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  • Title: Arthroscopic shoulder synovectomy in patients with rheumatoid arthritis.
    Author: Smith AM, Sperling JW, O'Driscoll SW, Cofield RH.
    Journal: Arthroscopy; 2006 Jan; 22(1):50-6. PubMed ID: 16399461.
    Abstract:
    PURPOSE: Currently, there is little information available concerning the results of shoulder synovectomy in patients with rheumatoid arthritis. Furthermore, it remains difficult to assess the success of shoulder synovectomy because of a high association of rotator cuff tears in rheumatoid patients. We hypothesized that synovectomy in patients with a functionally intact rotator cuff would provide durable pain relief. TYPE OF STUDY: Case series. METHODS: Sixteen shoulders in 13 patients with rheumatoid arthritis were treated with arthroscopic shoulder synovectomy from 1988 to 2002 with a mean follow-up of 5.5 years. Patients with full-thickness rotator cuff tears or partial tears that required repair were excluded. Two of the 13 patients had been diagnosed with juvenile rheumatoid arthritis and 11 had adult-onset disease. The medical records of the patients were reviewed and patients were assessed clinically and by questionnaire to assess pain, satisfaction, range of motion, radiographic outcomes, and occurrence of complications. RESULTS: There was an improvement in pain at long-term follow-up in 13 of 16 patients (P < .001). Active shoulder elevation improved from a median of 145 degrees to 160 degrees but was not significant (P = .14). External rotation improved significantly (P = .01) from a median of 45 degrees (range, 0 degrees to 90 degrees) to 60 degrees (range, 0 degrees to 100 degrees). According to the Neer rating system, there were 5 excellent, 8 satisfactory, and 3 unsatisfactory results. Seven of 8 shoulders followed-up radiographically for more than 1 year showed radiographic progression of disease. All 3 patients reporting pain that was no better or worse than before surgery had radiographic arthrosis at last follow-up with advancing periarticular erosions and reduction of glenoid articular space. CONCLUSIONS: Arthroscopic synovectomy of the shoulder in patients with rheumatoid arthritis with an intact rotator cuff offers a reliable decrease in pain with less predictable improvements in range of motion. Limitations in predicting final results based on preoperative radiographs should be discussed with patients; those with more advanced radiographic changes may not benefit from the procedure. LEVEL OF EVIDENCE: Level IV, therapeutic study, case series, no control group.
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