Pain attribution in concomitant rotator cuff tears and proximal humeral enchondromas: outcomes of arthroscopic repair alone at 2-year follow-up — a case series

Abstract

Enchondromas of the proximal humerus are benign cartilaginous lesions frequently identified incidentally during magnetic resonance imaging (MRI) performed for shoulder pain. Their coexistence with rotator cuff tears, particularly supraspinatus tears, creates diagnostic uncertainty regarding the primary pain generator and may influence management strategies. Evidence guiding treatment in such dual-pathology scenarios remains limited. This case series evaluates five consecutive patients (mean age 47.4 years) presenting with symptomatic full-thickness supraspinatus tears and incidental proximal humeral enchondromas. All patients underwent arthroscopic double-row rotator cuff repair without intervention for the osseous lesion, followed by a standardized rehabilitation protocol. Clinical outcomes were assessed using Visual analog scale (VAS) and Oxford shoulder score (OSS) over a 2-year follow-up period. All patients demonstrated excellent clinical outcomes, with VAS scores improving from 8 to 9 preoperatively to 0 to 1 at final follow-up and mean OSS improving from 24.2 to 46.0. No rotator cuff re-tears or lesion-related complications were observed. Serial imaging confirmed radiological stability of the enchondromas, supporting their benign and incidental nature. These findings suggest that in patients with concomitant rotator cuff tears and proximal humeral enchondromas, symptoms are primarily attributable to rotator cuff pathology. Arthroscopic repair alone yields favourable outcomes, while stable enchondromas can be safely managed with observation. Accurate clinic-radiological correlation is essential to avoid unnecessary surgical intervention for incidental benign lesions.