Thus, the intraosseous cyst was considered to be an intraosseous ganglion. 3-5cm, bulging, with a white outer fibrous surface, usually multilocular. These cysts are produced in areas of damaged articular cartilage, subjacent to the underlying subarticular cortical plate. A subchondral cyst is an intraosseous epiphyseal synovial fluid-filled void prevalent in osteoarthritis that may attain a diameter of 1-15 mm or more in size with the cyst’s longest axis usually along the coronal plane in the craniocaudal axis. with intraosseous ganglia of carpal bones. Postoperatively, the patient’s shoulder pain resolved promptly. To our knowledge, 19 cases of intraosseous ganglion of the glenoid have been reported in the English literature [4–10]. Curettage is a useful treatment option for a ganglion inside bone and very close to the suprascapular nerve. The patient was a 47-year-old woman with a painful left shoulder with a limited range of motion. The cysts may be the result of mucoid degeneration in the adjacent ligament, or both the degeneration and … Mean average age of patients is 42 years. Clinical presentation Patients may have mild localized pain. Epidemiology Tends to occur in middle age. Intraosseous ganglia are intramedullary, non-neoplastic, subchondral cystic lesions containing mucoid fluid. 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. Copyright © 2017 Daichi Ishimaru et al. The sac is usually primarily filled with hyaluronic acid. Intraosseous ganglia are benign cystic and often multiloculated lesions located in the subchondral bone. Abstract We describe a case of suprascapular nerve entrapment caused by protrusion of an intraosseous ganglion of the glenoid into the spinoglenoid notch. Consequently, the shoulder pain was resolved promptly without suprascapular nerve complications, and the cyst was histologically diagnosed as an intraosseous ganglion. 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. 1). Intraosseous ganglia are uncommon in skeletal sites such as the carpal bones, wrist, proximal femur, distal tibia, and glenoid bone. The fluid is sticky, jelly like colorless substance. We describe a case of suprascapular nerve entrapment caused by protrusion of an intraosseous ganglion of the glenoid into the spinoglenoid notch. They are more common in women. At the 1-year follow-up, the patient was asymptomatic and had no functional deficits and osteoarthritic changes of the glenohumeral joint were not observed on CT, but recurrence of the ganglion was observed at the glenoid on MRI. In the absence of nerve compression symptoms it is a tad difficult to zero in on the diagnosis unless there is an image that supports the diagnosis. Postoperatively, the patient's shoulder pain resolved promptly. Curettage was performed under general anesthesia in the right lateral position (Figure 3(a)). Although the cyst develops commonly on the palmar side or dorsal of wrist joint, sometimes this tumor like lump can also grow over elbow, knee, hip, ankle and shoulder. 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. This case demonstrated that the intraosseous ganglion of the glenoid was a benign lesion but could be a cause of suprascapular nerve entrapment syndrome. Other locations include the finger, palm of hand, wrist, elbow, shoulder, hip, knee, ankle and foot (Fig. All the authors certify that they have no commercial associations that might pose a conflict of interest in connection with this report. It requires an MRI or MR Arthrogram to find out if it is as a consequence of a paralabral cyst. Intraosseous ganglion cyst References [1] Adam Greenspan, Gernot Jundt , Wolfgang Remangen (2007) Differential diagnosis in orthopaedic oncology. He did not show sensory and motor paralysis of the supra- and infraspinatus muscles and did not exhibit muscle atrophy on visual examination. First, based on the radiographic finding of bone cortex destruction at the spinoglenoid notch, the differential diagnosis included an intraosseous ganglion, giant cell tumor, aneurysmal bone cyst, and chondroblastoma [12, 13], so we needed a specimen to perform histological examination. Clinical presentation Patients may have mild localized pain. 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. 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. Treatment generally isn't necessary, but if the lipoma bothers you, is painful or is growing, you may want to have it removed. 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 The exact cause of ganglion cysts in shoulder is not known. please consult your Orthopedician he will examine and treat you accordingly. Tam W, Resnick D, Haghighi P, Vaughan L: Intraosseous ganglion of the patella. This compression can result in atrophy of the supraspinatus or infraspinatus muscle or both. J Hand Surg 17B:429-32,1992. These lesions are often asymptomatic, but, in cases located close to neurovascular structures or articular surfaces, they can be symptomatic, causing pain, neurologic dysfunction, or articular fractures. 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). 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. Only 13 cases around the shoulder have been described in the literature. 28-194). In such cases surgical intervention may be necessary. 