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Aleksiev V, Argirov D, Yavorov B, Markov D, Shterev F. Cystic Anomaly Manifestation Within the Axillary Fossa: A Case Report of Clinical Significance. Cureus 2024; 16:e61200. [PMID: 38939263 PMCID: PMC11208758 DOI: 10.7759/cureus.61200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/27/2024] [Indexed: 06/29/2024] Open
Abstract
Ganglion cysts represent a small group of lesions that can arise from almost any joint in the body. Demonstrating a predilection for the joints in the hand and wrist, ganglion cysts in the glenohumeral joint are extremely rare. Due to the vivid array of masses that can be found in the axillary fossa, forming a free-from-error work-up to the correct diagnosis can be quite confounding. In this paper, we present a case of a paralabral cyst of the shoulder joint, located in the axilla. With there being only eight other such cases published in clinical literature, we believe this case report to be of unique importance in gaining further insight into the genesis and treatment of this pathology.
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Affiliation(s)
- Vladimir Aleksiev
- Department of Cardiovascular Surgery, Medical University of Plovdiv, Plovdiv, BGR
| | - Dimcho Argirov
- Department of Surgery, Medical University of Plovdiv, Plovdiv, BGR
| | - Boyko Yavorov
- Department of Cardiovascular Surgery, Medical University of Plovdiv, Plovdiv, BGR
| | - Daniel Markov
- Department of General and Clinical Pathology, Medical University of Plovdiv, Plovdiv, BGR
| | - Filip Shterev
- Department of Internal Diseases, Section of Pneumonology and Physiatrics, Medical University of Plovdiv, Plovdiv, BGR
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Comparisons between treatment of isolated posterosuperior paralabral cysts and simultaneous treatment of cysts combined with associated shoulder pathologies: arthroscopic treatment of posterosuperior paralabral cysts. Arch Orthop Trauma Surg 2023; 143:665-675. [PMID: 34398279 DOI: 10.1007/s00402-021-04128-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 08/12/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION The purpose of this study is to report the radiologic and clinical outcomes of arthroscopic intervention for isolated posterosuperior paralabral cysts and simultaneous treatment of cysts combined with associated shoulder pathologies. MATERIALS AND METHODS From March 2008 through December 2016, 70 cases (48 males and 22 females) operated on for symptomatic posterosuperior paralabral cysts were included. Mean age was 45 (range 18-69). These patients were classified into two groups depending on if they had accompanying lesions: Group I (isolated group, 27 patients) and Group II (concomitant group, 43 patients). Arthroscopic cyst decompression with a labral repair or posterior capsulotomy for patients without labral tear were performed. All concomitant pathologies were also operated simultaneously. Follow-up MRI were performed at postoperative 6 months and clinical outcomes were evaluated during the follow-up. RESULTS Arthroscopic all intra-articular cyst decompression and labral repair was performed on 67 patients. In three patients, posterior capsulotomy without labral repair was performed for cyst removal. For 43 patients with concomitant lesions, 31 rotator cuff repairs, three SLAP repairs along with biceps tenodesis, two distal clavicle resections due to A-C joint arthritis, one calcific deposit removal, four Bankart repairs, and two acromioplasties were performed. The follow-up MRI showed complete cyst resorption except for two patients. The mean VAS, ASES, UCLA, SST and CS scores significantly improved at the last follow-up. Although both groups showed significantly improved range of motion after the surgery, improvement of ROM in Group II lagged at early periods of the rehabilitation. CONCLUSIONS Arthroscopic labral repair with all intra-articular cysts decompression or simple posterior capsulotomy were both effective treatment modalities. If paralabral cysts were associated with other shoulder lesions, simultaneous treatment of combined lesions could be performed for the improved clinical outcomes at final follow-up with expected lag in the early rehabilitation period. LEVEL OF EVIDENCE Level III, Retrospective Comparative Trial, Treatment Study.
