Bone Cyst of Proximal Humerus after Local Betamethasone Injection (Case Report)

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Abstract

A potent anti-inflammatory effect and wide application of corticosteroids were the origin of their extensive use for treatment of diseases and injuries of the shoulder joint. The authors describe a clinical case of tumor-like cyst in the proximal humerus after intra-articular injection of glucocorticosteroid (GCS) in a 43 year old woman. Current medical literature reports various complications following GCS injections but the authors found no other cases of tumor-like cyst in proximal humerus associated with intra-articular GCS injection. This can be an underestimated phenomenon or a unique case. In any case, all physicians performing treatment and diagnostics medication blockades of the large joints should be aware of this occurrence. The authors assume that such complication can be prevented by clear understanding of shoulder joint anatomy and current visualization techniques such as ultrasound navigation.

About the authors

P. G. Kogan

Vreden National Medical Research Center of Traumatology and Orthopedics

Author for correspondence.
Email: pgkogan@rniito.ru

Pavel G. Kogan — Cand. Sci. (Med.), Researcher

St. Petersburg

Russian Federation

I. Sh. Kurbanov

Vreden National Medical Research Center of Traumatology and Orthopedics

Email: fake@neicon.ru

Ilias Sh. Kurbanov — Clinical Resident

St. Petersburg

Russian Federation

S. A. Lasunsky

Vreden National Medical Research Center of Traumatology and Orthopedics

Email: fake@neicon.ru

Sergey A. Lasunskiy — Cand. Sci. (Med.), Head of 7th  Department

St. Petersburg

Russian Federation

D. V. Chugaev

Vreden National Medical Research Center of Traumatology and Orthopedics

Email: fake@neicon.ru

Dmitry V. Chugaev — Cand. Sci. (Med.), Assistant Researcher

St. Petersburg

Russian Federation

E. P. Sorokin

Vreden National Medical Research Center of Traumatology and Orthopedics

Email: fake@neicon.ru

Evgeniy P. Sorokin — Cand. Sci. (Med.), Researcher

St. Petersburg

Russian Federation

A. I. Gudz

Vreden National Medical Research Center of Traumatology and Orthopedics

Email: fake@neicon.ru

Anton I. Gudz — Assistant Researcher

St. Petersburg

Russian Federation

M. A. Lis'kov

Vreden National Medical Research Center of Traumatology and Orthopedics

Email: fake@neicon.ru

Mikhail A. Lis’kov — Anestesiologist

St. Petersburg

Russian Federation

V. V. Krushnikov

Vreden National Medical Research Center of Traumatology and Orthopedics

Email: fake@neicon.ru

Vladislav V. Trushnikov — Head of Pathoanatomical Department

St. Petersburg

Russian Federation

References

  1. Engebretsen K.B., Grotle M., Natvig B. Patterns of s der pain during a 14-year follow-up: results from a longitudinal population study in Norway. Shoulder Elbow. 2015;7(1):49-59. doi: 10.1177/1758573214552007.
  2. Picavet H.S., Schouten J.S. Musculoskeletal pain in the Netherlands: prevalences, consequences and risk groups, the DMC(3)-study. Pain. 2003;102(1-2):167-178. doi: 10.1016/s0304-3959(02)00372-x.
  3. Luime J.J., Koes B.W., Hendriksen I.J., Burdorf A., Verhagen A.P., Miedema H.S., Verhaar J.A. Prevalence and incidence of shoulder pain in the general population; a systematic review. Scand J Rheumatol. 2004;33(2):73-81. doi: 10.1080/03009740310004667.
  4. McBeth J., Jones K. Epidemiology of chronic m etal pain. Best Pract Res Clin Rheumatol. 2007;21(3):403-425. doi: 10.1016/j.berh.2007.03.003.
