Two Cases with a Suprasinous Fossa Ganglion treated by Arthroscopic Decompression Midorikawa Koji, Shibata Yozo, and Naito Masatoshi Department of Ort
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1 Two Cases with a Suprasinous Fossa Ganglion treated by Arthroscopic Decompression Midorikawa Koji, Shibata Yozo, and Naito Masatoshi Department of Orthopaedic Surgery, School of Medicine, Fukuoka University by We performed arthroscopic decompressions in 2 patients with pain and paralysis due to a supraspinous fossa ganglion. Under anterior arthroscopy of the glenohumeral joint (joint), the posterosuperior joint capsule was partially resected using a punch and an electocautery, and the ganglion capsule was partially resected. This procedure is indicated for patients with symptoms and a relatively large ganglion. Patient 1 was a 24-year-old-male with pain around the shoulder and weakness in the upper limbs. Patient 2 was a 47-year-old-male with pain in the scapular lesion, especially at rest and at night. In both patients, marked atrophy of the infraspinatus muscle was observed. MRIs showed a large cystic lesion in the scapular spine (T1W low and T2W high), which led to the diagnosis of a ganglion. Soon after the arthroscopic decompression, nocturnal pain disappeared, and a postoperative MRI revealed no findings to suggest recurrence. With the recovery of muscle strength, the complaints disappeared. The symptoms causing a ganglion in the supraspinous fossa are generally treated by aspiration or resection. Though aspirations can be performed on an outpatients basis, recurrence is sometimes observed, and accurate decompression is difficult. In resection by incision, a large incision and muscle detachment are necessary for large ganglions, and surgical scars are problems. Arthroscopic decompressions performed in this study allows for an accurate decompression without risks of a functional decrease or scars. However, the patent period of the opening is unclear, and further careful observation of the course is necessary
2 The Shoulder Joint, Vol.24, No2, ,
3 -267-
4 The Shoulder Joint, Vol.24, No2, , 方 へ の 交 通 は明 らか で は な か っ たの で 前 述 の 手技 と同 様 に開 口 部 を作 っ た とこ ろ ゼ リー状 内 容 の 排 出 を認 め た(図13) 関節 包 切 除 部 は開 口 の ま ま と し 損 傷 関 節 唇 も放 置 した 鏡 視 下 除圧 術 後2週 間 で夜 間痛 や だ る さは 消 失 術 後 2ヵ 月 で 運 動 時痛 と可 動 域 改 善 し現 職 に復 帰 術 後3カ 月 のMRIで 14) は嚢 胞 状 陰 影 は 消 失 し再 発 所 見 は な く(図 術 後5ヵ 月 で筋 力5ま で 回 復 した 術後8ヵ 月 で 図10症 例2:単 純X線 鎖骨遠位端骨折変形治癒 以外 の異常所見は ない 筋 萎 縮 も改 善 し(図15) JOAス 図11症 例2:MRIT2WI 冠 状 断 横 断 像 で は 関 節 近 傍 まで の 広 が りが あ iり 矢 状 断 像 で は肩 甲棘 に騎 乗 し T2wでhigh ntensityの多包性のcystic lesionを認める 図14症 例2:術 後3ヵ 月 のMRIT2WI 嚢胞 状 陰 影 は消 失 し再 発 所 見 はな い コ ア は術 前72点 か ら 100点 とな っ た 図15症 例2:術 後8ヵ 月 筋 萎 縮 は改 善 して い る 図12症 例2:関 節内後方鏡視 上 後 方 関 節 唇 損 傷 は無 処 置 の ま ま と した 考 察 症 状 を有 す る肩 甲骨 棘 上 窩 ガ ン グ リオ ンに対 す る治 療 法 と して は穿 刺 に よ る除 圧 また は 後方 切 開 に よ る観 血 的 摘 出が 一 般 的 で あ る しか し 穿 刺法 は外 来 で簡 単 にで き る もの の 再 発 す る こ とや確 実 な 除圧 が 出来 ない こ と が 欠 点 で あ る また 切 開 に よる摘 出 は 今 回の2例 の よ う な棘 上 窩 か ら棘 下 窩 まで騎 乗 す る大 きな ガ ン グ リ オ ン の 場 合 切 開 や 筋 剥 離 が広 範 に な り 手 術 侵 襲 の 大 き さ や術 後 の 機能 低 下 また 手術 癩 痕 の問 題 が生 じる(図16) 今 回 行 っ た鏡 視 下 ガ ン グ リ オ ン 除 圧 術 は1996年 図13症 例2:関 節 内 後 方鏡 視 後 上 方 関 節 包 部 分 切 除 に よ る ゼ リー状 内容 の排 出(矢 印) に Iannottiら3,が 初 め て報 告 した 肩 甲骨 棘 一 ヒ窩 ガ ン グ リ オ ンに よる 肩 甲 上 神経 麻 痺 症 例3例 に対 し 関 節 内 よ り
5 the literature. Arthroscopy, 1995;11: ) Barrie HJ: The Pathogenesis and significance of meniscal cysts. J.Bone Joint Surg., 1979; 61-B: ) Fehrman DA, et al.: Suprascapular nerve entrapment by ganglion cysts: A report of six cases with arthroscopic findings and review of 3) Iannotti JP, et al.: Arthroscopic decompression of a ganglion cyst causing suprascapular nerve compression. Arthroscopy,1996;12: ) Seger,BM. Arthroscopic management of lateral meniscal cysts. Am.J.Sports Med., 1986; 9: ) Tirman PF, et al.: Association of glenoid labral cysts with labral tears and glenohumeral instability: Radiologic findings and clinical significance. Radiology, 1994; 190:
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