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Kaya S, Ogul H, Koksal A, Koru A, Kiziloglu A, Kantarci M. Magnetic resonance arthrographic demonstration of extension of labral defects in paraglenoid labral cysts. REVISTA DA ASSOCIACAO MEDICA BRASILEIRA (1992) 2023; 69:e20221019. [PMID: 37075440 PMCID: PMC10176652 DOI: 10.1590/1806-9282.20221019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Accepted: 01/03/2023] [Indexed: 04/21/2023]
Abstract
OBJECTIVE This study aimed to investigate the extension of labral tears associated with paraglenoid labral cysts by magnetic resonance arthrography. METHODS The magnetic resonance and magnetic resonance arthrography images of patients with paraglenoid labral cysts who presented to our clinic between 2016 and 2018 were examined. In patients with paraglenoid labral cysts, the location of the cysts, the relation between the cyst and the labrum, the location and extent of glenoid labrum damage, and whether there was contrast medium passage into the cysts were investigated. The accuracy of magnetic resonance arthrographic information was evaluated in patients undergoing arthroscopy. RESULTS In this prospective study, a paraglenoid labral cyst was detected in 20 patients. In 16 patients, there was a defect in the labrum adjacent to the cyst. Seven of these cysts were adjacent to the posterior superior labrum. In 13 patients, there were contrast solution leak into the cyst. For the remaining seven patients, no contrast-medium passage was observed in the cyst. Three patients had sublabral recess anomalies. Two patients had rotator cuff muscle denervation atrophy accompanying the cysts. The cysts of these patients were larger compared to those of the other patients. CONCLUSION Paraglenoid labral cysts are frequently associated with the rupture of the adjacent labrum. In these patients, symptoms are generally accompanied by secondary labral pathologies. Magnetic resonance arthrography can be successfully used not only to demonstrate the association of the cyst with the joint capsule and labrum, but also to reliably demonstrate the presence and extension of labral defects.
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Affiliation(s)
- Serhat Kaya
- Ataturk University, Medical Faculty, Department of Radiology - Erzurum, Turkey
| | - Hayri Ogul
- Duzce University, Medical Faculty, Department of Radiology - Duzce, Turkey
| | - Ali Koksal
- Bayindir Private Hospital - Ankara, Turkey
- Atilim University, Vocational School of Health Services, Department of Radiology - Ankara, Turkey
| | - Ahmet Koru
- Ataturk University, Medical Faculty, Department of Radiology - Erzurum, Turkey
| | - Alper Kiziloglu
- Ataturk University, Medical Faculty, Department of Radiology - Erzurum, Turkey
| | - Mecit Kantarci
- Ataturk University, Medical Faculty, Department of Radiology - Erzurum, Turkey
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Saccheri P, Sabbadini G, Travan L. Two paleopathological cases suggestive of paralabral cysts of the shoulder. INTERNATIONAL JOURNAL OF PALEOPATHOLOGY 2022; 39:109-114. [PMID: 36347173 DOI: 10.1016/j.ijpp.2022.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 10/12/2022] [Accepted: 10/28/2022] [Indexed: 06/16/2023]
Abstract
OBJECTIVE To undertake differential diagnosis of scapular bone defects found in two medieval skeletons buried in different necropoles of Friuli Venezia Giulia (Italy) and to evaluate the clinical significance of paralabral cysts in the context of shoulder pathology. MATERIALS Individual JoT36 is an adult male exhumed from a necropolis belonging to a rural agricultural settlement dated to the 10th to 11th century A.D. Individual CIVT58 is an adult male from a Langobard necropolis dated to 630-670 A.D. METHODS Macroscopic examination of the skeletons was performed using standard osteological methods and review of pertinent clinical literature to assist differential diagnosis. RESULTS Between the glenoid cavity and the spinoglenoid notch of the right scapula of JoT36 there is a multilocular circular defect adjacent to the glenoid rim. On the neck of the left scapula of CIVT58, immediately above the spinoglenoid notch, there is a unilocular circular depression. In both cases, the cortical bone appears smooth without any evidence of erosion or sclerosis. CONCLUSIONS Skeletal findings and historical/archaeological contexts of both cases are compatible with the diagnosis of paralabral cysts. SIGNIFICANCE Paralabral cysts are relatively frequently observed in clinical settings but very few examples have been documented in paleopathological literature. This study seeks to improve recognition and interpretation of this pathology in historical/archaeological contexts. LIMITATIONS Findings from a case report can neither generate epidemiological information nor be generalized. SUGGESTIONS FOR FURTHER RESEARCH Identification of new cases may add valuable information about lifestyles and related shoulder pathologies in ancient times.
