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Table 3 Main findings

From: Surgical management of upper limb lipoma arborescens: a systematic review

Study

Number of lesions

Location

Imaging studies

Procedure

Follow-up

Recurrence

Postoperative outcomes

Elamin et al. [36]

1

Shoulder (subacromial)

Xray: no

Arthroscopic excision

60

No

Full active ROM and normal RC strength

   

MRI: supraspinatus tendinopathy with a partial tear. Soft tissue mass in the subacromial space measuring 2.5 × 1.0 × 0.5 cm

    

Kawashima et al. [3]

1

Shoulder (subdeltoid)

Xray: normal

Arthroscopic synovectomy and RC repair

9

No

Occasional aching, good function

   

MRI: subdeltoid fluid villous projections, full-thickness supraspinatus tear

    

Paccaud and Cunningham [13]

1

Elbow (intraarticular)

Xray: no

Arthroscopic synovectomy and posterior humeroulnar decompression

14

No

Full ROM. Asymptomatic

   

MRI: large intra-articular multilobulated pseudo-tumoral mass causing posterior humeroulnar impingement with mixed components including lipomatous and synovial fringes

    

Lim et al. [35]

1

Shoulder (subacromial, subdeltoid)

Xray: bony spurs in the acromion and greater tuberosity

Arthroscopic bursectomy, lipoma excision, acromioplasty, and RC repair

5

No

Asymptomatic

   

MRI: Partial-thickness bursal tear of the supraspinatus tendon, subacromial-subdeltoid bursa fluid-distended-fat like nodular projections, greater tuberosity, and lateral acromion osteophytes

    

Beyth and Safran [2]

1

Shoulder (intraarticular)

Xray: Hill Sachs

Arthroscopic synovectomy and lipoma excision

12

No

Full ROM. Asymptomatic

   

MRI: joint effusion and synovial hyperplasia

    

Mohammad et al. [34]

1

Elbow (antecubital fossa)

Xray: reactive changes in the radial tuberosity

Open bicipitoradial bursectomy, lipoma excision, and biceps debridement

6

No

Occasional aching, no calcifications

   

MRI: cystic swelling in the right bicipitoradial bursa with peripheral frond-like and ovoid fatty components. Thickening of the distal biceps tendon insertion and hypertrophy of the bicipital radial tuberosity with some associated edema and chronic bicipitoradial bursitis

    

Kim et al. [33]

1

Shoulder (subdeltoid, subacromial)

Xray: multiple calcifications, enthesophyte at greater tuberosity

Open lipoma excision, lipoma arborescens excision, and arthroscopic posterior labrum repair

36

No

High satisfaction and no limitations

   

MRI: paralabral cyst which extends into suprascapular and spinoglenoid notch after a posterior labral tear, SLAP, lipoma in front of the anterolateral cortex of the humeral head, encapsulated mass between infraspinatus and deltoid muscle, villous projections (lipoma arborescens) within the mass with osteochondral metaplasia

    

Stepan et al. [14]

1

Wrist (dorsal-extensor retinaculum)

Xray: mass dorsal to the carpus, soft tissue, and fat attenuation

Open tenosynovectomy of the fourth dorsal compartment and fatty mass excision

3

No

Pain-free full shoulder function

   

MRI: proliferative tenosynovitis distending the fourth dorsal compartment, containing extensive areas of thick, enhancing tenosynovium as well as macroscopic lobules of subsynovial fat encircling extensor digitorum communis and extensor indicis tendons

    

White et al. [32]

1

Shoulder (bicipital groove)

Xray: normal

Open synovectomy, lipoma excision, tenodesis, diagnostic arthroscopy

6

No

Pain-free with full shoulder function and rotation

   

MRI: frond-like tissue extending from the synovium, which followed the signal intensity of subcutaneous fat on all sequences. The synovium of the glenohumeral joint had no evidence of involvement by this process

    

Benegas et al. [1]

1

Shoulder (intrarticular, subacromial)

Xray: increased soft tissue. Simple radiography did not show any abnormalities, except for increased soft-tissue volume

Arthroscopic and open synovectomy, lipoma excision, and RC repair

4

No

Asymptomatic

   

MRI: full-thickness tear of the anterior portion of the supraspinatus tendon and significant glenohumeral and subacromial synovitis, with signs of fatty metaplasia

    

Hill et al. [37]

1

Wrist (dorsal-extensor retinaculum)

Xray: dorsal soft-tissue mass-mild degenerative disease of the radioscaphoid joint

Open lipoma excisional biopsy

2

No

Significant improvement. Complication: minor postoperative cellulitis

   

MRI: high signal intensity soft tissue lesion consistent with fat and multiple frond-like projections of similar intensity investing the extensor tendons

    

Silva et al. [31]

1

Wrist (dorsal-extensor retinaculum, also in the knee and ankle)

Xray: soft tissue mass

Open excision

48

No

Asymptomatic

Chae et al. [30]

1

Shoulder (intraarticular)

Xray: humeral head erosion

Open synovectomy and lipoma excision

12

No

Favorable outcome

   

MRI: well-capsulated, mass-like projections were encircling the right glenohumeral joint and containing a villonodular fat component

    

Mayayo Sinues et al. [29]

1

Elbow (antecubital fossa)

Xray: soft tissue mass

Open partial synovectomy

48

No

Full ROM

   

MRI: circumscribed mass along the bicipitoradial bursa enveloped the biceps tendon, with a heterogeneous signal bursal effusion and fat tissue deposits similar to small polypoid lesions from the wall to the interior of the mass

    

In et al. [28]

1

Shoulder (intraarticular)

Xray: osteopenia and arthritic changes

Arthroscopic synovectomy

12

No

Uneventful

   

MRI: intra-articular frond-like or villous nodules of high signal intensity represent fat. Bone erosion was present at the superior aspect of the humerus

    

Yildiz et al. [27]

1

Wrist (dorsal-extensor retinaculum)

Xray: soft tissue mass

Open excision

24

No

Asymptomatic

Dinauer et al. [26]

2 (asynchronous bilateral lesion)

Elbow (bicipitoradial bursa)

Xray: a) normal; b) soft tissue swelling

Open excisional biopsy

a) 46; b) 6

No

Good function

   

MRI: diffuse frond-like, fat-containing lesion involving the bicipitoradial bursa, lipoma arborescens arising from the bicipitoradial bursa was offered

    

Doyle et al. [25]

1

Elbow (antecubital fossa)

Xray: no

Open excisional biopsy

12

No

Diminished pain

   

MRI: lobulated mostly fatty mass anterior to the elbow joint and wrapping around the distal biceps tendon

    

Kaneko et al. [24]

1

Shoulder (subdeltoid)

Xray: increased soft tissue

Open excisional biopsy and supraspinatus tear open repair

40

No

Full ROM. Residual pain

   

MRI: villous mass with surrounding synovial fluid in sub-deltoid bursa FT tear ST. Enormous bursa

    

Levadoux et al. [23]

1

Elbow (anterolateral mass)

Xray: normal

Open excisional biopsy

48

No

Full ROM. Asymptomatic

   

MRI: joint effusion and synovial-based soft tissue mass. Numerous frond-like projections

    

Nisolle et al. [22]

1

Shoulder (subdeltoid, subacromial)

Xray: soft tissue swelling

Open bursectomy and RC repair

12

No

Full ROM. Diminished pain

   

MRI: full-thickness tear of the supraspinatus tendon and a large effusion within the bursa containing numerous frond-like projections