This case demonstrated that the intraosseous ganglion of the glenoid was a benign lesion but could be a cause of suprascapular nerve entrapment syndrome. The most common is the paralabral cyst that results from a glenoid labral tear. The cyst is removed with arthroscopic procedure. (a) Magnetic resonance (MR) T2-weighted axial image of the left shoulder shows a high intensity area at the glenoid. An intraosseous ganglion (plural: ganglia) is a benign subchondral radiolucent lesion without degenerative arthritis. It is because of the constant stress put on the shoulder joint. 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. While they’re usually harmless, they can occasionally be cancerous. [1-7] While the medial malleolus and proximal femur are the most common sites, intraosseous ganglia of the glenoid have been reported in only 11 patients. This compression can result in atrophy of the supraspinatus or infraspinatus muscle or both. 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. All the authors certify that they have no commercial associations that might pose a conflict of interest in connection with this report. 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. Intraosseous ganglion cysts are rare causes of wrist pain. @article{Yi2009IntraosseousGO, title={Intraosseous ganglion of the glenoid causing suprascapular nerve entrapment syndrome: a case report. with intraosseous ganglia of carpal bones. Only 13 cases around the shoulder have been described in the literature. Ganglion cysts can decrease or increase in size and sometimes they disappear completely. Treatment generally isn't necessary, but if the lipoma bothers you, is painful or is growing, you may want to have it removed. Intraosseous ganglia are intramedullary, non-neoplastic, subchondral cystic lesions containing mucoid fluid. Her symptoms did not improve after non-operative treatment. Intraosseous ganglion of the glenoid causing suprascapular nerve entrapment syndrome: a case report. The nerve was stretched and edematous, and it highly adhered to the cyst wall. As a result, we could perform curettage of the cyst wall, which relieved the patient of the symptom. 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. The patient’s posterior shoulder pain resolved after successful curettage of the ganglion. (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. Subchondral cysts are of variable size from a f… Intervention and outcome: A trial of passive care was conducted, including Two main types of periarticular cysts are frequently seen on shoulder MRI, both of which have a strong association with underlying abnormalities. GROSS PATHOLOGY. 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… 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. This study was based on a series of 4 patients, all of whom had wrist pain because of intraosseous ganglion cysts. After injecting 1% xylocaine into the spinoglenoid notch under ultrasonographic guidance, the posterior shoulder pain resolved. 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. Abstract. Intraosseous ganglia are uncommon in skeletal sites such as the carpal bones, wrist, proximal femur, distal tibia, and glenoid bone. Clinical Features: An 18-year old female flat water canoeist complaining of right shoulder pain following a strenuous paddling training camp. Intraosseous ganglion of the glenoid causing suprascapular nerve entrapment syndrome: a case report. 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. Nusselt T(1), Freche S, Klinger HM, Baums MH. 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. The patient was a 61-year-old woman with a painful left shoulder with a limited range of motion. (c, d) Computed tomography (CT) axial and 3-dimensional CT images of the left shoulder show a bone cystic lesion of the glenoid with cortical bone destruction linked to the spinoglenoid notch. However, only 11 cases of intraosseous ganglia of the glenoid have been reported. Curettage was performed under general anesthesia in the right lateral position (Figure 3(a)). This report describes a case of an intraosseous ganglion of the proximal humerus. A ganglion cyst is diagnosed during physical examination if it is on the shoulder. 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. Biodegradable implants lead to problems such as cyst formation, soft-tissue inflammation, loose implant fragments or local osteolysis. A lipoma, which feels doughy and usually isn't tender, moves readily with slight finger pressure. 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. 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 operation - resection of the cyst with parallel bone graft and application of Ilizarov's apparatus. However, if the cyst is inside the shoulder joint certain tests such as ultrasound, MRI, may be required for its diagnosis. These findings were consistent with an intraosseous ganglion. The suprascapular nerve is a mixed motor and sensory nerve originating from the brachial plexus. (a) Clinical photograph before the surgery shows a dotted circle at the left shoulder that indicates the area at which the patient complained of pain. We describe a case of suprascapular nerve entrapment caused by protrusion of an intraosseous ganglion of the glenoid into the spinoglenoid notch. Recently, a simple and safe less invasive arthroscopic approach was reported for patients with spinoglenoid ganglion cysts [11]. A 48-year-old female patient presented with pain in her right shoulder. The exact reason why a ganglion develops in shoulder is not known. This case demonstrated that the intraosseous ganglion of the glenoid was a benign lesion but could be a cause of suprascapular nerve entrapment syndrome. Annals Of Orthopaedics, Trauma And Rehabilitation 03 Arthroscopic Management of an Intraosseous Ganglion Cyst in the Prox imal Tibia. 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. However, treatment is required if this non cancerous lump causes pain in shoulder or difficulty in movement. They are more common in women. 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. 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)). Intraosseous ganglia located in the scaphoid have rarely been described in the literature. 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. Needle aspiration for the cyst was performed using an 18-gauge needle under ultrasonographic guidance; however, no aspirate was obtained. It has a stalk through which fluid enters in the lump. Some people have more than one lipoma.A lipoma isn't cancer and usually is harmless. The cysts are typically round or oval filled with jelly like viscous fluid. 