  5. Huisstede B.M., Wijnhoven H.A., Bierma-Zeinstra S.M., Koes B.W., Verhaar J.A. Picavet S. Prevalence and characteristics of complaints of the arm, neck, and/or shoulder (CANS) in the open population. Clin J Pain. 2008;24(3):253-259. doi: 10.1097/AJP.0b013e318160a8b4.
  6. Jordan K.P., Kadam U.T., Hayward R., Porcheret M., Young C., Croft P. Annual consultation prevalence of regional musculoskeletal problems in primary care: an observational study. BMC Musculoskelet Disord. 2010;11:144. doi: 10.1186/1471-2474-11-144.
  7. Ahacic K., Kåreholt I. Prevalence of musculoskeletal pain in the general Swedish population from 1968 to 2002: age, period, and cohort patterns. Pain. 2010;151(1): 206-214. doi: 10.1016/j.pain.2010.07.011.
  8. House J., Mooradian A. Evaluation and m ment of shoulder pain in primary care clinics. South Med J. 2010;103(11):1129-1135; quiz 1136-1137. doi: 10.1097/SMJ.0b013e3181f5e85f.
  9. Mitchell C., Adebajo A., Hay E., Carr A. Shoulder pain: diagnosis and management in primary care. BMJ. 2005;331(7525):1124-1128. doi: 10.1136/bmj.331.7525.1124.
  10. Пиляев В.Г., Терешенков В.П., Титов С.Ю. Внутрисуставное введение препаратов в комплексном лечении заболеваний суставов. Российский медицинский журнал. 2013;(6):30-33.
  11. Игнатенко О.В., Водоевич В.П. Г стероидные гормоны в практике терапевта. Журнал Гродненского государственного медицинского университета. 2006;(1):7-13.
  12. Давыдов О.С., Яхно Н.Н., Кукушкин М.Л., Чурюканов М.В., Абузарова Г.Р., Амелин А.В. и др. Невропатическая боль: клинические рекомендации по диагностике и лечению Российского общества по изучению боли. Российский журнал боли. 2018;58(4): 5-41. doi: 10.25731/RASP.2018.04.025.
  13. От редакции. Российский журнал боли. 2019;17(1):73-74.
  14. Lin Y.C., Wu J., Mhuircheartaigh J. Bone tumor m ickers: A pictorial essay. Indian J Radiol Imaging. 2014;24(3):225-236. doi: 10.4103/0971-3026.137026.
  15. Noordin S., Allana S., Umer M., Jamil M., Hilal K., Uddin N. Unicameral bone cysts: Current concepts. Ann Med Surg (Lond). 2018;34:43-49. doi: 10.1016/j.amsu.2018.06.005.
  16. Wilkins R.M. Unicameral bone cysts. J Am Acad Orthop Surg. 2000;8(4):217-224. doi: 10.5435/00124635-200007000-00002.
  17. Pretell-Mazzini J., Murphy R.F., Kushare I., Dormans J.P. Unicameral bone cysts: general characteristics and management controversies. J Am Acad Orthop Surg. 2014;22(5):295-303. doi: 10.5435/JAAOS-22-05-295.
  18. Bagewadi R.M., Nerune S.M., Hippargi S.B. Chondromyxoid fibroma of radius: a case report. J Clin Diagn Res. 2016;10(5):ED01–ED2. doi: 10.7860/JCDR/2016/17967.7728.
  19. Mascard E., Gomez-Brouchet A., Lambot K. Bone cysts: unicameral and aneurysmal bone cyst. Orthop Traumatol Surg Res. 2015;101(1 Suppl):119-127. doi: 10.1016/j.otsr.2014.06.031.
  20. Митрофанов А.И. Борзунов Д.Ю. Результаты лечения пациентов с активными солитарными костными кистами с применением чрескостного остеосинтеза. Гений ортопедии. 2010;(2):55-59.
  21. Андреев П.С., Скворцов А.П., Хасанов Р.Ф., Яшина И.В. Хирургическое лечение костных кист и опухолевидных образований длинных трубчатых костей метадиафизарной локализации. Практическая медицина. 2015;(4):12-15.
  22. Шевцов В.И., Митрофанов А.И., Борзунов Д.Ю. Комплексный подход к лечению костных кист. Травматология и ортопедия России. 2007;(1):59-62.
