No abstract

A ganglion is a benign cystic mass, commonly found around a joint or tendon sheath. It frequently occurs at the wrist, foot, ankle, and knee. Intratendinous ganglion has been rarely reported, and intratendinous ganglion of the long head of biceps brachii is extremely rare. According to our literature review, this is the third case of intratendinous ganglion of the long head of biceps brachii, and the first case of arthroscopic treatment. Therefore we report a case of an arthroscopic treatement for an intratendinous ganglion of the long head of biceps brachii. (Clin Shoulder Elbow 2014;17(4):194-196) Key Words: Shoulder; Ganglion cysts; Biceps tendon; ArthroscopyThe ganglion cyst is the most common tumor-like lesion in the hand and the wrist.1-7) The ganglion cyst in the upper arm is uncommon and the intratendinous ganglion is also rare.1,2,4-9)Intratendinous ganglion cyst of the long head of biceps brachii (LHBB) tendon is an extremely rare entity. 1,2) To the best of our knowledge, this is the third case of the intratendinous ganglion cyst of the LHBB tendon and the first case of arthroscopic treatment for it in English literature. Case ReportA 68-year-old woman reported left shoulder pain and weakness appeared spontaneously 1 year ago, and she found a palpable tender mass in the anterior aspect on her left shoulder 3 months ago. She had no history of trauma or infection on the shoulder and the upper arm. The mass was about 2×3 cm in size, soft, movable, and with tenderness. Physical examination indicated normal on passive range of motion and decreases in active range of motion of flexion to 140 degrees and that of abduction to 110 degrees. Neer's impingement test, Hawkins' impingement test, empty can test, full can test, speed test and Yergason test were positive. Instability tests for the gleno-humeral joint were negative.Simple x-ray films showed no abnormal findings. The magnetic resonance image revealed a 1.7×3.0×1.8 cm sized oval shaped cystic mass on the bicipital groove just distal to greater tubercle (Fig. 1A). The mass looked to be encapsulated by the biceps tendon sheath, and the LHBB was thin like a sheet, probably due to mass effect of the cystic mass (Fig. 1B). The intraarticular portion of the LHBB had higher signal intensity in T2 weighted image, which was assumed as a partial tear. A partial tear of the subscapularis tendon and a small full thickness tear of the supraspinatus tendon were seen.Under the diagnosis of a intratendinous ganglion cyst, we performed an arthroscopic operation. We placed the patient in lateral position and began arthroscopic examination through the standard anterior and posterior portal. In arthroscopic findings, the partial rupture of the LHBB was seen just distal to its origin of superior labrum in the gleno-humeral joint. The subscapularis tendon was partially detached but not retracted from its footprint. In the subacromial space, small full thickness tear of supraspinatus tendon was found. First, we repaired subscapularis tendon to its footprint with an anchor a...