A cyst of the humerus

A shoulder girdle cyst is diagnosed as aneurysmal in most cases, solitary cysts in this area are formed only in 20-25% of patients. The humerus is a long bone, a complex anatomical structure, in which intraosseous cysts often develop.

The favorite area for the development of ACC is the metaphysis, especially the upper metaphysis. The humeral cyst is asymptomatic for a long time, slowly destroying bone tissue. The patient may experience periodic pain when moving the arm, especially when playing sports - badminton, tennis, dancing.

Rotational movements are gradually limited, sometimes completely unnoticed by the person himself, who unconsciously compensates for the defect with other postures and movements.

The developing cyst is provoked by deformation of the shoulder and thinning of the cortical layer.

On X-ray images of a detected cyst, deformation of both the metaphysis and epiphysis of the humerus is clearly visible, and a very thin cortical layer is visible, which is destroyed to the point of spontaneous fracture.

The specificity of diagnostics is determined by the complex structure of the shoulder girdle and the topographic anatomical connections of the bone with adjacent tissues. Radiography is performed in several projections, the condition, size and other characteristics of the cyst are determined by computed tomography, scintigraphy. The main methods of treating a humeral cyst can be combined into three categories:

• Bone plastic surgery.
• A conservative method that is part of the standard of care for simple bone fractures.
• A conservative method that includes repeated punctures and aspiration of the cyst contents.

Treatment of bone cysts of the shoulder in children is carried out conservatively, including by puncturing, adult patients are more often operated. During the operation, marginal bone resection is performed, the tumor is removed within the boundaries of visible healthy tissues, in parallel, the removed part of the bone is compensated with a transplant. Allo or autoplasty helps to restore shoulder function within 6-8 months, everything depends on the age of the patient and the reparative abilities of his body.

[ 1 ], [ 2 ], [ 3 ], [ 4 ]

Bone cyst of the humerus

Benign bone tumors in the shoulder area are most often detected in childhood, in adult patients such cases are considered hidden and previously undetected osteopathology. There are no exact statistics showing which bone cyst of the humerus is predominant - aneurysmal or solitary. According to some authors of monographs devoted to diseases of the skeletal system, ACC in the humerus is diagnosed in 65% of cases, other surgeons claim that the species ratio of cysts is in favor of a solitary tumor. The unity of opinion concerns only the preference for the place of development of the bone cyst - these are long, large, tubular bones in the proximal metaphysis.

Despite the visible progress in the study of bone cysts and orthopedic treatment methods, the problem of differential diagnosis and adequate timely treatment of ACC and SCC of the humerus remains acute and requires a solution. The proposed options and standards for identifying the type, location, size and nature of a bone tumor are not accepted by all practicing surgeons, and the percentage of relapses of the pathology is correspondingly high. According to data for the last decade, the recurrence of cystic neoplasms in the bones of the shoulder is up to 55%. This is not only a complication and additional trauma for a sick person, but also a factor that provokes disability. It is also noted that the right humerus is most often affected, the bone zones where the cyst is formed are located as follows:

• Proximal metaphysis.
• Proximal epiphysis.
• Upper part of the diaphysis.
• Middle of the diaphysis.

There is also data on the species “preference” of one or another cyst depending on the area of the shoulder bone:

• Solitary cyst - epiphysis.
• Aneurysmal cyst - metaphysis, diaphysis.

Unlike other localizations, a tumor-like formation in the bone tissue of the shoulder in 70% of cases ends in pathological fractures, often repeated. This is due to the asymptomatic development of the cyst, and to specific hand movements, torso rotation. Bone tissue destroyed over many years by an increasing tumor is very fragile and can be deformed even from an awkward movement. Repeated fractures of the humerus lead to shortening of the injured segment and obvious deformation of the arm.

Treatment of humeral bone cyst:

1. An uncomplicated small cyst can be treated with puncture.
2. Methods of transosseous treatment (osteosynthesis):
   • Closed monolocal osteosynthesis using the compression method.
   • Closed osteosynthesis using traction (distraction).
   • Closed monolocal osteosynthesis using alternating compression and distraction.
   • Intraosseous surgery – cyst resection with parallel bone grafting and the use of the Ilizarov apparatus.
   • Open monolocal osteosynthesis using distraction.
   • Intraosseous resection combined with bone grafting – autografting with local cortical material, fixation with the Ilizarov apparatus.

The recovery period after treatment of a bone cyst in the shoulder area takes from one to two years; the rehabilitation period is determined by the long-term restructuring of the body and the implantation of the transplant.