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)). These cysts should be considered causes of unexplained rotator cuff weakness in young patients, although they may also be discovered incidentally on MRI. Two main types of periarticular cysts are frequently seen on shoulder MRI, both of which have a strong association with underlying abnormalities. Surgical treatment of this pathologic condition yields good results and a low recurrence rate. The exact reason why a ganglion develops in shoulder is not known. 2019; 2(2):133. posterior to the anterior horn of medial meniscus (Figure 4) . Some people have more than one lipoma.A lipoma isn't cancer and usually is harmless. Ganglion cysts are also common in people having osteoarthritis of shoulder. … The cysts appear in chronic osteoarthritis cases and tend to progress in size and number as the overlying cartilage surface thins. 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. A skin incision of approximately 10 cm was made along the glenoid on the lateral side of the scapula. This case demonstrated that the intraosseous ganglion of the glenoid was a benign lesion but could be a cause of suprascapular nerve entrapment syndrome. Ways to Stop This Pain, Causes of Hiccups at Night During Pregnancy: How Do You Stop It, There are several conditions that begin with fever as the only symptom. It can be symptomatic in A 47-year-old female patient presented at the Cankiri state hospital complaining of pain and restricted motion in the righ arm since 2 months. 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 site was then injected with a small amount of demineralized bone matrix. A subchondral cyst (Fig. 3-5cm, bulging, with a white outer fibrous surface, usually multilocular. It is more prevalent in men. 2017, Article ID 1704697, 5 pages, 2017. https://doi.org/10.1155/2017/1704697, 1Department of Orthopaedic Surgery, Gifu University School of Medicine, Yanagido 1-1, Gifu, Gifu Prefecture, Japan. A. Slullitel, “Juxta-articular bone cysts (intra-osseous ganglia): a clinicopathological study of eighty-eight cases,”. Ganglion cysts can decrease or increase in size and sometimes they disappear completely. Recently, a simple and safe less invasive arthroscopic approach was reported for patients with spinoglenoid ganglion cysts [11]. An intraosseous ganglion (plural: ganglia) is a benign subchondral radiolucent lesion without degenerative arthritis. As a result, we could perform curettage of the cyst wall, which relieved the patient of the symptom. Certain factors increase the risk of ganglion cysts. Biodegradable implants lead to problems such as cyst formation, soft-tissue inflammation, loose implant fragments or local osteolysis. Figure 3: MRI of the knee joint T2 Image (a) and (b) showing periarticular intraosseous cyst. Only 13 cases around the shoulder have been described in the literature. However, it is a significant diagnosis as they may cause a compression neuropathy of the suprascapular or axillary nerves depending on where they occur, along with a variety of other symptoms. Objective: To present the diagnostic and clinical features of an intraosseous ganglion cyst of the humeral head of a female flat water canoe athlete. Intraosseous ganglion (IOG) cyst of the scaphoid is an infrequent cause of hand and wrist pain. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 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. 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. Intraosseous ganglion cyst is benign bony cyst that mainly involves epiphysis and metaphysis of long bones. There was no communication between the cyst and the joint space. 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 nerve was stretched and edematous, and it highly adhered to the cyst wall. Intraosseous ganglion of the glenoid causing suprascapular nerve entrapment syndrome: a case report. Intraosseous foreign body granuloma in rotator cuff repair with bioabsorbable suture anchor. with intraosseous ganglia of carpal bones. However, only 11 cases of intraosseous ganglia of the glenoid have been reported. The aim of this study was to investigate the characteristics of cysts in the tuberosities of the humeral head and their relationship with rotator cuff tear and age. This report describes a case of an intraosseous ganglion about to cause fracture of the glenoid. Intraosseous ganglion cysts are very frequent in the carpal bones, located at the attachments of degenerative ligaments 5. We describe a case of suprascapular nerve entrapment caused by protrusion of an intraosseous ganglion of the glenoid into the spinoglenoid notch. 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. Brantley et al. dysfunction caused by an intraosseous ganglion of the glenoid is extremely rare, to the best of our knowledge, only 1 case of suprascapular nerve entrapment due to an intraosseous ganglion cyst has been reported previously in the published literature. Therefore, curettage of the cyst was performed. 