Deltoid defect from a trans-deltoid synovial cyst in a patient undergoing reverse shoulder arthroplasty: a case report
Abstract
https://doi.org/10.1016/j.jseint.2020.10.001 2666-6383/© 2020 The Author(s). Publishe license (http://creativecommons.org/license Rheumatoid arthritis in the shoulder can lead to significant rotator cuff tears, glenohumeral arthritis, and eventually, a scenario consistent with cuff tear arthropathy. Several case reports have previously shown that massive rotator cuff tears and cuff tear arthropathy can lead to large cysts extending from the subacromial space through the acromioclavicular joint into a subcutaneous cyst, with a characteristic “geyser sign” on imaging.2,3,9,11,13,14 A single study has reported extension into the trapezius, but extension through the deltoid has not been reported.7 In 1993, Grammont and Baulot, in their series on reverse shoulder arthroplasty (RSA) for cuff-deficient shoulders, argued that the deltoid could compensate for cuff deficiency in the biomechanical setting of an RSA.6 Deltoid deficiency has long been considered a contraindication to RSA, as the deltoid is the primary driver of shoulder elevation postoperatively. Proper functioning of an RSA in cuff-deficient shoulders is predicated on an intact deltoid.6 Dysfunction, tears, or defects of the deltoid can lead to poor function, poor forward elevation, or even instability.1,8 Over time, some reports have started to emerge on repair or reconstruction of deltoid deficiency in patients undergoing RSA, leading to good outcomes.4,5,10 We present the case of a synovial cyst in a patient with…
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