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

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.

Osteochondral Autograft Transfer Technique for Glenoid Osteochondral Defect

Glenoid osteochondral defects can be a significant source of pain and disability in an active population. Many treatments are available, but most joint-preserving procedures are limited to debridement, abrasion chondroplasty, or marrow-stimulation techniques, all of which depend on healthy underlying bone and none of which address underlying bony pathology. Osteochondral autograft transfer has been a successful form of treatment for lesions in the knee, elbow, and ankle, especially when subchondral bone is involved. We describe an arthroscopic method of treating glenoid osteochondral lesions with an osteochondral autograft transfer using a graft from the patient's ipsilateral knee. This technique addresses both cartilage and osseous pathology with minimal morbidity and provides a good biological restorative option for patients with isolated glenoid osteochondral defects.

An abnormal bone lesion of the scapula in a collegiate basketball player: a case report

OBJECTIVE

To present the case of a bone lesion of the scapula in a collegiate basketball player.

BACKGROUND

A 19-year-old National Collegiate Athletic Association Division I male basketball player presented with pain in the posterior region of the right shoulder. During practice, he was performing a layup when his arm was forced into hyperflexion by a defender. Evaluation revealed a bone lesion involving the scapular spine and base of the acromion.

DIFFERENTIAL DIAGNOSIS

Acromioclavicular joint sprain, subacromial bursitis, subscapular bursitis, humeral head contusion, acromial fracture.

TREATMENT

The patient was treated for 2 months with therapeutic modalities and rehabilitation exercises. Because of persistent pain and the risk of a pathologic fracture, open surgical biopsy and bone grafting were then undertaken.

UNIQUENESS

Most simple bone cysts affect the proximal humerus and femur, whereas our patient's lesion was in the acromial complex.

CONCLUSIONS

Athletic trainers should be alert to the unusual possibility of bone cysts, which are usually identified incidentally when radiographs are obtained for other reasons. Most simple bone cysts are asymptomatic, but a pathologic fracture can occur with trauma.

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.

An unusual presentation of a simple bone cyst in the scapula

A 38-year-old man presented with pain in the left shoulder following a fall. A rotator cuff tear was suspected but roentgenograms revealed a lytic, expanded, multiseptate lesion of the scapula adjacent to glenoid. This was compatible with a giant cell tumor, aneurysmal bone cyst or simple bone cyst. The MRI showed rim enhancement and clinched the diagnosis of simple bone cyst. An infraspinous approach to scapula was undertaken and open biopsy confirmed the diagnosis of simple bone cyst. Definitive treatment in the form of curettage and calcium phosphate cementation was carried out. The postoperative period was uneventful. Early mobilization was started. Patient remained well on follow-up and has returned to work in a physically demanding capacity.

Anatomic osteochondral glenoid reconstruction for recurrent glenohumeral instability with glenoid deficiency using a distal tibia allograft

The treatment of glenoid bone loss in the setting of recurrent shoulder instability remains a challenge. This is because of the nonanatomic nature and resultant incongruous joint resulting from most bony augmentation procedures. We present a novel technique for the management of glenoid bone deficiency by using a fresh osteochondral distal tibial allograft. We have found that the distal tibia has excellent articular conformity to unmatched humeral heads, fits nearly anatomically on the distal two thirds of the glenoid, is composed of dense weight-bearing cortical and metaphyseal distal tibia bone, and provides for a cartilaginous surface for which the humeral head to articulate. This article describes the technique, initial results, and postoperative findings with the use of a distal tibia allograft (the lateral portion of the distal tibia) for the treatment of glenoid bone deficiency (mean loss of 30%) in a series of 3 patients.

Unicameral bone cyst of the humeral head: arthroscopic curettage and bone grafting

Arthroscopic surgery has improved greatly over the past decade. Treatment of various juxta-articular disorders around the shoulder have benefited from endoscopic approaches. Cystic lesions of the shoulder on the scapular side have been treated in this way. This article describes a case of a 29-year-old patient with a unicameral bone cyst on the posterior aspect of the humeral head. Arthroscopic visualization using an accessory posteroinferior portal localized the cyst through the bare area of the humeral head. A cannulated burr was used to create an opening through the cortical wall between the cyst and the joint, and a careful curettage was performed. The cavity was filled with a demineralized bone matrix enriched with autologous blood packed into an arthroscopic cannula and delivered through the accessory portal. The patient reported pain relief immediately postoperatively and at follow-up. This case demonstrates the feasibility of arthroscopic treatment of a simple bone cyst of the humeral head. We believe that the knowledge of the juxta-articular anatomy allows the applications of scope-assisted procedures to be expanded, maximizing the results of a technique that allows a shorter recovery and less painful rehabilitation.

Revision using modified transglenoid reconstruction in recurred glenohumeral instability combined with anchor-induced arthropathy

A 25-year-old man presented with a history of pain and crepitus in the right shoulder; he had been previously treated with arthroscopic anterior stabilization using four metallic suture anchors for recurrent traumatic anterior instability 1 year earlier. In this report, we present a patient with recurrent glenohumeral instability combined with anchor-induced arthropathy who was managed with modified arthroscopic transglenoid reconstruction following arthroscopic suture anchor retrieval.

Intraosseous ganglion about to cause a fracture of the glenoid: a case report

Intraosseous ganglia of the glenoid are rare, and their etiology is unknown. This report describes a case of an intraosseous ganglion about to cause fracture of the glenoid. The patient was a 61-year-old woman with a painful left shoulder with a limited range of motion. Her symptoms did not improve after non-operative treatment. Arthroscopic examination showed a cartilage defect and erosion in the posteroinferior portion of the glenoid, behind which computed tomography (CT) showed a cystic lesion of the glenoid. There was no communication between the cyst and the joint space. The patient was treated by curettage and an autogenous cancellous bone graft from the iliac crest. Two years after the operation, the patient was almost free from pain, and CT showed good integration of the bone graft.

Arthroscopic-assisted reduction and percutaneous external fixation of a displaced intra-articular glenoid fracture

Arthroscopic reduction and percutaneous external fixation is a well-known technique for treating selected fractures. This is the first report of a method of treating intra-articular glenoid rim fracture using shoulder arthroscopy and percutaneous external fixation. The surgical trauma associated with open operative treatment of these fractures can be minimized using minimally invasive techniques under arthroscopic control. This technique not only allows for anatomic reduction with minimal surgical trauma but provides a valid diagnostic and treatment alternative for associated injuries. Arthroscopic reduction and percutaneous external fixation yielded excellent results with no complications. The authors describe the principles of the procedure and discuss its advantages compared with traditional surgery.