Massive acromioclavicular joint cyst

Aspiration of a Large Acromioclavicular Joint Cyst Complicated by Recurrence and Enlargement: A Case Report

This case report describes a patient with an enlarging and painless lump over the right acromioclavicular joint (ACJ). MRI showed a synovial cyst superior to the ACJ with a concomitant full-thickness tear of the supraspinatus. The patient underwent needle aspiration of the lump, which yielded 100ml of gelatinous fluid with no microbe growth. Despite repeated aspirations, the ACJ cyst continually enlarged beyond its initial size. This case report describes an ACJ cyst that enlarged in size after needle aspiration. The authors suggest surgical alternatives if cyst recurrence is observed after the initial attempt of aspiration.

Arthroscopic treatment of massive acromioclavicular joint ganglion cysts with color-aided visualization: a case series of 4 patients

Background

Acromioclavicular joint ganglion cysts are rare lesions that mainly arise from the degeneration of the acromioclavicular joint in elderly patients. Although surgical management may be required because of their high recurrence rate after aspiration, few reports have described arthroscopic surgical procedures to treat acromioclavicular ganglion cysts. We report the surgical results of arthroscopic ganglionectomy with color-aided visualization for massive acromioclavicular ganglion joint cysts.

Methods

This retrospective case series examined patients identified with massive ganglion cysts that were localized above the acromioclavicular joint. All patients underwent an arthroscopic removal of subacromial synovium and subsequent injection of indigo carmine into the ganglion. The distal end of the clavicle was excised arthroscopically from the inferior surface, and the ganglion stalk was confirmed using indigo carmine for enhanced visualization and magnification. A ganglion portal was created, and the ganglion cyst was resected with the aid of the dye.

Results

Four female patients, aged 78-90 years, were identified with a massive acromioclavicular joint ganglion cyst. Plain radiography showed joint degeneration in the acromioclavicular joint, and magnetic resonance imaging scans showed fluid-filled mass formation. Although all patients initially underwent multiple aspirations of the ganglion cyst, we opted for surgical intervention because of its persistent recurrence. Three patients exhibited concurrent rotator cuff tears, and one patient had a prior history of cuff repair with no retear. After arthroscopic ganglionectomy with color-aided visualization for massive acromioclavicular ganglion joint cysts, none of the patients have shown recurrences at 2 years postoperatively.

Conclusion

Novel aspects of this case series include the use of indigo carmine to provide a better visualization and identification of the ganglion stalk under arthroscopy. Furthermore, a ganglion portal is useful for achieving complete resection of the indigo carmine-stained ganglion cyst. Color-aided visualization using indigo carmine and the construction of a ganglion portal were useful techniques for performing arthroscopic ganglionectomy in patients with a massive acromioclavicular joint ganglion cyst.

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 Treated with Excision and Anterolateral Thigh Flap Reconstruction

Acromioclavicular joint (ACJ) cysts are a rare clinical entity that can impair patients’ cosmetic appearance as well as activities of daily living. Both nonsurgical and surgical treatments are available, but nonsurgical treatments are often associated with a high recurrence rate. Surgical excision can provide resolution of patients’ symptoms, but excision of the cyst as monotherapy is also associated with recurrence. Therefore, various surgical techniques to prevent recurrence have been described, but there is no general consensus regarding the appropriate surgical methods. We describe the case of an 81-year-old man with a recurrent ACJ cyst. The cyst had been excised twice, but it recurred shortly after the excisions. We performed surgical resection and anterolateral thigh (ALT) flap reconstruction. The deteriorated ACJ capsule was repaired with durable fascia lata and the defect after tumor excision was obliterated with an ALT flap harvested from the same donor site as fascia lata. On the 12-month follow-up, the patient had no recurrence of the ACJ cyst. Our case suggests that excision of ACJ cysts as monotherapy is likely to fail, and fascia lata patch for durable ACJ capsule reconstruction can be a viable alternative preventing cyst recurrence.

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.

A Case Report of an Acromioclavicular Joint Ganglion Associated with a Rotator Cuff Tear

We report a case of subcutaneous ganglion adjacent to the acromioclavicular joint with massive rotator cuff tear [1-7]. An 81-year-old woman presented with a ganglion adjacent to the acromioclavicular joint that had first been identified 9 months earlier. The ganglion had recurred after having been aspirated by her local physician, so she was referred to our hospital. The puncture fluid was yellowish, clear and viscous. Magnetic resonance imaging identified a massive rotator cuff tear with multi- lobular cystic lesions continuous to the acromioclavicular joint, presenting the "geyser sign". During arthroscopy, distal clavicular resection and excision of the ganglion were performed together with joint debridement. At present, the ganglion has not recurred and the patient has returned to normal daily activity. In this case, the ganglion may have developed subsequent to the concomitant massive cuff tear, due to subcutaneous fluid flow through the damaged acromioclavicular joint.

Reverse Total Shoulder Replacement with Minimal ACJ Excision Arthroplasty for Management of Massive ACJ Cyst - A Case Report

Massive acromioclavicular joint (ACJ) cysts are an extremely rare cause of shoulder impairment and with limited consensus in its management. We present the first published case report of a patient with a massive ACJ cyst treated with a reverse total shoulder replacement with minimal ACJ excision arthroplasty.

Acromio-clavicular joint cyst associated with a complete rotator cuff tear - a case report

This case report describes a patient with an acromio-clavicular joint (ACJ) cyst, associated with a complete tear of the supraspinatus tendon, and the related arthropathy. Ultrasound was a suitable imaging modality to make the diagnosis, and rule out other pathologies. Full assessment of the rotator cuff must be carried out in the presence of ACJ cysts due to their common co-existence with large cuff tears. Cyst aspiration is not a suitable treatment, due to the high likelihood of recurrence. Optimal treatment requires management of the underlying rotator cuff tear.

Ultrasonography of the shoulder

The shoulder is the most common region to be evaluated with musculoskeletal ultrasound. The shoulder's complex anatomy enables an exceptional range of mobility at the expense of static stability. Consequently, the shoulder is susceptible to a multitude of traumatic and atraumatic injuries. This article presents an overview of shoulder anatomy, recommends a standardized approach to the sonographic shoulder evaluation, and discusses common sonographically apparent pathology of the shoulder.