The cyst is removed with arthroscopic procedure. Therefore, we concluded that the protrusion of an intraosseous cyst of the glenoid into the spinoglenoid notch was a cause of the pain, and performed curettage. Only 13 cases around the shoulder have been described in the literature. The area at which he experienced spontaneous shoulder pain was innervated by the suprascapular nerve (Figure 1(a)). This case demonstrated that the intraosseous ganglion of the glenoid was a benign lesion but could be a cause of suprascapular nerve entrapment syndrome. They often recede in the size and sometimes disappear. Annals Of Orthopaedics, Trauma And Rehabilitation. }, author={Jin Woong Yi and Nam Su Cho and Y. Rhee}, journal={Journal of shoulder and elbow surgery}, year={2009}, volume={18 3}, pages={ e25-7 } } 3-5cm, bulging, with a white outer fibrous surface, usually multilocular. Intraosseous ganglion (IOG) cysts of the humerus is a rare and often painful condition.5–9 There is only one other case in the literature describing an IOG cyst of the humerus, while most papers describe cystic lesions of the carpal and tarsal bones.6,10,11 Symptomatic IOG cysts present with intermittent pain, occasional swelling and it These cysts should be considered causes of unexplained rotator cuff weakness in young patients, although they may also be discovered incidentally on MRI. The spinoglenoid notch was directly visualized after splitting the teres minor and infraspinatus muscles, and the suprascapular nerve and cyst were identified at the spinoglenoid notch (Figure 3(b)). This report represents the first published case of an intraosseous foreign body gran-uloma in the humeral head after arthroscopic rotator cuff tear fixation with a poly-L-lactide (PLLA) suture anchor. Suprascapular nerve entrapment is an uncommon but significant cause of shoulder pain [1], and a ganglion originating from the soft tissues around the spinoglenoid notch has been reported to be a cause of suprascapular nerve entrapment [2]. Ganglion cysts typically form within deep tissue as one or a cluster of smaller cysts connected by a common stalk. Subchondral bone cysts (SBCs) are sacs filled with fluid that form inside of joints such as knees, hips, and shoulders. showing intraosseous cyst. Osteoarthritis and rheumatoid arthritis can lead to the development of these cysts… Third, the suprascapular nerve was found to be very close to the cyst at the spinoglenoid notch on MRI. Intraosseous ganglion cysts are rare causes of hand and wrist pain. Intraosseous ganglia located in the scaphoid have rarely been described in the literature. However, if the cyst is inside the shoulder joint certain tests such as ultrasound, MRI, may be required for its diagnosis. pain is due to an intraosseous bone ganglion cyst. Postoperatively, the patient’s shoulder pain resolved promptly. Usually ganglion cysts do not require to be treated if they do not produce any symptoms. Among these cases, 2 cases showed a fracture around the ganglion [7, 8] and only 1 case was accompanied with suprascapular nerve entrapment, which is similar to our case [9]. The cysts were … This fluid is similar to the fluid that found in joints to keep it lubricated. The treatment options include rotator cuff repair, excisional AC joint arthroplasty and resection of the cyst base, aspiration, hemi‐arthroplasty, and reverse total shoulder arthroplasty 1. A 47-year-old man with left shoulder pain developed an intraosseous cyst in the left glenoid, which came into contact with the suprascapular nerve. The main complications are joint stiffness and vascular disturbances of the lunate bone. Second edition by Lippincott Williams & Wilkins. On magnetic resonance imaging a cystic lesion of the proximal humerus was detected. Plain anteroposterior radiography of the left shoulder showed a circular lesion with marginal osteosclerosis at the glenoid (Figure 1(b)). Copyright © 2017 Daichi Ishimaru et al. Only 13 cases around the shoulder have been described in the literature. A 47-year-old man with left shoulder pain developed an intraosseous cyst in the left glenoid, which came into contact with the suprascapular nerve. The area at which the patient experienced spontaneous shoulder pain was innervated by the suprascapular nerve, and 