  23. Fritz L.B., Ouellette H.A., O’Hanley T.A., Kassarjian A., Palmer W.E. Cystic changes at supraspinatus and infraspinatus tendon insertion sites: association with age and rotator cuff disorders in 238 patients. Radiology. 2007;244(1):239-248.
  24. Kanatli U., Ozturk B.Y., Esen E., Bolukbasi S. Humeral head cysts: association with rotator cuff tears and age. Eur J Orthop Surg Traumatol. 2014;24(5):733-739. doi: 10.1007/s00590-013-1247-5.
  25. Williams M., Lambert R.G., Jhangri G.S., Grace M., Zelazo J., Wong B., Dhillon S.S. Humeral head cysts and rotator cuff tears: an MR arthrographic study. Skeletal Radiol. 2006;35:909-914.
  26. Fonseca E.K.U.N., Castro A.D.A.E., Kubo R.S., Miranda F.C., Taneja A.K., Santos D.D.C.B, Rosemberg L.A. Musculoskeletal “don’t touch” lesions: pictorial essay. Radiol Bras. Radiol Bras. 2019;52(1):48-53. doi: 10.1590/0100-3984.2016.0225.
  27. Subramanian S., Viswanathan VK. Lytic Bone Lesions. 2019 Apr 4. StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2019. Available from: http://www.ncbi.nlm.nih.gov/books/NBK539837.
  28. Ritchie D.A., Davies A.M. MR imaging of tumors and tumor-like lesions of the shoulder girdle. Magn Reson Imaging Clin N Am. 2004;12(1):125-141. doi: 10.1016/j.mric.2004.01.002.
  29. Lee D.H., Hills J.M., Jordanov M.I., Jaffe K.A. Common Tumors and Tumor-like Lesions of the Shoulder. J Am Acad Orthop Surg. 2019;27(7):236-245. doi: 10.5435/JAAOS-D-17-00449.
  30. Hong E.D., Carrino J.A., Weber K.L., Fayad L.M. Prevalence of shoulder enchondromas on routine MR imaging. Clin Imaging. 2011;35(5):378-384. doi: 10.1016/j.clinimag.2010.10.012.
  31. Семенова Л.А., Булычева И.В. Хондромы (энхондрома, периостальная хондрома, энхондроматоз). Архив патологии. 2007;(5):45-48.
  32. Xu H., Nugent D., Monforte H.L., Binitie O.T., Ding Y., Letson G.D. et al. Chondroblastoma of bone in the extremities: a multicenter retrospective study. J Bone Joint Surg Am. 2015;97(11):925-931. doi: 10.2106/JBJS.N.00992.
  33. Ramappa A.J., Lee F.Y., Tang P., Carlson J.R., Gebhardt M.C., Mankin H.J. Chondroblastoma of bone. J Bone Joint Surg Am. 2000;82(8):1140-1145.
  34. Unni K.K., Inwards C.Y. Dahlin’s bone tumors: general aspects and data on 10,165 cases. 6th ed. Philadelphia: Lippincott Wiliams & Wilkins; 2010.
  35. International Agency for Research on Cancer. In: Fletcher CDM, Bridge J.A., Hogendoorn P, Mertens F, editors. WHO classification of tumors of soft tissues and bone. 4th ed. Geneva: WHO Press; 2013.
  36. Desai S.S., Jambhekar N.A., Samanthray S, Merchant N.H., Puri A., Agarwal M. Chondromyxoid fibromas: a study of 10 cases. J Surg Oncol. 2005;89(1):28-31. doi: 10.1002/jso.20113.
  37. Bhamra J.S., Al-Khateeb H., Dhinsa B.S., Gikas P.D., Tirabosco R., Pollock R.C., Briggs T.W. Chondromyxoid fibroma management: a single institution experience of 22 cases. World J Surg Oncol. 2014;12:283. doi: 10.1186/1477-7819-12-283.
  38. Mascard E., Gomez-Brouchet A., Lambot K. Bone cysts: unicameral and aneurysmal bone cyst. Orthop Traumatol Surg Res. 2015;101(1 Suppl):S119-127. doi: 10.1016/j.otsr.2014.06.031.
  39. Niu X., Zhang Q., Hao L., Ding Y., Li Y., Xu H., Liu W. Giant cell tumor of the extremity: retrospective analysis of 621 Chinese patients from one institution. J Bone Joint Surg Am. 2012;94(5):461-467. doi: 10.2106/JBJS.J.01922.
  40. Блудов А.Б., Неред А.С., Замогильная Я.А., Кочергина Н.В. Гигантоклеточная опухоль кости. Саркомы костей, мягких тканей и опухоли кожи. 2014;(1):16-34.
