Humerus cyst

The cyst of the shoulder girdle in most cases is diagnosed as an aneurysmal, solitary cysts in this zone are formed only in 20-25% of patients. The humerus is a long bone, an anatomical structure that is complex in structure, in which intraosteal cysts are often developed.

The favorite zone for the development of ACC is metafepiphysis, especially the upper metaphysis. The humerus cyst for a long time proceeds asymptomatically, slowly destroying bone tissue. The patient may experience periodic pain during movement by hand, especially when doing sports - badminton, tennis, dancing.

Rotational movements are gradually limited, sometimes completely unnoticeable for the person who unconsciously compensates for the defect with other poses and movements.

The developing cyst provokes deformity of the shoulder, thinning of the cortical layer.

X-ray images show a deformity and metaphysis, and an epiphysis of the humerus, and a very thin cortical layer is visible, which breaks down to the appearance of a spontaneous fracture.

Specificity of diagnosis determines the complex structure of the shoulder girdle and topografoanatomic connections of the bone with nearby tissues. Radiography is carried out in several projections, the condition, dimensions and other characteristics of the cyst determines computed tomography, scintigraphy. The main methods of treatment of the humerus cyst can be combined into three categories:

• Osteoplastic surgical treatment.
• Conservative method, referring to the standards of medical care with simple fractures of bones.
• Conservative method, including repeated puncture and aspiration of the contents of the cyst.

Treatment of the bony cyst of the shoulder in children is conducted in a conservative way, including by puncturing, adult patients are more often operated on. During the operation, an edge bone resection is performed, removal of the tumor within the boundaries of visible healthy tissues, parallel to the removed part of the bone is compensated for by the transplant. Allo or autoplasty helps to restore the function of the shoulder for 6-8 months, it all depends on the age of the patient and on the reparative abilities of his body.

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

Bone cyst of humerus

Bony benign tumors in the humerus are most often detected in childhood, in adult patients such cases are considered to be a hidden and previously unknown osteopathology. Precise statistics showing which bony cysts of the humerus predominate - an aneurismal or solitary one, does not exist. According to some authors of monographs devoted to diseases of the bone system, ACC in the humerus is diagnosed in 65% of cases, other surgeons argue that the species ratio of cysts tends to favor a solitary tumor. Unity of opinions concerns only the preference for the place of development of the bony cyst - these are long, large, tubular bones in the zone of the proximal metaphysis.

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

• The proximal metaphysis.
• Proximal epiphysis.
• The upper part of the diaphysis.
• The middle of the diaphysis.

There is also data on the species "preference" for a cyst, depending on the area of the shoulder bone:

• The cyst is an epiphysis.
• Aneurysmal cyst - metaphysis, diaphysis.

Unlike other localizations, tumor formation in the bone tissue of the shoulder in 70% results in pathological fractures, often recurring. This is associated with the asymptomatic development of the cyst, and with specific movements of the hands, turning the trunk. Bone tissue, destroyed over many years by an increasing tumor, is very fragile and can deform even from an awkward movement. Repeated fractures of the humerus lead to a shortening of the injured segment and an obvious deformation of the arm.

Treatment of the bony cyst of the humerus cyst:

1. An uncomplicated small cyst can be treated with puncture.
2. Methods of transosseous treatment (osteosynthesis):
   • Closed monolocal osteosynthesis with the help of the compression method.
   • Closed osteosynthesis by traction (distraction).
   • Closed monolocal osteosynthesis by alternation of compression and distraction.
   • Intraosseous operation - resection of the cyst with parallel bone graft and application of Ilizarov's apparatus.
   • Open monolocal osteosynthesis with the help of distraction.
   • Intraosseous resection, combined with bone plasty - autoplasty with local cortical material, fixation with Ilizarov's apparatus.

The recovery period after treatment of the bony cyst in the shoulder region takes from one to two years, the terms of rehabilitation are due to a long restructuring of the body and implantation of the transplant.

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

Cyst of head of humerus

Articulatio humeri - a spherical joint of the humeri consists of caput humeri - heads of the hemispherical form and cavitas glenoidalis - articular cavity of the scapula. The head of the humerus is the proximal epiphysis, due to which the circular and other movements of the shoulder are carried out. The head is formed starting from the intrauterine period, and the synaptic epiphysis is completed only by the age of 25, so often at an x-ray examination of children and young people an atypical light area is identified, which can be mistaken for a tumor-like formation, fracture or crack. However, any abnormal picture in this zone should be compared with the possible phenomenon of incomplete fusion of the proximal end of the shoulder bone.

