Intraosseous ganglion with impending fracture of the glenoid

Abstract

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.