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    • #61580
      Diane
      Participant

      Hi Steve,
      I scanned a male 40 yo for shoulder pain from repetitive movements at work.
      There was a elongated cystic structure within the supra fibres.. I was unsure whether it was an intrasubstance tear or an intratendinous ganglion. I just thought the margins were too smooth to be a tear.. and there was no signs of enthesopathy/bony irregularity.

      Thanks!

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    • #61585
      Stephen Bird
      Keymaster

      I think you are right,

      It doesn’t look like any tear I have seen before.

      No enthesis change, no other signs of tendon degeneration.

      I feel like you can trace a tiny neck right back to the biceps sheath. This may be the origin I think.

      I have seen ganglion cysts extending down the long head of biceps tendon plenty of times making it look like a longitudinal split. These are associated with labral tears and are simply an intratendinous extension of the paralabral tear.

      But inside supraspinatus is different. Intratendinous cysts are usually associated with a small articular surface tear that has allowed a communication between the GH joint space and the inside of the SST where a cyst can develop through the defect in the GH joint capsule.

      This could also be the case with yours as in the videos you can see the proximity of the cyst to the articular surface just where the joint capsule begins.
      This bit of anatomy is interesting as it is also where you get synovial herniation pits as a normal variant. I am recording a case of the week on this topic today.

      So in summary, I think it is a collection of joint fluid inside the tendon arising from a small articular surface tear in the joint capsule and the coracohumeral ligament (rotator cuff cable)
      Or it may be arising as a ganglion from the LHBT sheath
      I think I prefer the first option.
      See if you can get an MRI and pass on the findings.

      Great images as always from you Diane,

      Steve.

    • #61808
      Diane
      Participant

      Hi Steve,
      Thanks for the explanation because when I looked back at the pics for this pt, there was actually a cyst in the SGN!!

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    • #61825
      Stephen Bird
      Keymaster

      Nice one !

      Steve.

    • #61836
      Diane
      Participant

      Hi Steve,

      Just to clarify.. do cysts from the SGN come from a tear of articular surface tear in the joint capsule or a tear of the labrum? Or is it the same thing? Thanks!

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