Inferior paralabral ganglion cyst of the shoulder with labral tear -- a rare cause of shoulder pain

Cystic Anomaly Manifestation Within the Axillary Fossa: A Case Report of Clinical Significance

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.

Comparisons between treatment of isolated posterosuperior paralabral cysts and simultaneous treatment of cysts combined with associated shoulder pathologies: arthroscopic treatment of posterosuperior paralabral cysts

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.

Magnetic resonance arthrographic demonstration of extension of labral defects in paraglenoid labral cysts

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.

Two paleopathological cases suggestive of paralabral cysts of the shoulder

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.

Acetabular Paralabral Cyst Causing Obturator Nerve Compression in the Setting of Femoroacetabular Impingement Syndrome: A Case Report

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.

MR arthrographic evaluation of posterior paraglenoid labral cysts: a retrospective study

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.

Humeral Chondral Defect and Labral Tear Associated with Paraglenoid Labral Cyst: A Case Report

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.

Outcome After Arthroscopic Decompression of Inferior Labral Cysts Combined With Labral Repair

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.

The isolated inferior glenohumeral labrum injury, anterior to posterior (the ILAP): A case series

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.