Osteology and Rheumatology · Vol. 1, No. 2 · 2025 · pp. 20–22 · e-ISSN 2996-5918

A Rare Cause of Shoulder Pain: Ganglion Cyst of the Acromioclavicular Joint

Hakan Sarman, Metin Celik, Mehmet Murat Bala

Department of Orthopedics and Traumatology, Abant Izzet Baysal University School of Medicine, Bolu, TurkeyTurkey

DOI: https://doi.org/10.17140/orhoj-1-107 · Published 2025-09-11 · Licence: https://creativecommons.org/licenses/by/4.0 · © 2025 The Author(s)

Also available as PDF (figures and tables appear in the PDF).

Abstract

Ganglion cysts generally form after repeated microtrauma to the dorsum of the wrist. They are gel-filled cystic formations that may be rooted in the joint capsule, tendon, or tendon sheath. Ganglion cysts rooted in the shoulder and acromioclavicular joint are rare. We report a patient who presented with pain in the right shoulder, who was diagnosed with atypical localization of a ganglion cyst after clinical and radiological investigation. Post-operatively, histopathology confirmed the diagnosis. The case is presented along with the surgical results.

Keywords: Shoulder; Acromioclavicular joint; Pain; Tumor; Ganglion cyst; Shoulder; Acromioclavicular joint; Pain; Tumor; Ganglion cyst

Discussion

Ganglion cysts occur most commonly at the hand and wrist and are only very rarely observed in the shoulder region and 2,3,6,7 bone. The incidence is greatest in women 30-50 years of age. The etiology of GC is not fully known, but joint pathology and microtrauma are thought to contribute.8,9 Our patient was a laborer who used his arm very frequently and often experienced minor trauma. He presented to our clinic complaining of shoulder pain and swelling.

The most widely accepted theory for the pathogenesis of a GC in the AC joint is fluid spreading around the joint in the rotator cuff in conjunction with labrum tears. Schroder et 13 14 al and Youmet al reported that treating the labrum pathology led to regression of the cyst without surgical intervention. Tung et al investigated the causes of shoulder pain and identified a paralabral GC visible on MRI imaging in 2.3% of their cases. In our case, an excision biopsy was performed, the shoulder pain resolved, and the shoulder ROM improved.

After total excision, a GC may recur in the same loca-

Figure 2
Figure 2. Radiography imaging of patient.
Figure 3
Figure 3. Magnetic resonance imaging of patient.
Figure 4
Figure 4. Operation macroscopic imaging.

tion, especially in cases where the joint capsule in the pedicle 3,16-18 isnot sutured with appropriate tension. In our case, the GC was excised using an open approach and the mass was observed to be connected to the AC joint. At the 1.5-year follow-up, the patient’s pain was improved and the shoulder ROM had increased. There was no recurrence of the AC joint cyst. 8,9

Conclusion

Although GCs are rarely observed in the shoulder region, they may cause pain and restrict ROM. Surgical excision may improve symptoms and function with very low rate of recurrence. 2,6,10-12

Conflicts Of Interest

The authors declare that they have no conflicts of interest.

Consent

The patient has provided written permission for the publication of this case details.

