PMC4181170_01
There are severe degenerative changes involving the
glenohumeral joint with direct bone on bone articulation between
the humeral head and the undersurface of the acromion consistent
with a chronic complete rotator cuff tear. There is a lobulated soft
tissue mass projected superior to the acromioclavicular joint.
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ROM consistent with rotator cuff arthropathy. Radiographs showed severe degeneration of the glenohumeral (GH) joint and proximal humeral head migration (Fig. 1).
(a) Sagittal PD (b) Coronal T2 MRI of the right shoulder showing marked degeneration of the glenohumeral joint with a
longstanding chronic full-thickness rotator cuff tear with complete atrophy of the supraspinatus and infraspinatus muscles and a lesser extent
the subscapularis muscle. There is direct bone on bone articulation between the superior and humeral head and the undersurface of the
acromion. Prominent degenerative changes are also noted within the acromioclavicular joint. There is a large multiloculated cystic lesion (9 x
5 cm) relating to the soft tissues overlying the deltoid muscle which has relatively simple features and is consistent with a large ganglion cyst
likely relating to the adjacent markedly degenerated glenohumeral joint and cuff pathology.
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Magnetic resonance imaging demonstrated a longstanding chronic full-thickness rotator cuff tear with complete atrophy of the supraspinatus and infraspinatus muscles, and of the subscapularis muscle (Fig. 2).
(a) Preoperative picture showing the 10 x 6 x 2 cm multiloculated shoulder lump overlying the ACJ (b) Intraoperative pictures of
the right shoulder showing expression of a yellowish cheesy-like material, following an ACJ excision arthroplasty.
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A beach chair position was used and an antero-superior approach of the shoulder was utilised (Fig. 3a). This was preceded with an ACJ excision arthroplasty (Fig. 3b).
6-month postoperative pictures and radiograph showing (a, b) patients improved ROM (c) remission of the cyst and (d) the right
reverse shoulder total shoulder replacement in satisfactory position.
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The patient had no pain symptoms and had excellent ROM (forward flexion 180 , abduction 120 , internal rotation to level of 4th lumbar vertebrae) and post-operative radiograph showing the prosthesis in satisfactory position (Fig. 4).