  41. Konatalapalli R.M., Demarco P.J., Jelinek J.S., Murphey M., Gibson M., Jennings B., Weinstein A. Gout in the Axial Skeleton. J Rheumatol. 2003;36(3):609-613. doi: 10.3899/jrheum.080374.
  42. Volkov A., Rhoiney D. L., Claybrooks R. Tophaceous Gout of the Lumbar Spine: Case Report and Review of the Literature. Turk Neurosurg. 2015;25(6):954-958. doi: 10.5137/1019-5149.JTN.11612-14.1.
  43. Cohn B.T., Ibarra J.A., Jackson D.W. Erosion of the patella secondary to gout. Acase report. Am J Sports Med. 1988;16(4):421-423. doi: 10.1177/036354658801600422.
  44. Morino T., Fujita M., Kariyama K., Yamakawa H., Ogata T., Yamamoto H. Intraosseous gouty tophus of the talus, treated by total curettage and calcium phosphate cement fi lling: a case report. Foot Ankle Int. 2007; 28(1):126-128. doi: 10.3113/FAI.2007.0021.
  45. Foucar E., Buckwalter J., EI-Khoury G.Y. Gout p ing as a femoral cyst. A case report. J Bone Joint Surg Am. 1984;66(2):294-297.
  46. Dos Santos V.M., Passini Soares V.V., de Faria P.S., Borges Viana FGM, Duarte M.L. A 52-year-old man with gouty arthritis and erosive lesion in the hip. Rom J Morphol Embryol. 2017;58(2):557-560.
  47. Liu S.Z., Yeh L., Chou Y.J., Chen C.K., Pan H.B. Isolated intraosseous gout in hallux sesamoid mimicking a bone tumor in a teenaged patient. Skeletal Radiol. 2003;32(11):647-650. doi: 10.1007/s00256-003-0692-3.
  48. Clark S., Evans J.M., Armstrong N., Schnitz W. Tophaceous gout with rare involvement of the patella. Radiol Case Rep. 2016;11(4):380-385. doi: 10.1016/j.radcr.2016.07.002.
  49. Mahapatro R.C., Sylvia L.C., Becker S.M. Case report: i traosseous gouty tophus. J Med Soc N J. 1985;82(1):41-42.
  50. Snoddy M.C., Lee D.H., Kuhn J.E. Charcot shoulder and elbow: a review of the literature and update on treatment. J Shoulder Elbow Surg. 2017;26(3):544-552. doi: 10.1016/j.jse.2016.10.015.
  51. Su J., Al-Delfi F., Mills G., Peddi P. Charcot’s o arthropathy mimicking an osteosarcoma of humerus. BMJ Case Rep. 2016;2016. pii: bcr2015212638. doi: 10.1136/bcr-2015-212638.
  52. Buckley S.L., Alexander A.H., Barrack R.L. Scapular osteomyelitis. An unusual complication following subacromial corticosteroid injection. Orthop Rev. 1989;18(3):321-324.
  53. Birkinshaw R., O’Donnell J., Sammy I. Necrotising fasciitis as a complication of steroid injection. J Accid Emerg Med. 1997;14(1):52-54. doi: 10.1136/emj.14.1.52.
  54. Yangco B.G., Germain B.F., Deresinski S.C. Case r port. Fatal gas gangrene following intra-articular steroid injection. Am J Med Sci. 1982;283(2):94-98. doi: 10.1097/00000441-198203000-00008.
  55. Beissert S., Presser D., Rütter A., Metze D., Luger T.A., Schwarz T. [Embolia cutis medicamentosa (Nicolau syndrome) after intra-articular injection]. Hautarzt. 1999;50(3):214-216. (In German).
  56. Christensson B., Ryd L., Dahlberg L., Lohmander S. Candida albicans arthritis in a nonimmunocompromised patient. Complication of placebo intraarticular injections. Acta Orthop Scand. 1993;64(6):695-698.
  57. Nichols AW. Complications associated with the use of corticosteroids in the treatment of athletic injuries. Clin J Sport Med. 2005;15(5):370-375. doi: 10.1097/01.jsm.0000179233.17885.18.
  58. Cheng J., Abdi S. Complications of joint, tendon, and muscle injections. Tech Reg Anesth Pain Manag. 2007;11(3):141-147. doi: 10.1053/j.trap.2007.05.006.
  59. Zink W., Graf B.M. Local anesthetic myotoxicity. Reg Anesth Pain Med. 2004;29(4):333-340. doi: 10.1016/j.rapm.2004.02.008.

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