Gigantic acromioclavicular joint cyst: presentation and mini review

Acromioclavicular joint (ACJ) cyst is an uncommonly documented condition of the shoulder, first described by Craig.5Craig E.V. The acromioclavicular cyst. An unusual presentation a rotator cuff tear.Clin Orthop Relat Res. 1986; : 189-192Google Scholar According to Hiller's classification,13Hiller A.D. Miller J.D. Zeller J.L. formation.Clin Anat. 2010; 23: 145-152https://doi.org/10.1002/ca.20918Crossref PubMed Scopus (35) Google there are 2 types cysts, based on various etiologies that generate them. Type I cysts caused degenerative changes ACJ due injury, metabolic/infectious disease, or excessive use and therefore restricted joint, with intact cuff. Gradually, these can inflame synovium, leading overproduction fluid formation superficial ACJ. II associated tears, partial complete, subsequent tear arthropathy, including superior migration humeral head irritation inferior capsule. Synovial from glenohumeral (GHJ) escapes through subacromial/subdeltoid bursa (Geyser sign) into ACJ, deteriorated capsule acting like 1-way valve prevents returning, cyst.6Cvitanic O. Schimandle J. Cruse A. Minter cyst: communication revealed MR arthrography.J Comput Assist Tomogr. 1999; 141-143Crossref (24) We report massive over right in 80-year-old man, followed short literature review. database search was carried out using terms cyst, ganglion No date criteria were placed. All articles reporting cyst's size its underlying pathology, as well applied treatment methods recurrence rate, included. inclusion (1) full-text studies (2) English language official translation provided. initial research query provided 166 records. Eleven excluded duplicates, 79 irrelevant reviewing title. In addition, cases describing juxta-articular myxoma chondromyxoid fibroma, respectively, excluded. From remaining 76 reports, 10 rejected their abstracts, because apparent irrelevancy. tried retrieve full text 66 articles. For them, whole could not be obtained; therefore, they for 8 articles, which also A total number 48 thoroughly reviewed. Six data 6 low level evidence. 34 finally entered review, 57 (Table I).Table ISummary sorted descending casesStudyNo. casesAgeDimensions/ maximum diameterHistoryTreatmentRecurrenceFollow-up, moTshering Vogel et al, 200533Tshering D.W. Steinbach L.S. Hertel R. Bernhard Stauffer E. Anderson S.E. nine pseudotumor shoulder.Skeletal Radiol. 2005; 34: 260-265https://doi.org/10.1007/s00256-004-0883-6Crossref (42) Scholar957Ranging 1.5 6GH DJDNonspecified surgery––60GH DJD––68–Conservative––64–Nonspecified surgery––71GH DJD––68GH DJDCE––68GH DJD, CPPDNonspecified surgery––68GH CPPD––86–Conservative––Gumina 201612Gumina S. Candela V. Passaretti D. ASA 3-4 patients. Whether how quickly it recurs after aspiration steroid injection.Acta Belg. 2016; 82: 161-165Google Scholar478Max × 7–ConservativeYes182–85–87–Hiller 201013Hiller Scholar47310 6AC, GH DJDConservative––90–GH DJDACJ resection––768 7AC, DJDArthroscopic intervention, CE, DCE––76–AC, DJDArthroplasty, DCE––Groh 199310Groh G.I. Badwey T.M. Rockwood Jr., C.A. Treatment shoulder hemiarthroplasty.J Bone Joint Surg Am. 1993; 75: 1790-1794Crossref (31) Scholar465–GH RAArthroplastyNoAvg. 2767–GH DJD71–GH DJD60–GH DJDPostacchini 199323Postacchini F. Perugia Gumina tear. three cases.Clin 111-113Crossref (34) Scholar3735AC, DJDAcromioplasty, RCRYes12754GH resection, acromioplasty, CENo6763AC, DJDConservative––Cho, 20142Cho C.H. Complicated tear.Am J (Belle Mead NJ). 2014; 43: 70-73Google Scholar271–AC DCEΝο13773 3AC, DCE96Selvi 199827Selvi De Stefano Frati MAnganelli Manca Marcolongo Rotator rheumatoid arthritis.Clin Rheumatol. 1998; 17: 170-171Crossref (10) Scholar2623 RAConservativeYes–534AC, RA––Cooper AM 19933Cooper A.M. Hayward C. Williams B.D. Calcium pyrophosphate deposition disease—involvement pseudocyst formation.Br 32: 248-250Crossref (15) Scholar2743AC CPPDConservativeNo–735AC, CPPDCEYes–Craig, 19865Craig Scholar2864 4AC, DJDConservativeYes–675 5AC, RCR––Spinnato 201931Spinnato P. Facchini G. Bazzocchi Errani Marinelli intramuscular extension presenting mass at base neck [Epub ahead print].J Clin 2020; https://doi.org/10.1097/RHU.0000000000001231Crossref Scholar1825.5AC, DJDConservativeNo8Purohit 201924Purohit Keny Raja B. Marathe N. Massive acromio-clavicular arthropathy arthritis normal functional shoulder—a case report.J Trauma. 