1% xylocaine injection into the spinoglenoid notch under ultrasonographic guidance relieved the pain. It requires an MRI or MR Arthrogram to find out if it is as a consequence of a paralabral cyst. A ganglion cyst is diagnosed during physical examination if it is on the shoulder. Skeletal Radiol 25:588-91,1996. People who have shoulder injury in the past are likely to have ganglion cysts in shoulder. Intraosseous ganglion cysts are benign lesions located in the subchondral bone adjacent to the joint and are usually found in adults [1]. Therefore, curettage of the cyst was performed. The cysts may be the result of mucoid degeneration in the adjacent ligament, or both the degeneration and … This case demonstrated that the intraosseous ganglion of the glenoid was a benign lesion but could be a cause of suprascapular nerve entrapment syndrome. Intraosseous ganglia within the carpal bones are relatively rare, with only a limited number of cases previously reported (1–3).They are benign, non-neoplastic bone lesions that have similar histological characteristics to those of soft tissue ganglion cysts (4,5).The most common clinical symptom is wrist pain. The histological finding was an inner layer of fibrous connective tissue without any lining cells. The nerve was stretched and edematous, and it highly adhered to the cyst wall. Suprascapular Nerve Entrapment Caused by Protrusion of an Intraosseous Ganglion of the Glenoid into the Spinoglenoid Notch: A Rare Cause of Posterior Shoulder Pain, Department of Orthopaedic Surgery, Gifu University School of Medicine, Yanagido 1-1, Gifu, Gifu Prefecture, Japan, R. E. Boykin, D. J. Friedman, L. D. Higgins, and J. J. P. Warner, “Suprascapular neuropathy,”, S. Lichtenberg, P. Magosch, and P. Habermeyer, “Compression of the suprascapular nerve by a ganglion cyst of the spinoglenoid notch: the arthroscopic solution,”, G. R. Fisk, “Bone concavity caused by a ganglion,”, A. Sakamoto, Y. Oda, and Y. Iwamoto, “Intraosseous ganglia: a series of 17 treated cases,”, M. Urayama, E. Itoi, H. Watanabe, K. Sato, and J. Kamei, “Intraosseous ganglion of the glenoid,”, M. Kligman and M. Roffman, “Intraosseous ganglia of glenoid,”, K. Murata, Y. Nakagawa, T. Suzuki, M. Kobayashi, S. Kotani, and T. Nakamura, “Intraosseous ganglion about to cause a fracture of the glenoid: a case report,”, C. Tudisco and S. Bisicchia, “Intraosseous ganglion with impending fracture of the glenoid,”, J. W. Yi, N. S. Cho, and Y. G. Rhee, “Intraosseous ganglion of the glenoid causing suprascapular nerve entrapment syndrome: a case report,”, J. E. Wong, S. A. Aviles, and C. B. Ma, “Intraosseous ganglion of the glenoid,”, K. J. Westerheide, R. M. Dopirak, R. P. Karzel, and S. J. Snyder, “Suprascapular nerve palsy secondary to spinoglenoid cysts: results of arthroscopic treatment,”, U. Helwig, S. Lang, M. Baczynski, and R. Windhager, “The intraosseous ganglion A clinical-pathological report on 42 cases,”, F. Schajowicz, M. Clavel Sainz, and J. They often recede in the size and sometimes disappear. Usually ganglion cysts do not require to be treated if they do not produce any symptoms. About 2-4% of the general population is likely to have it and presentation may be common in males (especially around the third to fourth decade… Clinical Features: An 18-year old female flat water canoeist complaining of right shoulder pain following a strenuous paddling training camp. To our knowledge, 19 cases of intraosseous ganglion of the glenoid have been reported in the English literature [4–10]. This study was approved by the Human Ethics Committee of Gifu University (no. Consequently, the shoulder pain was resolved promptly without suprascapular nerve complications, and the cyst was histologically diagnosed as an intraosseous ganglion. This compression can result in atrophy of the supraspinatus or infraspinatus muscle or both. This report describes a case of an intraosseous ganglion of the proximal humerus. This study was based on a series of 4 patients, all of whom had wrist pain because of intraosseous ganglion cysts. Things to Do Immediately, How Long do Growing Pains Last? It is because of the constant stress put on the shoulder joint. The histological examination of cystic mass was expressed as ganglion. Magnetic resonance imaging (MRI) showed an osteolytic cystic lesion with very high intensity on T2-weighted images and low intensity on T1-weighted images, and the lesion was located at the posterior cranial portion of the glenoid and partially extended to the spinoglenoid notch (Figures 2(a) and 2(b)), and there were no findings about fatty change and intramuscular edema in supra- and infraspinatus muscles. All the authors certify that they have no commercial associations that might pose a conflict of interest in connection with this report. Second, needle aspiration or incision under arthroscopy was speculated to be arduous because the main part of the ganglion was located inside the glenoid and it was apart from the glenohumeral joint cavity. (d) Intraoperative photograph shows the bone cavity of the glenoid after curettage of the cyst (yellow arrowheads). Only 13 cases around the shoulder have been described in the literature. Annals Of Orthopaedics, Trauma And Rehabilitation 03 Arthroscopic Management of an Intraosseous Ganglion Cyst in the Prox imal Tibia. Consequently, the shoulder pain was resolved promptly without suprascapular nerve complications, and the cyst was histologically diagnosed as an intraosseous ganglion. Two main types of periarticular cysts are frequently seen on shoulder MRI, both of which have a strong association with underlying abnormalities. Consequently, the shoulder pain was resolved promptly without suprascapular nerve complications, and the cyst was histologically diagnosed as an intraosseous ganglion. An intraosseous ganglion (plural: ganglia) is a benign subchondral radiolucent lesion without degenerative arthritis. The area includes the supra- and infraspinatus muscles and the suprascapular nerve. Few reports have presented the characteristics of an intraosseous ganglion, such as its incidence and etiology, and this ganglion is considered to be relatively rare. Postoperatively, the patient's shoulder pain resolved promptly. … Lipomas are usually detected in middle age. The most common is the paralabral cyst that results from a glenoid labral tear. Brantley et al. @article{Yi2009IntraosseousGO, title={Intraosseous ganglion of the glenoid causing suprascapular nerve entrapment syndrome: a case report. However, ganglion cysts in shoulder may sometimes become large and compress the nerve which may give rise to pain and difficulty in movement. A 47-year-old man with left shoulder pain developed an intraosseous cyst in the left glenoid, which came into contact with the suprascapular nerve. An extraosseous cyst was located over the posterior glenoid neck, which had capsules filled with a transparent gelatinous substance. The cyst of the shoulder girdle in most cases is diagnosed as an aneurysmal, solitary cysts in this zone are formed only in 20-25% of patients. There was no communication between the cyst and the joint space. It is more prevalent in men. Introduction. GROSS PATHOLOGY. Ganglion cysts can decrease or increase in size and sometimes they disappear completely. They are lined by fibrous tissue with myxoid change and are not associated with osteoarthritis in the adjacent joint. as cyst formation, soft-tissue inflammation, loose implant fragments or local osteolysis. People who are prone to do repetitive movement of shoulder are more susceptible to develop ganglion cysts in shoulder. Consequently, the shoulder pain was resolved promptly without suprascapular nerve complications, and the cyst was histologically diagnosed as an intraosseous ganglion. A lipoma, which feels doughy and usually isn't tender, moves readily with slight finger pressure. An extraosseous cyst was located over the posterior glenoid neck, which had capsules filled with a transparent gelatinous substance. Intraosseous ganglia are uncommon in skeletal sites such as the carpal bones, wrist, proximal femur, distal tibia, and glenoid bone. The patient was a 61-year-old woman with a painful left shoulder with a limited range of motion. Author information: (1)Department of Orthopaedic Surgery, University of Göttingen, Medical Center, UMG, Germany. The cysts appear in chronic osteoarthritis cases and tend to progress in size and number as the overlying cartilage surface thins. This report describes a case of an intraosseous ganglion about to