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Affiliation(s)
- Paola Saccheri
- Department of Medicine, Section of Anatomy and History of Medicine, University of Udine, P.le Kolbe 3, 33100 Udine, Italy.
| | - Gastone Sabbadini
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Strada di Fiume 447, 34100 Trieste, Italy.
| | - Luciana Travan
- Department of Medicine, Section of Anatomy and History of Medicine, University of Udine, P.le Kolbe 3, 33100 Udine, Italy.
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Jafarnia J, Wininger AE, Holderread BM, Harris JD, Echo A. Acetabular Paralabral Cyst Causing Obturator Nerve Compression in the Setting of Femoroacetabular Impingement Syndrome: A Case Report. JBJS Case Connect 2022; 12:01709767-202212000-00038. [PMID: 36459571 DOI: 10.2106/jbjs.cc.22.00401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 09/01/2022] [Indexed: 12/04/2022]
Abstract
CASE Large acetabular paralabral cysts can cause compression of the surrounding neurovascular structures leading to sensory and motor deficits. We present a 68-year-old man with obturator nerve denervation from a paralabral cyst secondary to a labral tear associated with femoroacetabular impingement syndrome. Resolution of symptoms and return to full activities were achieved at 3 months and maintained beyond 1 year through open cyst excision, obturator neurolysis, arthroscopic femoral osteoplasty, and labral repair in the same surgical setting. The patient had a successful clinical outcome, with pain and dysfunction resolution. CONCLUSION Large paralabral cysts may cause obturator nerve compression, which can be successfully treated with open nerve decompression and arthroscopic treatment of labral pathology.
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Affiliation(s)
- Jordan Jafarnia
- Department of Orthopedics and Sports Medicine, Houston Methodist Hospital, Houston, Texas
| | - Austin E Wininger
- Department of Orthopedics and Sports Medicine, Houston Methodist Hospital, Houston, Texas
| | - Brendan M Holderread
- Department of Orthopedics and Sports Medicine, Houston Methodist Hospital, Houston, Texas
| | - Joshua D Harris
- Department of Orthopedics and Sports Medicine, Houston Methodist Hospital, Houston, Texas
| | - Anthony Echo
- Department of Plastic and Reconstructive Surgery, Houston Methodist Hospital, Houston, Texas
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Guven F, Ogul H, Kaya S, Kantarci M. MR arthrographic evaluation of posterior paraglenoid labral cysts: a retrospective study. Acta Radiol 2020; 61:789-795. [PMID: 31653186 DOI: 10.1177/0284185119883389] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Paraglenoid labral cysts (PLCs) around the shoulder are uncommon. Magnetic resonance imaging (MRI) is the primary imaging modality for the description of PLCs. PURPOSE The purpose of this study was to evaluate PLCs in the posterior part of the glenoid bone via MR arthrography as well as to describe associated labral abnormalities. MATERIAL AND METHODS This retrospective study included 14 patients, diagnosed with 15 posterior PLCs at MR arthrography between 2007 and 2012. Conventional MRI and MR arthrography were used for all patients. RESULTS A total of 15 PLCs were detected in 14 patients with eight located on the right shoulder and six on the left shoulder. One case had two PLCs. While two cysts were multiloculated, the remaining 13 were seen as unilocated simple cysts. Moreover, 14 of 15 posterior PLCs (60%) were associated with labral tears at MR arthrography. The cysts in proximity to the glenoid labrum were posterosuperior in 33.3% (n = 5), mid-posterior in 36.7% (n = 7), and postero-inferior in 20% (n = 3). The majority of patients with posterosuperior and mid-posterior cysts had an associated superior labral tear from anterior to posterior (SLAP) lesions. Four of six patients with mid-posterior cysts had minimal denervation atrophy in the infraspinatus muscle. CONCLUSION Posterior PLCs are mostly associated with posterior labral defects. The majority of cysts localized in the posterosuperior and mid-posterior were also associated with SLAP lesions. Denervation atrophy in the infraspinatus muscle may frequently accompany mid-posterior PLCs.