References

  1. MontetXZamorani-BianchiMPMehdizadeAMartinoliCBianchiS. Intramuscular ganglion arising from the acromioclavicular joint. Clin Imaging. 2004; 28(2): 109-112. doi: 10.1016/ s0899-7071(03)00104-9
  2. SkedrosJGKnightAN. Massive acromioclavicular ganglionic cyst treated with excision and allograft patch of acromioclavicular region. J Shoulder Elbow Surg. 2012; 21(3): 1-5. doi: 10.1016/j.jse.2011.07.03310.1016/j.jse.2011.07.033 https://doi.org/10.1016/j.jse.2011.07.033
  3. Sarman H, Işık C, Şahin AA, et al. El ve El bilek tümörlü hastalarda eksizyonel biyopsi sonuçlarinin değerlendirilmesi [In Turkish]. Abant Med J. 2014; 3(1): 55-61. doi: 10.5505/abantmedj.2014.30602 https://doi.org/10.5505/abantmedj.2014.30602
  4. OrmanGYesiladaliGOlcayEDuymusM. Comparison of ultrasonography and magnetic resonance imaging for diagnosis of soft tissue masses of the hand and wrist. Eur J Gen Med. 2015; 12(1): 38-43. doi: 10.15197/sabad.1.12.0710.15197/sabad.1.12.07 https://doi.org/10.15197/sabad.1.12.07
  5. FerrickMRMarzoJM. Ganglion cyst of the shoulder associated with a glenoid labral tear and symptomatic glenohumeral instability. A case report. Am J Sports Med. 1997; 25(5): 717- 719. doi: 10.1177/03635465970250052310.1177/036354659702500523 https://doi.org/10.1177/036354659702500523
  6. GoodLMDiCarloJBHighWA. An unusual cutaneous manifestation of a ganglion cyst. J Am Acad Dermatol. 2011; 64(6): 1206-1208. doi: 10.1016/j.jaad.2009.09.03410.1016/j.jaad.2009.09.034 https://doi.org/10.1016/j.jaad.2009.09.034
  7. ParperisKCarreraGBaynesK. The prevalence of chondrocalcinosis (CC) of the acromioclavicular (AC) joint on chest radiographs and correlation with calcium pyrophosphate dihydrate (CPPD) crystal deposition disease. Clin Rheumatol. 2013; 32(9): 1383-1386. doi: 10.1007/s10067-013-2255-x10.1007/s10067-013-2255-x https://doi.org/10.1007/s10067-013-2255-x
  8. GentaMSGabayC. Images in clinical medicine. Milwaukee shoulder. N Engl J Med. 2006; 354(2): e2. doi: 10.1056/ NEJMicm050094
  9. MatevBGeorgievGPStokovL. A rare case of intraosseous ganglion of the triquetrum. J Clin Exp Invest. 2012; 3(1): 111- 112. doi: 10.5799/ahinjs.01.2012.01.012410.5799/ahinjs.01.2012.01.0124 https://doi.org/10.5799/ahinjs.01.2012.01.0124
  10. HaberLHWaandersNAThompsonGHPetersilgeCBallockRT. Sternoclavicular joint ganglion cysts in young children. J Pediatr Orthop. 2002; 22(4): 544-547. Web site. http://journals.lww.com/pedorthopaedics/Abstract/2002/07000/Sternoclavicular_Joint_Ganglion_Cysts_In_Young.24.aspx. Accessed August 10, 2016
  11. DeutschAAltchekDWVeltriDMPotterHGWarrenRF. Traumatic tears of the subscapularis tendon. Clinical diagnosis, magnetic resonance imaging findings, and operative treatment. Am J Sports Med. 1997; 25(1): 13-22. doi: 10.1177/03635465970250010410.1177/036354659702500104 https://doi.org/10.1177/036354659702500104
  12. KesslerMAStoffelKOswaldAStutzGGaechterA. The SLAP lesion as a reason for glenolabral cysts: A report of five cases and review of the literature. Arch Orthop Trauma Surg. 2007; 127(4): 287-292. doi: 10.1007/s00402-006-0154-110.1007/s00402-006-0154-1 https://doi.org/10.1007/s00402-006-0154-1
  13. TirmanPFFellerJFJanzenDLPeterfyCGBergmanAG. Association of glenoid labral cysts with labral tears and glenohumeral instability: Radiologic findings and clinical significance. Radiology. 1994; 190(3): 653-658. doi: 10.1148/radiology.190.3.811560510.1148/radiology.190.3.8115605 https://doi.org/10.1148/radiology.190.3.8115605
  14. WesterheideKJDopirakRMKarzelRPSnyderSJ. Suprascapular nerve palsy secondary to spinoglenoid cysts: Results of arthroscopic treatment. Arthroscopy. 2006; 22(7): 721-727. doi: 10.1016/j.arthro.2006.03.01910.1016/j.arthro.2006.03.019 https://doi.org/10.1016/j.arthro.2006.03.019
  15. SchroderCPSkareOStirisMGjengedalEUppheimGBroxJI. Treatment of labral tears with associated spinoglenoid cysts without cyst decompression. J Bone Joint Surg Am. 2008; 90(3): 523-530. doi: 10.2106/jbjs.f.0153410.2106/jbjs.f.01534 https://doi.org/10.2106/jbjs.f.01534
  16. Youm T, Matthews PV, El Attrache NS. Treatment of patients with spinoglenoid cysts associated with superior labral tears without cyst aspiration, debridement, or excision. Arthroscopy. 2006; 22(5): 548-552. doi: 10.1016/j.arthro.2005.12.060 https://doi.org/10.1016/j.arthro.2005.12.060
  17. TungGAEntzianDSternJBGreenA. MR imaging and MR arthrography of paraglenoid labral cysts. AJR Am J Roentgenol. 2000; 174(6): 1707-1715. doi: 10.2214/ajr.174.6.174170710.2214/ajr.174.6.1741707 https://doi.org/10.2214/ajr.174.6.1741707
  18. SatkuKGaneshB. Ganglia in children. J Pediatr Orthop. 1985; 5(1): 13-15