cause fracture of the glenoid. Intraosseous ganglia are benign cystic and often multiloculated lesions located in the subchondral bone. }, author={Jin Woong Yi and Nam Su Cho and Y. Rhee}, journal={Journal of shoulder and elbow surgery}, year={2009}, volume={18 3}, pages={ e25-7 } } Intervention and outcome: A trial of passive care was conducted, including Patients suffering from paralabral cyst have chronic shoulder pain as the chief complaint. Therefore, in the present case, it was believed that the ganglion did not occur in the soft tissue around the spinoglenoid notch and then penetrate into the glenoid, but it occurred primarily inside the glenoid and protruded into the spinoglenoid notch accompanied with bone destruction over a long period. Intraosseous ganglia are rare lesions that can cause pain and leave patients susceptible to pathologic fracture. 3-5cm, bulging, with a white outer fibrous surface, usually multilocular. The patient’s posterior shoulder pain resolved after successful curettage of the ganglion. They are the equivalent of soft tissue ganglia. The cyst is just underneath the skin near a joint. The suprascapular nerve was retracted gently, and curettage was performed until the bone surrounding the cyst was completely exposed (Figure 3(d)). 2019; 2(2):133. posterior to the anterior horn of medial meniscus (Figure 4) . However, ganglion cysts in shoulder may … Intraosseous ganglia are benign cystic and often multiloculated lesions located in the subchondral bone. Two main types of periarticular cysts are frequently seen on shoulder MRI, both of which have a strong association with underlying abnormalities. We will be providing unlimited waivers of publication charges for accepted research articles as well as case reports and case series related to COVID-19. This article describes an arthroscopic technique used for lunate intraosseous cyst resection associated with an autologous bone graft in a series of cases to prevent joint stiffness while respecting the scapholunate ligament (Fig 1, Fig 2, Fig 3).Our hypothesis was that arthroscopic treatment provides good results regarding cyst resorption with fewer complications. Plain radiographs show an eccentric intraosseous radiolucent lesion that should be differentiated from osteoarthritic cyst, post-traumatic cyst, simple bone cyst, osteoid osteoma, or osteoblastoma. The patient gave informed consent and permission for this publication. Objective: Humeral tuberosity cysts are a common finding, with previous reports suggesting they are related to rotator cuff tear or aging. To date, these lesions have been treated with curettage and bone grafting through an open approach, although more recent techniques have allowed arthroscopic treatment of lesions located at the wrist, knee, and ankle. An intraosseous ganglion is a benign bone lesion but is considered a neoplasm, which is similar to a ganglion occurring in soft tissue [3, 4]. (a) Surgery for the intraosseous ganglion is performed in the right lateral position. Based on the findings of MRI and CT, an intraosseous ganglion, cyst of degenerative disease, giant cell tumor, aneurysmal bone cyst, and chondroblastoma of the glenoid were suspected. West Indian Med J 54:247-9,2005. Consequently, the shoulder pain was resolved promptly without suprascapular nerve complications, and the cyst was histologically diagnosed as an intraosseous ganglion. Another theory put forward suggests a flaw in the joint space which allows the tissue to protrude out. May extend through the cortex into the joint, esp. Epidemiology Tends to occur in middle age. Intraosseous ganglia are intramedullary, non-neoplastic, subchondral cystic lesions containing mucoid fluid. A small incision was made in the anterior shoulder, the cyst site was identified due to a small hole noticed in the bone deep to bicep tendon. Intraosseous ganglia are benign cystic and often multiloculated lesions located in the subchondral bone. (a, b) Microscopic section of the cyst wall shows that the wall contained connective tissue, including collagen fibers and a few fibroblasts, and that the inner layer of connective tissue had myxoid change. The cysts were curetted and filled with artificial bone (β-TCP). In our case, we used curettage and did not consider