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Affiliation(s)
- Fadime Guven
- Department of Radiology, Medical Faculty, Ataturk University, Erzurum, Turkey
| | - Hayri Ogul
- Department of Radiology, Medical Faculty, Ataturk University, Erzurum, Turkey
| | - Serhat Kaya
- Department of Radiology, Medical Faculty, Ataturk University, Erzurum, Turkey
| | - Mecit Kantarci
- Department of Radiology, Medical Faculty, Ataturk University, Erzurum, Turkey
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Pirimoglu B, Ogul H, Kantarci M. Humeral Chondral Defect and Labral Tear Associated with Paraglenoid Labral Cyst: A Case Report. Med Princ Pract 2016; 25:488-90. [PMID: 27318468 PMCID: PMC5588443 DOI: 10.1159/000447669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2015] [Accepted: 06/16/2016] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To report an unusual combination of paraglenoid labral cyst and labral tear with chondral defect of the humeral head. CLINICAL PRESENTATION AND INTERVENTION A 34-year-old man presented with right shoulder pain. Conventional MR imaging showed paraglenoid labral cyst. MR arthrography revealed a humeral chondral defect and labral tear associated with paraglenoid labral cyst, and a defect of the posterior inferior labrum extending to the superior labrum and humeral chondral defect. The patient underwent arthroscopic surgery. CONCLUSION This case showed the importance of MR arthrography in a case that involved an unusual combination of paraglenoid labral cyst and labral tear with chondral defect.
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Affiliation(s)
| | - Hayri Ogul
- *Hayri Ogul, MD, Department of Radiology, Medical Faculty, Ataturk University, Kazìm Karabekir Mah., Terminal Cad., Site Polat Apt. B Blok, Kat 1, No 2, TR-25240 Erzurum (Turkey), E-Mail
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Jeong JJ, Panchal K, Park SE, Kim YY, Lee JM, Lee JK, Ji JH. Outcome After Arthroscopic Decompression of Inferior Labral Cysts Combined With Labral Repair. Arthroscopy 2015; 31:1060-8. [PMID: 25769479 DOI: 10.1016/j.arthro.2015.01.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2014] [Revised: 12/15/2014] [Accepted: 01/09/2015] [Indexed: 02/02/2023]
Abstract
PURPOSE To analyze the clinical and radiologic outcomes of arthroscopic cyst decompression and labral repair in patients with inferior paralabral cysts with chronic shoulder pain. METHODS Between March 2006 and September 2012, 16 patients who were identified as having inferior paralabral cysts presented with chronic shoulder pain. All patients underwent a thorough physical examination and preoperative magnetic resonance arthrographic evaluation. The mean age was 30 years (range, 17 to 50 years). The mean follow-up period was 38 months (range, 16 to 60 months). Clinical outcome scores (American Shoulder and Elbow Surgeons; University of California, Los Angeles; and Simple Shoulder Test) and passive shoulder range of motion were evaluated at last follow-up. Follow-up magnetic resonance imaging was performed at a mean of 8 months to determine the labral healing status and assess for cyst recurrence. RESULTS The incidence of isolated inferior paralabral cysts was 0.6% (16 of 2,656 cases). Of the patients, 8 had multiple cysts and 8 had a single cyst. The mean length and width of the cysts were 1.0 cm and 0.4 cm, respectively. Eight cases had a history of trauma, and 13 patients were involved in sports activities. Seventy-five percent of cases showed a positive relocation test. The mean American Shoulder and Elbow Surgeons; University of California, Los Angeles; and Simple Shoulder Test scores improved from 64, 22, and 8.7, respectively, preoperatively to 83, 31, and 10, respectively (P < .001), at final follow-up. Shoulder range of motion did not show any significant improvement. The location of the labral tear was as follows: anteroinferior tear in 5 cases, posteroinferior tear in 8 cases, and combined anteroinferior and posteroinferior tear in 3 cases. All cysts were found to be in association with a labral tear. A mean of 2.7 anchors were used for inferior labral repair. These cysts were found only in male patients. None of the patients showed any evidence of cyst recurrence on follow-up magnetic resonance imaging. CONCLUSIONS Inferior labral tears treated with cyst decompression and labral repair showed satisfactory clinical results without any recurrence. Inferior paralabral cysts should be considered in the differential diagnosis in patients presenting with chronic shoulder pain, particularly active male patients. LEVEL OF EVIDENCE Level IV, therapeutic case series.
