Rotator cuff tear associated with an acromioclavicular cyst in rheumatoid arthritis

Arthroscopic Distal Clavicle Resection for an Acromioclavicular Ganglion Cyst with Cuff Tear Arthropathy: A Case Report

CASE

A 77-year-old man with an acromioclavicular joint ganglion cyst with cuff tear arthropathy had a large mass in the left shoulder. Arthroscopic distal clavicle resection successfully relieved his symptoms without loss of shoulder function by enlargement of the bypass between the cyst and subacromial space through the acromioclavicular joint.

CONCLUSION

Arthroscopic distal clavicle resection can remove a 1-way check valve in a minimally invasive manner. This case indicated that arthroscopic distal clavicle resection could be a useful treatment option for patients with acromioclavicular joint ganglion cysts with functional but irreparable rotator cuff tears.

Acromioclavicular joint cyst formation in a patient with rotator cuff-tear arthropathy: a rare cause of shoulder discomfort

We report a case of a 77-year-old man who presented to our shoulder department with a soft tissue mass on his right acromioclavicular (AC) joint. Previously attempted puncture aspiration had revealed serous fluid retention which recurred after each of several drainage attempts. Conventional radiography and MRI of the affected shoulder joint demonstrated a progressed cuff-tear arthropathy with an irreparable tear of the supraspinatus tendon, static superior migration of the humeral head, opening of the AC joint capsule and a superior joint-fluid 'eruption' and accumulation called 'Geyser sign'. Given that the patient's cuff-tear arthropathy was very well compensated, arthroscopic rotator cuff debridement and open cyst excision were performed. Closure of the superior aspect of the AC joint capsule was performed by the aid of a collagen matrix with additional closure of the deltotrapezial fascia. One year postoperatively, no cyst recurrence was noted.

[Acromioclavicular (AC) joint cyst. A case report and review of literature]

The acromioclavicular (AC) joint cyst is a rare sequela of complete supraspinatus tendon rupture and arthritis of the AC joint. It appears as a swelling on the AC joint and must be distinguished from tumours of the shoulder and neck region. Besides physical examination, magnetic resonance imaging is the most useful tool for correct diagnosis. As reported in the literature, therapeutic procedures include observation, aspiration, excision of the cyst with or without resection of the AC joint, and repair of the underlying supraspinatus tendon rupture. All procedures should be based on consideration of the comorbidity and recurrence of the cyst. Combinations of cyst excision and rotator cuff repair or AC resection seem to be the most promising therapeutic options. We report on a 75-year-old patient with a painless swelling over the AC joint who had suffered shoulder trauma 15 years previously.