as those with underlying diseases, local severe infection factors, coagulation mechanism disorders, etc. The treatment method is mainly symptomatic treatment and disease control.

2. Surgical treatment: There are two ways.

(1) Arthroscopic treatment: It is suitable for the treatment of most cases of rice body bursitis, but it requires high technical skills of the operator. The advantage is that it causes less trauma and can treat relatively deep and narrow lesions.

(2) Open incision: It causes greater trauma and is suitable for patients with larger lesions, those who need extensive soft tissue resection locally, those who need to repair adjacent lesions, and those who cannot use arthroscopy due to limited operating space.

References

【1】RIESE H. Di Reiskorpchen in tuberculos erkranken synovalsack en[J]. Detsch Z Chir, 1895, 42: 1-99.

【2】Sugano I, Nagao T, Tajima Y, et al. Variation among giant rice bodies:report of four cases and their clinicopathological featur es[J]. Skeletal Radiol, 2000, 29: 525-529.

【3】CHEUNG HS RYAN LM, KOZIN F, MC CARTHY DJ. Synovial origins of rice bodies in joint fluid[J]. Arthritis Rheum, 1980, 23: 72-76.

【4】CHEN A , WONG LY , SHEU CY , et al. Distinguishing multiple rice body formation in chronic subacromial-subdeltoid bursitis from synovial chondromatosis[J]. Skeletal Radiology, 2002, 31(2): 119-121.

【5】M KÖNIGSHAUSEN, SEYBOLD D, HEYER CM, et al. Tuberculous rice body synovitis of the shoulder joint[J]. Der Orthopäde, 2009, 38(11): 1106-1112.

【6】CHEN A, WONG LY, SHEU CY, et al. Distinguishing multiple rice body formation in chronic subacromial-subdeltoid bursitis from synovial chondromatosis[J]. Skeletal Radiol, 2002, 31(2): 119-121.