Case report 783. Intraosseous ganglion of scapula

Tumours and Tumour - Like Lesions of Scapula

A retrospective study of 68 cases of tumours and tumour - like lesions related to the scapula, included in the registry of the Bone Tumour Reference Centre at the Institute of Pathology/University Clinics, Basle, has been carried out. Each case was evaluated for lesion entity, activity and location, age and sex of the patient, and, in 49 files with available radiographic documentation (mostly plain films), for radiologic appearance, with the aim to predict the histologic diagnosis or at least the correct dignity of the lesion. Statistically most frequent were cartilaginous tumours. More than 1/3 of all cases were osteochondromas, which demonstrated mostly a typical appearance. They were encountered predominantly in the first 3 decades in males and were located most often in the body of the scapula. 1/4 of all cases were chondrosarcomas, which were prevailing in the 4th-7th decades, but were occasionally found at a younger age too. Chondrosarcomas were located mainly at the lateral scapular margin over the inferior angle and in the acromion and coracoid process and their appearance ranged from typical to falsely benign. 1/3 of the cases represented a number of other benign and malignant histological entities.

Suprascapular nerve entrapment caused by an intraosseous ganglion of the scapula: A case report

RATIONALE

Suprascapular nerve compression is a rare but important entity that is often missed in clinical practice. Nerve 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.

PATIENT CONCERNS

We report a 61-year-old woman who had complained right shoulder pain that lasted over 3 years which was exacerbated by overhead activities.

DIAGNOSES

We diagnosed it as suprascapular nerve entrapment at the spinoglenoid notch caused by an intraosseous ganglion of the scapula.

INTERVENTIONS

Plain X-ray, computed tomography, magnetic resonance imaging (MRI), and electromyography (EMG) of the shoulder.

OUTCOMES

She undertook surgical excision with curettage of the cyst. The infraspinatus fossa dull pain subsided immediately after surgery. No recurrence of the cystic lesion was noted on follow-up plain radiograph and MRI performed 18 months postoperatively. Shoulder external rotation strength was graded as 5 of 5.

LESSIONS

Intraosseous ganglion of the glenoid can cause compression of the suprascapular nerve when the lesion is expanded toward the spinoglenoid notch. The EMG study confirmed compression of the suprascapular nerve. The patient showed clinical and radiologic improvement after surgical decompression with no recurrence.

Intraosseous ganglion with impending fracture of the glenoid

Intraosseous ganglia are benign cystic and often multiloculated lesions located in the subchondral bone. Only 13 cases around the shoulder have been described in the literature. 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 reports the clinical, radiographic, and pathological findings of a 34-year-old man reporting shoulder pain during heavy working activities. At physical examination, his left shoulder showed complete active and passive range of motion but was painful in external rotation and extension. Tests for the evaluation of the rotator cuff were all negative. The anterior apprehension test provoked pain. The Constant-Murley score was 59 points. Radiographs, computed tomography (CT) scan, and magnetic resonance arthrography showed an elliptical-shaped osteolytic area in the anteroinferior portion of the glenoid extending to the anteroinferior glenoid margin. Leakage of the intra-articular contrast medium showed that the cyst had eroded the articular surface and was about to cause an intra-articular fracture of the glenoid. The patient was operated on with the suspicion of an intraosseous ganglion. The cyst was curetted carefully and packed with autologous bone from the proximal tibia and artificial bone chips. At 1-year follow-up, the patient was completely asymptomatic and reported no pain during his working activities. Physical examination was negative. Radiographs and CT scan showed a cystic lesion in the anteroinferior margin of the glenoid that was partially filled by bone.

Local arthroscopic bone grafting of a juxta-articular glenoid bone cyst

This report describes a rare, juxta-articular bone cyst of the posterior glenoid that developed after a fracture of the glenoid in a 38-year-old male. The patient had persistent pain, popping and stiffness of his right shoulder for 3 years, and failed to improve after a nonoperative rehabilitation program. At arthroscopy, the senior author transported an autogenous bone graft from the bare area of the humeral head to fill the glenoid cyst arthroscopically. At second-look arthroscopy approximately 1 year after the index procedure, the bone graft had consolidated within the original cystic defect and the surface was covered with fibrocartilage. The graft harvest site posteriorly on the humeral head had healed with a small amount of scar tissue at the articular margin. Comfortable motion and function were restored.

Intraosseous pneumatocyst of the iliac bone

Intraosseous pneumatocyst of the iliac bone is usually an innocuous incidental finding with characteristic radiographic features. Because this entity is uncommon and has not been described in the orthopaedic literature, many orthopaedic surgeons are unfamiliar with the entity. Three cases of intraosseous pneumatocyst of the iliac bone are presented to illustrate some of the imaging features to assist in recognizing it for what it is: an innocuous incidental finding that should not prompt invasive procedures such as a biopsy.