Dietz Sven-Oliver, Lichtenberg Sven, Habermeyer Peter
Department of Shoulder and Elbow Surgery, ATOS Praxisklinik, Heidelberg, Germany.
Acta Orthop Belg. 2003 Aug;69(4):373-6.
A 34-year-old patient presented to our outpatient clinic with the chief complaint of shoulder instability, without any history of trauma. Physical examination revealed a painful apprehension test at 60 degrees, 90 degrees and 120 degrees but no objective sign of shoulder instability or hyperlaxity. MRI-scan showed a cyst over the anterior inferior glenoid rim. Arthroscopic findings were an enlarged capsule, a positive drive-through sign, a SLAP I lesion and a sublabral cyst at the anterior-inferior labrum. Detachment of the anterior labrum could be detected with a probe. The cyst's membrane was resected using a whisker shaver. The capsule and the anterior labrum were refixated with a suture anchor. Following capsular shrinking, there was no further laxity and the drive-through sign was diminished. After three months there was full range of active and passive motion. The patient had no subjective instability sensations. MRI showed no residuum of the cyst. Juxta-articular cysts are a known entity in large joints. There are different types of periarticular cysts. A ganglion cyst of the shoulder associated with glenohumeral instability has, to our knowledge, only been described twice. Our case suggests that mere excision of a juxtaglenoidal ganglion is not sufficient; reconstruction of the labrum must be performed to restore stability of the shoulder.
一名34岁患者因肩部不稳定为主诉前来我院门诊就诊，无任何外伤史。体格检查发现，在60度、90度和120度时恐惧试验疼痛，但无肩部不稳定或关节过度松弛的客观体征。磁共振成像扫描显示肩胛盂前下缘有一个囊肿。关节镜检查发现关节囊扩大、通过征阳性、肩胛上盂唇前上象限损伤（SLAP I型损伤）以及肩胛下盂唇前下象限有一个盂唇下囊肿。用探针可检测到肩胛下盂唇前下象限分离。用刮匙切除囊肿包膜。用缝合锚钉重新固定关节囊和肩胛下盂唇。关节囊收缩后，不再有松弛，通过征减轻。三个月后，主动和被动活动范围恢复正常。患者无主观不稳定感。磁共振成像显示囊肿无残留。关节旁囊肿在大关节中是一种已知的病变。有不同类型的关节周围囊肿。据我们所知，与盂肱关节不稳定相关的肩部腱鞘囊肿仅被描述过两次。我们的病例表明，单纯切除关节旁腱鞘囊肿是不够的；必须进行盂唇重建以恢复肩部稳定性。