Nevertheless, the bony cyst in the area of the head of the shoulder is considered one of the typical diseases belonging to the category of osteopathology and dystrophic fibrotic changes in childhood. According to statistics, the solitary cyst of the head of the humerus in the epiphyseal zone is diagnosed in 30-35% of adolescents with bone pathologies, the second place is occupied by cysts of the metaphysis of the shoulder, the third place is benign than the tumor of the femur.

To benign neoplasms of the head of the shoulder are such diseases, which should be differentiated from a simple bone cyst:

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

The diagnosis of cystic neoplasm is confirmed by X-ray, CT, MRI, biopsy. Conservative treatment is indicated if the activity of the cyst is defined as low, and the content of the histological structure is not malignant. Primary therapy can be prolonged and last up to 3 months, the code of the cyst cavity undergoes repeated puncturing. If such treatment does not give results, the process recurs, there are indications for the operation. The volume and method of surgical intervention determine the type and size of the cyst, the age of the patient, the standard methods of tumor removal are marginal, intraosseous or segmental resection in conjunction with concomitant bone grafting.

The bony cyst of the head of the shoulder in children is most often characterized as solitary, single-cell, in 55-70% of its treatment is operative. This is due to the fact that pathological fractures in the anatomical area of the shoulder are rarely seen, namely the fracture helps to reduce the cyst and neutralize it. The adult cyst of the head of the humerus is in most cases defined as an aneurysmal, multi-chamber, it is surgically removed in almost 90% of patients, often after a pathological fracture caused by a fall with an emphasis on the hands. Fracture of the head of the bone is always located on the line of the focus of tumor-like formation, on the X-ray is determined the thinning of the plates of the cortical substance with an injection into the cavity of the cyst. In orthopedic practice, cases in which the patient has a history of multiple, recurrent fractures are noted in the orthopedic practice, when each bone integrity was violated above or below the previous fracture, causing the humerus to shorten. The gold standard in the treatment of fracture of the head of the humerus on the background of cystic education is intraosseous resection of the tumor, bone plastic, fixation with the help of the Ilizarov apparatus. Bone plastic helps to restore a full volume of shoulder movements, although it requires a long recovery period. Duration of treatment of patients with bony cysts in the area of the head of the shoulder:

1. Compression osteosynthesis - 2.5 months.
2. Closed distraction osteosynthesis:
   • Gradual medical stretching - distraction - 2 months.
   • Fixation - 4 months.
3. Closed local compression-distraction osteosynthesis - 4,5 months.
4. Intraosseous resection and autologous plastics - 2,5 months.

On average, the final recovery of shoulder function occurs after 1-1,5 years.

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

Treatment of humerus cyst

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

• Type of cyst - solitary or aneurysmal. In the humerus, a CCM is more often identified - a solitary cyst that is characterized by a slow development, an asymptomatic course.
• Age of the patient. Children are most often treated conservatively. The operation 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 a significant limitation of mobility of the shoulder and arm, the risk of fracture.

Adult patients are most often treated with surgical methods, the humerus cyst is well liable to marginal resection, when the entire tumor capsule is removed and coagulation of its walls is carried out. Also in the treatment of the cyst of the shoulder, cryotherapy is also effective.

Conservative treatment is carried out in this way: 

• Local anesthesia of the shoulder zone is performed.
• The cyst is perforated, drained with a needle. Aspiration of the contents of the cavity is performed using a syringe.
• The cavity of the cyst is washed with aminocaproic acid.
• In the cyst, a drug is administered that reduces the activity of fibrinolysis or the cyst is filled with bone matrix to a tight state (tight tamponade).
• The cyst is filled with a homogenate for 2-3 months.
• The shoulder is to be immobilized with the help of a bandage bandage, less often - longiets.

It should be noted that none of the existing methods of treatment of bone cysts does not guarantee a disease-free outcome. The humerus cyst can reappear with the wrong tactic of surgical treatment, with technical errors during the operation in such a complex anatomical zone. The relapse rate is from 15 to 30%.