2019; 10: 522-525https://doi.org/10.1016/j.jcot.2019.03.001Abstract Full Text PDF (6) Scholar1768 8AC, DJDCE, DCENo12Schneider 201925Schneider K.N. Gosheger Liem Progressive prominent swelling joint.Dtsch Arztebl Int. 116: 38https://doi.org/10.3238/arztebl.2019.0038Crossref Scholar181–AC, CENo6Zhang Oldet 201834Zhang Y. Old extension: review.Case Rep Orthop. 2018; 2018https://doi.org/10.1155/2018/7602549Crossref Scholar1802 13 1.8GH DCENo3Maziak 201817Maziak Plachel Scheibel M. Moroder patient cuff-tear arthropathy: rare cause discomfort.BMJ Case Rep. 2018https://doi.org/10.1136/bcr-2018-226188Crossref (5) Scholar177–GH DJDCENo12Tanaka 201632Tanaka Gotoh Mitsui Shirachi I. Okawa T. Higuchi al.A tear.Kurume Med 63: 29-32https://doi.org/10.2739/kurumemedj.MS6300002Crossref (3) Scholar1814 DCENo24Chang Chien 20151Chang G.C. Best C.S. Clay B.S. Candido K.D. Ultrasonography leads accurate diagnosis management painful cyst.Pain Pract. 2015; 15: E72-E75https://doi.org/10.1111/papr.12316Crossref Scholar1361 1AC traumaConservativeNo–Guillen Astete 201511Guillen de la Casa Resino synovial integrity.Reumatol Clin. 11 (Article Spanish): 121-122https://doi.org/10.1016/j.reumae.2014.04.005Crossref Scholar1402.2 1.3AC trauma–––Shaarani 201428Shaarani S.R. Mullett H. Reverse replacement minimal excision arthroplasty cyst—a report.Open 8: 298-301https://doi.org/10.2174/1874325001408010298Crossref Scholar1839 5GH resectionNo6McCreesh 201418McCreesh K.M. Riley S.J. Crotty J.M. Acromio-clavicular complete -a report.Man Ther. 19: 490-493https://doi.org/10.1016/j.math.2013.11.004Abstract (8) Scholar174–AC, DJDConservative––Khor 201414Khor A.Y. Wong S.B. Clinics diagnostic imaging (151). geyser sign chronic full-thickness supraspinatus tendon (SST) tear.Singapore 55: 53-56https://doi.org/10.11622/smedj.201401Crossref Scholar182–AC, DJDConservative––Singh 201329Singh R.A. Hay B.A. S.M. Management revisited.Shoulder Elbow. 2013; 5: 62-64https://doi.org/10.1111/j.1758-5740.2012.00221.xCrossref (7) Scholar1823 DJDConservativeΝο–Skedros al 201230Skedros J.G. Knight A.N. ganglionic treated allograft patch region.J Shoulder Elbow Surg. 2012; 21: e1-e5https://doi.org/10.1016/j.jse.2011.07.033Abstract Scholar1848 NIDDACJ CENo16Cooper HJ 20114Cooper H.J. MIlillo Klein D.A. DiFelice G.S. MRI sign: setting 2011; 40: E118-E121PubMed Scholar1713.8 4.1 2.6AC, CENo8Good 20119Good L.M. DiCarlo J.B. High W.A. cutaneous manifestation cyst.J Am Acad Dermatol. 64: 1206-1208https://doi.org/10.1016/j.jaad.2009.09.034Abstract Scholar1914 7GH DCEYes1de Hartog 20117de Schimmel J.W. Rijk P.C. Spontaneous disappearance report.Am 367-368Google Scholar1583.5AC, DJDConservativeNo–Nowak 200922Nowak D.D. Covey A.S. Grant R.T. Bigliani L.U. 2009; 18: e12-e14https://doi.org/10.1016/j.jse.2008.11.009Abstract (12) Scholar1777.8 4.2 2.8AC, RCRNo12Murena 200921Murena L. D'Angelo Falvo Vulcano Surgical aseptic fistulized review literature.Cases 2: 8388https://doi.org/10.4076/1757-1626-2-8388Crossref (16) Scholar1817 2.5AC, DCENo6Kontakis 200715Kontakis G.M. Tosounidis T.H. Karantanas Isolated degeneration cuff.Acta 2007; 73: 515-520PubMed Scholar167–AC DCENo18Mullett 200720Mullett Benson Levy Arthroscopic cyst.Arthroscopy. e1-e4https://doi.org/10.1016/j.arthro.2005.12.037Abstract (11) Scholar1759 resectionNo6Montet 200419Montet X. Zamorani-Bianchi M.P. Mehdizade Martinoli Bianchi Intramuscular arising joint.Clin Imaging. 2004; 28: 109-112https://doi.org/10.1016/S0899-7071(03)00104-9Abstract Scholar1809GH DJDConservative––De Santis 20018De Palazzi D'Amico Di Mascio D.E. Pace-Palitti Petricca ‘porcupine shoulder’ gout.Rheumatology (Oxford). 