Humeral head cysts: association with rotator cuff tears and age

Abstract

The objective of this study was to retrospectively evaluate the prevalence of the cystic changes at rotator cuff footprint on proximal humeral tuberosities and investigate their relationship with rotator cuff tears and patient age. Magnetic resonance (MR) images of 657 patients who underwent shoulder arthroscopy for treatment of rotator cuff disorders were reviewed to localize the cystic changes at anterior (supraspinatus insertion) and posterior (infraspinatus insertion) aspects of greater tuberosity (GT) and lesser tuberosity (subscapularis insertion). Preoperative MR reports as well as cyst size and locations on MR images were correlated with arthroscopic records of rotator cuff pathology (tear type, size, location and tendon involvement) and patient age. The prevalence of cystic changes was 9.1% (60 patients) in the study population. Anterior GT cysts were found in 56% of patients and were strongly associated with full-thickness (p<.001) and articular-sided partial-thickness rotator cuff tears (p=.02). Posterior GT and lesser tuberosity cysts were found in 27 and 17% of patients, respectively, and were not significantly related to rotator cuff tears, although there was an increased trend of posterior cysts in patients with infraspinatus tears (p=.09). A significant relation was found between patient age and the cyst size (p=.01), while none of the cyst localizations were statistically related to age. Anterior GT cysts were more common in this patient group and demonstrated a strong association with rotator cuff disorders regardless of age. Posterior GT and lesser tuberosity cysts were less common and showed no association with rotator cuff pathology or patient age.

Intratendinous supraspinatus cyst as a cause of shoulder impingement

“…2 Several studies have shown an association with partial and full-thickness rotator cuff tears involving the tendon footprint. [2][3][4][5] Paralabral cysts occur in 2% to 3% of symptomatic shoulders. 7,8 They are located mostly medial to the glenoid rim, lying in the supraspinatus or infraspinatus fossa, and can enlarge around the supraglenoid and spinoglenoid notch.…”

Magnetic resonance imaging parameters of the greater tuberosity morphology in different types of chronic rotator cuff tears

“…Previous studies have reported that the reduction in bone density of the greater tuberosity leads to decrease in strength of the rotator cuff attachment, which causes chronic rotator cuff tears [23]. Cystic changes in the front of greater tuberosity are also closely related to rotator cuff tears [27]. However, the relationship between the morphological features of greater tuberosity and chronic rotator cuff tears is unclear.…”

“…Footprints of supraspinatus, infraspinatus, and teres minor tendons are distributed around the greater tuberosity, which is close to the position of the acromion. Several researchers have proposed that bone mineral density decrease and cystic degeneration of the greater tuberosity are risk factors for chronic rotator cuff tears [23][24][25][26][27]. However, the roles of the greater tuberosity morphology in different types of chronic rotator cuff tears have not been investigated to date.…”

MR Arthrography of the Shoulder: Technical Update and Clinical Applications

“…Cysts in the posterior humeral head are not associated with rotator cuff tears, 110,111 but cysts in the anterior greater tuberosity are associated with supraspinatus tears. 112 Calcific tendinitis often manifests as an amorphous area of mineralization seen in the rotator cuff on shoulder radiographs. Conventional MR imaging of the shoulder often shows increased blooming artifact around these calcific deposits in the rotator cuff tendons on gradient sequences; however, gradient sequences are not typically part of MR arthrography.…”