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. We experienced a rare case of suprascapular nerve entrapment caused by protrusion of an intraosseous ganglion of the glenoid into the spinoglenoid notch. A lipoma is a slow-growing, fatty lump that's most often situated between your skin and the underlying muscle layer. Third, the suprascapular nerve was found to be very close to the cyst at the spinoglenoid notch on MRI. 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. 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. A 10 cm skin incision is made at the posterior glenohumeral joint. Author information: (1)Department of Orthopaedic Surgery, University of Göttingen, Medical Center, UMG, Germany. The histological finding was an inner layer of fibrous connective tissue without any lining cells. Ganglion cysts are also common in people having osteoarthritis of shoulder. 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. Sclerotic lesions are spots of unusual thickness on your bones. Usually ganglion cysts do not require to be treated if they do not produce any symptoms. 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. An intraosseous ganglion (plural: ganglia) is a benign subchondral radiolucent lesion without degenerative arthritis. They often recede in the size and sometimes disappear. Objective: To present the diagnostic and clinical features of an intraosseous ganglion cyst of the humeral head of a female flat water canoe athlete. (a) Surgery for the intraosseous ganglion is performed in the right lateral position. }, 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 } } 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. Figure 3: MRI of the knee joint T2 Image (a) and (b) showing periarticular intraosseous cyst. 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]. These cysts should be considered causes of unexplained rotator cuff weakness in young patients, although they may also be discovered incidentally on MRI. The sac is usually primarily filled with hyaluronic acid. Second edition by Lippincott Williams & Wilkins. Two main types of periarticular cysts are frequently seen on shoulder MRI, both of which have a strong association with underlying abnormalities. The patient was a 47-year-old woman with a painful left shoulder with a limited range of motion. However, treatment is required if this non cancerous lump causes pain in shoulder or difficulty in movement. 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. Wrist arthroscopy is a surgical technique that reduces the intra-articular operative area and therefore minimizes postoperative stiffness. Intraosseous rheumatoid nodules are rare; however, they have been described in patients with rheumatoid nodulosis [21–23]. 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. Sign up here as a reviewer to help fast-track new submissions. Small intraosseous cysts (yellow arrowheads) typically form at the anterior margin of the femoral attachment of the ACL and at the posterior margin of the distal attachment. An intraosseous ganglion (plural: ganglia) is a benign subchondral radiolucent lesion without degenerative arthritis. 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. showing intraosseous cyst. People who are prone to do repetitive movement of shoulder are more susceptible to develop ganglion cysts in shoulder. Mean average age of patients is 42 years. Certain factors increase the risk of ganglion cysts. Histological examination revealed that the cyst wall contained connective tissue, including … Abstract Intraosseous ganglia are benign cystic and often multiloculated lesions composed of fibrous tissue with extensive mucoid changes located in the subchondral bone adjacent to … 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? Osteoarthritis and rheumatoid arthritis can lead to the development of these cysts… They often recede in the size and sometimes disappear. 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. An extraosseous cyst was located over the posterior glenoid neck, which had capsules filled with a transparent gelatinous substance. First you have to confirm it simple bone cyst or not. }, 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 } } The site was then injected with a small amount of demineralized bone matrix. Annals Of Orthopaedics, Trauma And Rehabilitation. Brantley et al. The extraosseous cyst extended to the intraosseous lesion directly. The cysts may be the result of mucoid degeneration in the adjacent ligament, or both the degeneration and … 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. The patient gave informed consent and permission for this publication. But this may be a temporary and soon the pain occurs once the medicines are stopped. In our case, we used curettage and did not consider arthroscopic treatment for various reasons. The yellow arrow indicates the myxoid area, and the yellow arrowheads show connective tissue, including collagen fibers and a few fibroblasts (hematoxylin and eosin staining; A: ×12.5 magnification, B: ×50 magnification). INTRAOSSEOUS GANGLION. Notice the intermediate signal within the cyst, suggestive of pannus invasion. Review articles are excluded from this waiver policy. An extraosseous cyst was located over the posterior glenoid neck, which had capsules filled with a transparent gelatinous substance. Intraosseous ganglia are benign cystic and often multiloculated lesions located in the subchondral bone. 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. Objective: Humeral tuberosity cysts are a common finding, with previous reports suggesting they are related to rotator cuff tear or aging. Intraosseous ganglia are uncommon in skeletal sites such as the carpal bones, wrist, proximal femur, distal tibia, and glenoid bone. Postoperatively, the patient’s shoulder pain resolved promptly. People who have shoulder injury in the past are likely to have ganglion cysts in shoulder. A subchondral cyst (Fig. Therefore, curettage of the cyst was performed. The exact reason why a ganglion develops in shoulder is not known. More often than not, paralabral cysts of the shoulder are an infrequent finding on MRI or MR Arthrogram. We performed curettage with protection of the suprascapular nerve, and the patient’s pain resolved completely without suprascapular nerve complications. The area was drilled and a curette was used to remove any material but little was extracted. 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)). This case demonstrated that the intraosseous ganglion of the glenoid was a benign lesion but could be a cause of suprascapular nerve entrapment syndrome. Recently, a simple and safe less invasive arthroscopic approach was reported for patients with spinoglenoid ganglion cysts [11]. 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