hospital for special surgery: what's the diagnosis - case 55
DESCRIPTION
What’s the Diagnosis? is a means for you to test your orthopaedic, rheumatologic and radiology/imaging knowledge. Monthly, new cases will be presented as unknowns. The answers will be available and indexed so that should you want to search on cases representative of a specific topic, you can do so. The cases are from the records of HSS and the teaching files of the Department of Radiology and Imaging. The cases are intended to be representative and informative demonstrating the comprehensive care of Orthopaedics, Rheumatology, Radiology and Imaging and related services at HSS. We know you like to be challenged and hope this section meets your expectations.TRANSCRIPT
1What’s the Diagnosis – Case 55
2What’s the Diagnosis – Case 55
3What’s the Diagnosis – Case 55
4What’s the Diagnosis – Case 55
5What’s the Diagnosis – Case 55
6What’s the Diagnosis – Case 55
7What’s the Diagnosis – Case 55
8What’s the Diagnosis – Case 55
9What’s the Diagnosis – Case 55
10What’s the Diagnosis – Case 55
11What’s the Diagnosis – Case 55
12What’s the Diagnosis – Case 55
13What’s the Diagnosis – Case 55
14What’s the Diagnosis – Case 55
15What’s the Diagnosis – Case 55
16What’s the Diagnosis – Case 55
Findings
A lobulated, fluid signal intensity mass pedunculates from the inferior aspect of the glenoid labrum into the quadrilateral or quadrangular space yielding mass effect upon the axillary nerve and mild edema pattern of the teres minor.
17What’s the Diagnosis – Case 55
18What’s the Diagnosis – Case 55
19What’s the Diagnosis – Case 55
20What’s the Diagnosis – Case 55
21What’s the Diagnosis – Case 55
22What’s the Diagnosis – Case 55
Diagnosis:
Degneration and tears of the glenoid and acetabular labrum may yield paralabral ganglion cysts. If the tear itself is not clearly delineated on imaging, it is presumed to be present. As in this case, the cysts can extend into spaces where neurovascular bundles are present and cause mass effect upon the neurovasular bundles. More commonly, tears of the superior or posterior glenoid labrum yield ganglion extending into the suprascapular notch or spinoglenoid notch. Extension into the quadrilateral space is less common and places the traversing axillary nerve at risk.
23What’s the Diagnosis – Case 55
Compromise of the nerve affects the innervated musculaure and yields neurogenic edema and in a more long standing process can cause fatty atrophy of the musculature. As in this case, not all the musculature innervated has to be affected. The deltoid musculature in this case was normal. Treatment may entail ultrasound guided aspiration to help resolve the impingement of the nerve. If unsuccessful in mitigating symptoms, surgery is required to asses the underlying pathology, the labral tear.