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. Intervention and outcome: A trial of passive care was conducted, including Annals Of Orthopaedics, Trauma And Rehabilitation 03 Arthroscopic Management of an Intraosseous Ganglion Cyst in the Prox imal Tibia. Subchondral bone cysts (SBCs) are sacs filled with fluid that form inside of joints such as knees, hips, and shoulders. Furthermore, in surgery, we could identify the intraosseous cyst and suprascapular nerve and protect the nerve under direct vision; nevertheless, the intraosseous cyst compressed the nerve and adhered to it causing edema. People who have shoulder injury in the past are likely to have ganglion cysts in shoulder. A 47-year-old man with left shoulder pain lasting for more than 2 years was referred to our hospital because a radiolucent cystic lesion of the glenoid was observed on plane radiography of the left shoulder. However, ganglion cysts in shoulder may … Generally, the bone cortex and periosteum act as substantial physical barriers, and a ganglion occurring in soft tissue has difficulty penetrating into the bone. Review articles are excluded from this waiver policy. Ganglion cysts are fluid mass that most often develop over the tendons and joints, usually the wrist and fingers. The most common is the paralabral cyst that results from a glenoid labral tear . Patients suffering from paralabral cyst have chronic shoulder pain as the chief complaint. Biodegradable implants lead to problems such as cyst formation, soft-tissue inflammation, loose implant fragments or local osteolysis. 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. The common stalk feeds fluid into the tumor-like mass. Third, the suprascapular nerve was found to be very close to the cyst at the spinoglenoid notch on MRI. (b) Radiograph of the left shoulder shows a radiolucent cystic lesion in the superior glenoid. The suprascapular nerve was raised upward by the cyst wall present below the nerve. A lipoma, which feels doughy and usually isn't tender, moves readily with slight finger pressure. @article{Yi2009IntraosseousGO, title={Intraosseous ganglion of the glenoid causing suprascapular nerve entrapment syndrome: a case report. Introduction. The histological finding was an inner layer of fibrous connective tissue without any lining cells. Ganglion cysts can decrease or increase in size and sometimes they disappear completely. This report describes a case of an intraosseous ganglion of the proximal humerus. Tuzuner T: Penetrating type intraosseous ganglion cyst of the lunate bone. An extraosseous cyst was located over the posterior glenoid neck, which had capsules filled with a transparent gelatinous substance. Sign up here as a reviewer to help fast-track new submissions. 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. The area includes the supra- and infraspinatus muscles and the suprascapular nerve. Up to 7cm in size, usu. 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. May extend through the cortex into the joint, esp. The main complications are joint stiffness and vascular disturbances of the lunate bone. Intraosseous ganglion of the glenoid causing suprascapular nerve entrapment syndrome: a case report. These lesions are often asymptomatic, but, in cases located close to neurovascular structures or articular surfaces, they can be symptomatic, causing pain, neurologic dysfunction, or articular fractures. 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. A subchondral cyst is an intraosseous epiphyseal synovial fluid-filled void prevalent in osteoarthritis that may attain a diameter of 1-15 mm or more in size with the cyst’s longest axis usually along the coronal plane in the craniocaudal axis. Thus, the intraosseous cyst was considered to be an intraosseous ganglion. 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. More often than not, paralabral cysts of the shoulder are an infrequent finding on MRI or MR Arthrogram. Things to Do Immediately, How Long do Growing Pains Last? The suprascapular nerve was retracted gently, and curettage was performed until the bone surrounding the cyst was completely exposed (Figure 3(d)). These cysts commonly occur between 20 to 40 years of age. 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. Intraosseous ganglion cysts are rare causes of wrist pain. 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]. We performed curettage with protection of the suprascapular nerve, and the patient’s pain resolved completely without suprascapular nerve complications. They are the equivalent of soft tissue ganglia. The histological examination of cystic mass was expressed as ganglion. However, if the cyst is inside the shoulder joint certain tests such as ultrasound, MRI, may be required for its diagnosis. (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 most common is the paralabral cyst that results from a glenoid labral tear. The extraosseous cyst extended to the intraosseous lesion directly. INTRAOSSEOUS GANGLION. It has a stalk through which fluid enters in the lump. Consequently, the shoulder pain was resolved promptly without suprascapular nerve complications, and the cyst was histologically diagnosed as an intraosseous ganglion. (b) MR T2-weighted sagittal image of the left shoulder shows that the intraosseous lesion is linked to the spinoglenoid notch. On magnetic resonance imaging a cystic lesion of the proximal humerus was detected. Intraosseous ganglia located in the scaphoid have rarely been described in the literature. Intra-Osseous ganglia ) is a benign lesion but could be a temporary and soon the pain once... 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