arthroscopic treatment for various reasons. He had no history of dislocation or trauma of the shoulder joint. We believe that open surgery including curettage is a useful treatment option for a ganglion inside bone and present very close to the suprascapular nerve. After releasing the nerve gently from the cyst (Figure 3(c)), an incision was made at the cyst wall, and gelatinous material flowed out from the cyst. Intraosseous foreign body granuloma in rotator cuff repair with bioabsorbable suture anchor. Intraosseous ganglion cyst is benign bony cyst that mainly involves epiphysis and metaphysis of long bones. @article{Yi2009IntraosseousGO, title={Intraosseous ganglion of the glenoid causing suprascapular nerve entrapment syndrome: a case report. Recently, a simple and safe less invasive arthroscopic approach was reported for patients with spinoglenoid ganglion cysts [11]. These cysts are produced in areas of damaged articular cartilage, subjacent to the underlying subarticular cortical plate. Abstract We describe a case of suprascapular nerve entrapment caused by protrusion of an intraosseous ganglion of the glenoid into the spinoglenoid notch. Mean average age of patients is 42 years. INTRAOSSEOUS GANGLION. MRI of the shoulder has proven to be an accurate noninvasive examination for the evaluation of patients with shoulder pain. However, suprascapular nerve entrapment caused by an intraosseous ganglion occurring in the glenoid is rare. 28-194). Intraosseous ganglia are uncommon in skeletal sites such as the carpal bones, wrist, proximal femur, distal tibia, and glenoid bone. Biodegradable implants lead to problems such as cyst formation, soft-tissue inflammation, loose implant fragments or local osteolysis. On visiting our hospital, he complained of continuous posterior shoulder pain at rest; however, he could move his shoulder actively at 160 degrees of flexion and abduction, 60 degrees of external rotation at the side, and 90 degrees of external rotation at abduction and could maintain muscle strength around the shoulder on manual muscle testing. Design and patients: Shoulder MR arthrograms were reviewed in 120 consecutive patients-83 males (mean age 38.0, range 19-59 years) and 37 females (mean age 41.2, range 15-59 years). even described an intraosseous rheumatoid nodule with avidity for gallium-67 citrate in the rib of a 9-year-old boy with rheumatoid nodulosis. Sign up here as a reviewer to help fast-track new submissions. Tham S, Ireland DC: Intraosseous ganglion cyst of the lunate: diagnosis and management. The exact reason why a ganglion develops in shoulder is not known. The exact pathogenesis of these degenerative cysts is not certain.26,27 Subchondral cysts are most often seen in association with osteoarthritis, but may occur as the result of degeneration or injury of the overlying articular cartilage by other causes. A skin incision of approximately 10 cm was made along the glenoid on the lateral side of the scapula. Only 13 cases around the shoulder have been described in the literature. (c) Intraoperative photograph shows a mucinous cyst wall after shifting the suprascapular nerve laterally. While they’re usually harmless, they can occasionally be cancerous. Intraosseous ganglia are uncommon in skeletal sites such as the carpal bones, wrist, proximal femur, distal tibia, and glenoid bone. Surgical treatment of this pathologic condition yields good results and a low recurrence rate.2 It consists of curettage of the cyst associated with a bone graft, mostly autologous graft, performed by an open surgical approach. Daichi Ishimaru, Akihito Nagano, Nobuo Terabayashi, Yutaka Nishimoto, Haruhiko Akiyama, "Suprascapular Nerve Entrapment Caused by Protrusion of an Intraosseous Ganglion of the Glenoid into the Spinoglenoid Notch: A Rare Cause of Posterior Shoulder Pain", Case Reports in Orthopedics, vol. May extend through the cortex into the joint, esp. Paralabral Cyst Symptoms: Paralabral Ganglion Cyst Treatment, Ganglion Cyst Removal Treatment | Ganglion Cyst on Finger Cure, Ganglion Cyst In Knee: Ganglion Cyst Alternative Treatment and Remedies, Ganglion Cyst Prevention | Home Remedies for Ganglion Cysts, How does Eating Breakfast Benefits to Health: Importance of Breakfast, Did You Get Scratch by Monkey? This