2001; 1320-1321Crossref (13) Scholar1752 2AC DISH, goutConservative––Cvitanic 19996Cvitanic Scholar1694AC, traumaCE, DCE––Marino 199816Marino A.J. Tyrrell P.N. el-Houdiri Y.A. Kelly C.P. tear.J 7: 435-437Abstract Scholar1665 NIDDAcromioplasty, DCE, RCRNo6Segmüller 199726Segmüller H.E. Saies Hayes M.G. Ganglion joint.J 1997; 6: 410-412Abstract Scholar1631AC NIDDArthroscopic DCENo18ACJ, joint; disease; CPPD, calcium dihydrate crystal AC RA, arthritis; NIDD, noninsulin-dependent diabetes mellitus; diffuse idiopathic skeletal hyperostosis; excision; distal clavicle RCR, repair; –, unknown/not stated. Open table new tab right-handed man admitted hospital located above his His medical history free, exception pulmonary echinococcosis, diagnosed 40 years ago. patient, retired manual laborer, denied any previous trauma prior surgeries affected side, but complained discomfort mild pain during daily life activities, gradually increasing lump. On physical examination, measured 6.5 cm diameter, length, 5 width, 4 height (Fig. 1). lump compressible, movable, nontender palpation. active ROM 160° forward elevation. Internal rotation L2-L3 level, whereas external abduction arm decreased, compared healthy side. plain radiographic examination narrowing space osteophytes. There signs longstanding proximal GHJ osteoarthritis 2). magnetic resonance (MRI) demonstrated subcutaneous, soft tissue density cystic projecting along changes. Both T1- T2-weighted showed well-defined, encapsulated, multilobulated homogenous appearance no adhesions adjacent tissues, necrosis, osteomyelitis 3). 7.6×4×3.5 (length width height). Chronic cranially migrated noted. obvious between subacromial space.Figure 3Magnetic image revealing cyst.View Large Image Figure ViewerDownload Hi-res Download (PPT) Because patient's history, echinococcosis had Serum enzyme-linked immunosorbent assay crude antigens Echinococcus granulosus negative. Supplementary chest radiograph abdominal ultrasonography lung liver lesions. underwent surgical mass. Under general anesthesia, incision made directly contained dense mucoid material, probably escaping degenerated Excision 1 performed, reduce risk recurrence, repaired. Histopathology suggestive wall consisted bundles fibrous connective collagenous depositions focal myxoid changes, lining internal surface. 3 surgery. clinical exact etiology still debatable scientific world. They present elderly patients being uncommon complication and/or changes.33Tshering this average age 72.6 (range: 36-91 years). vast majority (96.5%) older than 50 years, 36 (63.2%) 70 years. al12Gumina stated occasionally masses huge, affecting patients' activities. reviewed found extremely variable (1-8 diameter); 9 (15.8%) exceeded 7 diameter. It seems tendency grow bigger patients, perhaps those unwillingness seek prompt consultation. Our average; although troubled him he been reluctant visit physician. As result, reached almost our knowledge, volume second largest literature. Revealing great importance, ongoing controversy about cysts' pathogenesis, reflect type cysts.13Hiller Graig describe relation tears. accumulation results sign), distension ACJ's capsule.5Craig flow identified arthrogram, contrast, noncontrast computed tomographic arthrography.6Cvitanic Scholar,11Guillen Scholar,14Khor However, always possible demonstrate communication.27Selvi Kontakis al15Kontakis suggest overdistention may narrow channel hinder fluid's flow. Furthermore, already accumulated congeal within thus decrease presented classified valve, inhibiting returning formation. Cho claim most consistent pathology.2Cho Scholar,7de Accordingly, 51 (89.5%) tear, accompanied both GHJ. nature typically benign, either origin.30Skedros Nevertheless, malignant tumours should considered differential diagnosis, significant sizes.6Cvitanic Scholar,33Tshering synovium-lined structures containing articular comes joint. other hand, lack lining, unveiling thicker contain dense, mucinous material.19Montet more commonly appear subsequently related (1.7%) isolated degeneration.4Cooper Scholar,9Good Scholar,16Marino Scholar,18McCreesh Scholar,19Montet Scholar,22Nowak Scholar,24Purohit Scholar,26Segmüller Scholar,30Skedros Scholar,32Tanaka Regardless pathology mechanism, subcutaneous tissue.29Singh only (5.3%) reported cyst19Montet Scholar,31Spinnato Scholar,34Zhang communicating epidermis.9Good Reviewing we list 98 combined pathologies 4). pathology.15Kontakis cases, trauma1Chang 3, inflammatory metabolic DISH-Gout, NIDD respectively,3Cooper Scholar,8De confirming accepted theory origin. Previous DISH-Gout classification; however, al8De have lesion urate crystals, believe secondary local process. degen