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Affiliation(s)
- Jae-Jung Jeong
- Department of Orthopedic Surgery, College of Medicine, The Catholic University of Korea, Daejeon St. Mary's Hospital, Daejeon, South Korea
| | - Karnav Panchal
- Department of Orthopedic Surgery, College of Medicine, The Catholic University of Korea, Daejeon St. Mary's Hospital, Daejeon, South Korea
| | - Sang-Eun Park
- Department of Orthopedic Surgery, College of Medicine, The Catholic University of Korea, Daejeon St. Mary's Hospital, Daejeon, South Korea
| | - Young-Yul Kim
- Department of Orthopedic Surgery, College of Medicine, The Catholic University of Korea, Daejeon St. Mary's Hospital, Daejeon, South Korea
| | - Jae-Min Lee
- Department of Orthopedic Surgery, College of Medicine, The Catholic University of Korea, Daejeon St. Mary's Hospital, Daejeon, South Korea
| | - Jun-Ku Lee
- Department of Orthopedic Surgery, College of Medicine, The Catholic University of Korea, Daejeon St. Mary's Hospital, Daejeon, South Korea
| | - Jong-Hun Ji
- Department of Orthopedic Surgery, College of Medicine, The Catholic University of Korea, Daejeon St. Mary's Hospital, Daejeon, South Korea.
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Irion V, Cheah M, Jones GL, Bishop JY. The isolated inferior glenohumeral labrum injury, anterior to posterior (the ILAP): A case series. INTERNATIONAL JOURNAL OF SHOULDER SURGERY 2015; 9:13-9. [PMID: 25709240 PMCID: PMC4325385 DOI: 10.4103/0973-6042.150218] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
INTRODUCTION We describe the presentation, exam findings, surgical repair techniques, and short-term outcomes in a series of patients with isolated inferior labral tears. MATERIALS AND METHODS A retrospective chart review was performed at a large academic medical center. Isolated inferior labral tears were defined as between the 4 o'clock and 8 o'clock position of the glenoid as determined by direct arthroscopic visualization. Tears that were smaller were also included but were required to cross the 6 o'clock point, having anterior and posterior components. Patients were excluded if they had any other pathology or treatment of the shoulder. 1-year follow-up was required. RESULTS Of the 17 patients who met inclusion criteria for review, 12 were available for a minimum 1-year follow-up. Average total follow-up for patients to complete the phone interview/Oxford Shoulder Instability Score (OSIS) was an average of 37.7 months (range: 16-79 months). Postoperatively, all reported symptom improvement or resolution since surgery. The mean preoperative pain on a scale of 0-10 was 6.3 (range: 0-10). Mean postoperative pain on a scale of 0-10 was 2.25 (range: 0-5). Eleven of 12 patients (91.7%) had returned to the level of activity desired. The mean OSIS was 41.4 (median: 43; range: 27-47). Eleven of 12 patients (91.7%) had good or excellent scores. Ten of 12 patients (83.3%) had a feeling of stability in the shoulder. All 12 patients reached were satisfied with the procedure and would undergo surgery again in a similar situation. CONCLUSIONS We have presented our series of patients with isolated inferior labral injury, and have shown that when surgically treated, outcomes of this uncommon injury are good to excellent and a full return to sports can be expected.
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Affiliation(s)
- Val Irion
- Department of Orthopaedics, OSU Sports Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Michael Cheah
- Department of Orthopaedics, OSU Sports Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Grant L Jones
- Department of Orthopaedics, OSU Sports Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Julie Y Bishop
- Department of Orthopaedics, OSU Sports Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA
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