case demonstrated that the intraosseous ganglion of the glenoid was a benign lesion but could be a cause of suprascapular nerve entrapment syndrome. This case demonstrated that the intraosseous ganglion of the glenoid was a benign lesion but could be a cause of suprascapular nerve entrapment syndrome. Abstract. However, the ganglion relapsed at the 1-year follow-up on MRI, suggesting that curettage for the ganglion was inadequate and en bloc resection would be necessary if the symptoms of the left shoulder recur. However, treatment is required if this non cancerous lump causes pain in shoulder or difficulty in movement. (b) Intraoperative photograph of the posterior shoulder shows the suprascapular nerve after splitting the infraspinatus (yellow arrow). Based on these findings, it was considered that the intraosseous cyst in the glenoid compressed the suprascapular nerve at the spinoglenoid notch and induced the posterior shoulder pain, though a nerve conduction study for suprascapular nerve was not performed. with intraosseous ganglia of carpal bones. Sclerotic lesions are spots of unusual thickness on your bones. Histological examination revealed that the cyst wall contained connective tissue, including … An intraosseous ganglion/ cyst, however, is not common and is limited to the hip, knee, and ankle.5 In particular, an intraosseous ganglion of the glenoid is extremely rare, and no study to date has reported on an intraosseous glenoid ganglion /cyst. We performed curettage with protection of the suprascapular nerve, and the patient’s pain resolved completely without suprascapular nerve complications. Additionally, the previously reported case of an intraosseous ganglion accompanied with suprascapular nerve entrapment was treated with needle aspiration under arthroscopy [9], and posterior shoulder pain and muscle strength weakness of the shoulder resolved. Other locations include the finger, palm of hand, wrist, elbow, shoulder, hip, knee, ankle and foot (Fig. Posterior approach was used for operation incision. Axial (12a) and coronal (12b) proton density-weighted fat-suppressed images of the shoulder reveal a large intraosseous cyst (asterisks) in the greater tuberosity. The sac is usually primarily filled with hyaluronic acid. As a result, we could perform curettage of the cyst wall, which relieved the patient of the symptom. Clinical presentation Patients may have mild localized pain. Subchondral cysts are of variable size from a f… Clinical presentation Patients may have mild localized pain. We describe a case of suprascapular nerve entrapment caused by protrusion of an intraosseous ganglion of the glenoid into the spinoglenoid notch. The operative findings showed a 1.5×1.0 cm size supraspinatus tear and an intraosseous ganglion which had transparent jelly contents. Curettage was performed under general anesthesia in the right lateral position (Figure 3(a)). An intraosseous ganglion (plural: ganglia) is a benign subchondral radiolucent lesion without degenerative arthritis. Certain factors increase the risk of ganglion cysts. The common stalk feeds fluid into the tumor-like mass. We describe a case of suprascapular nerve entrapment caused by protrusion of an intraosseous ganglion of the glenoid into the spinoglenoid notch. Here, we present a case of suprascapular nerve entrapment caused by an intraosseous ganglion in the glenoid, which was treated with curettage of the ganglion. Thus, the intraosseous cyst was considered to be an intraosseous ganglion. Intraosseous ganglion of the glenoid causing suprascapular nerve entrapment syndrome: a case report. He did not show sensory and motor paralysis of the supra- and infraspinatus muscles and did not exhibit muscle atrophy on visual examination. (b) Radiograph of the left shoulder shows a radiolucent cystic lesion in the superior glenoid. Histological examination revealed that the cyst wall contained connective tissue, including collagen fibers and a few fibroblasts, and that the inner layer of connective tissue exhibited myxoid change (Figures 4(a) and 4(b)). Objective: To present the diagnostic and clinical features of an intraosseous ganglion cyst of the humeral head of a female flat water canoe athlete. 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