Massive acromio-clavicular joint ganglion cyst associated with cuff tear arthropathy and acromioclavicular joint arthritis with normal functional shoulder-A case report

Abstract

Acromio-clavicular joint ganglion cysts are a rare manifestation secondary to either degenerative acromio-clavicular joint arthritis or a rotator cuff tear arthropathy. We report a case of 76 year old female with acromio-clavicular joint cyst associated with cuff tear arthropathy and advanced acromio-clavicular joint arthritis with normal shoulder functions. She had superficial pain over the cyst with no complaints of cuff tear and provocative tests were negative. The shoulder arthrogram revealed the "geyser sign". The cyst was excised en bloc along with distal clavicular resection. The check valve was identified and the defect in the acromio-clavicular joint capsule was treated with capsulorraphy. Patient at one year follow up showed no signs of recurrence. Excision of cyst along with distal clavicular resection and capsulorraphy is a good procedure in patients with acromio-clavicular joint cysts.

Acromioclavicular Joint Cyst Treated with Excision and Anterolateral Thigh Flap Reconstruction

“…For the treatment of type-2 ACJ cysts, several operative maneuvers have been advocated that help to terminate the communication between the ACJ and GHJ, such as arthroplasty and even direct closure of the channel with purse-string sutures. 1 , 2 In our case, the “geyser sign” was not confirmed on the preoperative magnetic resonance imaging, and fluid leakage into the ACJ was not identified intraoperatively. Thus, we only performed a tight and firm closure of the ACJ capsule.…”

“…Both nonoperative and surgical treatments are available, but nonsurgical treatments such as aspiration are typically associated with a high recurrence rate. 1 Surgical excision can resolve patients’ symptoms, but cyst excision as monotherapy is also associated with recurrence. 2 Therefore, various surgical techniques to prevent recurrence have been explored, but a general consensus regarding surgical methods is lacking, as they have shown varied recurrence rates in the literature.…”

Gigantic acromioclavicular joint cyst: presentation and mini review

“…In this review, 9 cases (15.8%) are ganglion cysts related to rotator cuff tear and 1 (1.7%) presented as an isolated ganglion with ACJ degeneration. 4,9,16,18,19,22,24,26,30,32 Regardless of the underlying pathology and mechanism, these cysts are located in the subcutaneous tissue. 29 We found only 3 studies (5.3%) that reported intramuscular extension of the cyst 19,31,34 and 1 (1.7%) describing it communicating with the epidermis.…”

“…In 1 case, there was a previous shoulder trauma on the affected side. [2][3][4][5][6][7]9,10,[12][13][14][16][17][18][19][20][21][22][23][24][25][27][28][29][30][31][32][33][34] Based on the patient's age, general condition, symptoms, and shoulder functionality, the treatment may be conservative or surgical. 21 In this review, 20 patients (35.1%) were treated conservatively with cyst aspiration, steroid injection, or no intervention at all, whereas 36 patients (63.2%) were surgically managed.…”

“…Failure of conservative methods (mainly cyst aspiration) to prevent continuous recurrences eventually led to surgical management of the cyst. 6,10,12,13,16,17,21,22,24,25,30,32,33 Surgical treatment for type I cysts may include CE, distal clavicle excision, and joint d ebridement. 13 As these cysts are isolated to the ACJ and do not communicate with the GHJ, shoulder reconstruction is not needed.…”