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Arthroscopic Removal of Rice Bodies From the Shoulder

March 01, 2019

Contributors: Oluwadamilola Kolade; Dylan Lowe, MD; Mandeep Virk, MD; Anthony P Gualtieri, BS, MD; Anthony P Gualtieri, BS, MD

Rice bodies are loose bodies typically found in the joint synovium, bursae, and tendons sheaths. The etiology of rice bodies is not fully understood. They are thought to result from microvascular infarcts of the joint synovium, after which the infarcted tissue sloughs off and is encased in layers of fibrin. Typically, rice bodies are associated with chronic inflammatory pathologies, such as rheumatoid arthritis, seronegative arthritides, and tuberculous arthritis. The aggregation of rice bodies in the joint space may lead to painful movement, limited range of motion, and swelling. Rice bodies in the subacromial and glenohumeral joints may lead to immobility of the shoulder. The management of rice bodies typically consists of surgical removal from the articular space. Open versus arthroscopic intervention depends on the size and accessibility of the rice bodies. Typically, removal of rice bodies leads to resolution of all related symptoms. This video demonstrates arthroscopic removal of rice bodies from the glenohumeral joint. The video reviews the pathogenesis, diagnosis, and management of rice bodies in the articular space of the shoulder and discusses the case presentation of a 48-year-old woman with a right anterolateral shoulder mass and associated pain. Physical examination revealed limited range of motion in forward flexion, internal rotation, and external rotation. Imaging studies revealed multiple loose bodies in the glenohumeral joint and subscapularis recess. Diagnostic arthroscopy revealed synovitis. The rice bodies were arthroscopically removed from the joint space. Postoperatively, the patient experienced relief of all symptoms and regained complete range of shoulder motion. Arthroscopic removal of rice bodies in the shoulder is an efficient and effective treatment option.