[ 5 ], [ 6 ], [ 7 ], [ 8 ]

Cyst of the humeral head

Articulatio humeri – the spherical shoulder joint consists of the caput humeri – the hemispherical head and cavitas glenoidalis – the glenoid cavity of the scapula. The head of the humerus is the proximal epiphysis, due to which circular and other movements of the shoulder are carried out. The head is formed starting from the intrauterine period, and the synostosis of the epiphysis is completed only by the age of 25, therefore, quite often during X-ray examinations of children and young people, an atypical light area is detected, which can be mistaken for a tumor-like formation, fracture or crack. However, any abnormal picture in this area should be compared with the possible phenomenon of incomplete fusion of the proximal end of the humeral bone.

However, a bone cyst in the humeral head area is considered one of the typical diseases related to the category of osteopathologies and dystrophic fibrous changes in childhood. According to statistics, a solitary cyst of the humeral head in the epiphysis area is diagnosed in 30-35% of adolescents with bone pathologies, in second place are cysts of the humeral metaphysis, and third place is occupied by benign tumors of the femur.

Benign neoplasms of the humeral head include the following diseases, which should be differentiated from a simple bone cyst:

• Osteoma (osteoid).
• Chondroblastoma.
• Chondroma.
• Hemangioma.
• Osteoblastoclastoma.
• Fibroma.

The diagnosis of a cystic neoplasm is confirmed by X-rays, CT, MRI, and biopsy. Conservative treatment is indicated if the cyst activity is low and the contents are not malignant according to the histological structure. Primary therapy can be long-term and last up to 3 months, when the cyst cavity is repeatedly punctured. If such treatment does not produce results, the process recurs, and indications for surgery arise. The volume and method of surgical intervention determine the type and size of the cyst, the patient's age, and the standard methods of tumor removal are considered to be marginal, intraosseous or segmental resection in combination with simultaneously performed bone grafting.

A humeral head bone cyst in children is most often characterized as solitary, unicameral, and in 55-70% of cases, its treatment is surgical. This is due to the fact that pathological fractures in the anatomical zone of the shoulder are rare, and it is the fracture that helps to reduce the cyst and neutralize it. In adults, a humeral head cyst is in most cases defined as aneurysmal, multicameral, and is surgically removed in almost 90% of patients, often after a pathological fracture caused by a fall with emphasis on the hands. A fracture of the bone head is always located on the line of the tumor focus; an X-ray image shows thinning of the cortical plates with an indentation into the cyst cavity. In orthopedic practice, cases have been described where a patient has a history of multiple, recurrent fractures, when each bone integrity was violated above or below the previous fracture, causing shortening of the humerus. The gold standard in the treatment of a humeral head fracture against the background of a cystic formation is considered to be intraosseous tumor resection, bone grafting, fixation using the Ilizarov apparatus. Bone grafting helps restore a full range of shoulder motion, although it requires a long recovery period. The duration of treatment for patients with bone cysts in the humeral head area:

1. Compression osteosynthesis – 2.5 months.
2. Closed distraction osteosynthesis:
   • Gradual therapeutic stretching - distraction - 2 months.
   • Fixation – 4 months.
3. Closed local compression-distraction osteosynthesis – 4.5 months.
4. Intraosseous resection and autobone grafting – 2.5 months.

On average, final restoration of shoulder function occurs after 1-1.5 years.

[ 9 ], [ 10 ], [ 11 ], [ 12 ]

Treatment of humeral bone cyst

The humerus is affected by cystic tumors quite often, the method of treatment is determined by the following criteria:

• Cyst type - solitary or aneurysmal. In the humerus, SCC is most often detected - a solitary cyst, which is characterized by slow development and asymptomatic course.
• Age of the patient. Children are most often treated conservatively. Surgery is considered an extreme measure when there is no positive dynamics after standard conservative therapy.
• The size of the cyst and the corresponding complications in the form of significant limitation of mobility of the shoulder and arm, risk of fracture.

Adult patients are most often treated with surgical methods; a humeral cyst responds well to marginal resection, when the entire tumor capsule is removed and its walls are coagulated. Cryotherapy is also effective in treating a humeral cyst.

Conservative treatment is carried out in the following way:

• Local anesthesia of the shoulder area is performed.
• The cyst is perforated and drained with a needle. Aspiration of the cavity contents is performed with a syringe.
• The cyst cavity is washed with aminocaproic acid.
• A drug that reduces the activity of fibrinolysis is injected into the cyst, or the cyst is filled with bone matrix to a tight state (tight tamponade).
• The cyst is filled with homogenate within 2-3 months.
• The shoulder is subject to immobilization using a sling bandage, or less commonly, a splint.

It should be noted that none of the existing methods of treating bone cysts guarantees a relapse-free result. A humeral cyst may recur if the surgical treatment tactics are chosen incorrectly, or if there are technical errors during surgery in such a complex anatomical area. The relapse rate is 15 to 30%.