Cyst on shoulder back

What’s Causing This Cyst?

Cysts can vary in appearance depending on their type and location. Here are 13 different types of cyst.

Warning: Graphic images ahead.

Epidermoid cyst

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  • Epidermoid cysts are small, slow-growing, benign cysts most commonly found on the face, head, neck, back, or genitals.
  • They’re usually caused by a buildup of keratin under the skin.
  • They look like skin-colored, tan, or yellowish bumps filled with thick material.
  • They may become swollen, red, and painful if they are infected.

Read full article on epidermoid cysts.

Sebaceous cyst

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  • Sebaceous cysts are found on the face, neck, or torso
  • Large cysts may cause pressure and pain
  • They are noncancerous and very slow growing

Read full article on sebaceous cysts.

Breast cyst

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  • Most breast lumps are noncancerous, but there are many possible causes for a lump in your breast.
  • It’s important to be familiar with how your breasts normally feel so you are aware of changes.
  • Instead of performing breast self-examination, most experts recommend that women simply be aware of what their breasts normally look and feel like and report any changes to their healthcare provider.
  • You should make an appointment to see a healthcare provider if you discover a new lump; an area of your breast is noticeably different than the rest; a lump changes or grows larger; you notice bloody discharge from the nipple; or you have an inverted nipple (if it was not always inverted).

Read full article on breast cysts.

Ganglion

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  • A ganglion cyst is a round, fluid-filled lump of tissue that usually appears along tendons or joints, especially in the hands, wrists, ankles, and feet.
  • Fluid accumulation can occur due to injury, trauma, or overuse, but often the cause is unknown.
  • Ganglion cysts are common, harmless, and don’t cause pain or problems unless they grow and put pressure on other structures.

Read full article on ganglion cysts.

Pilonidal cyst

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  • A pilonidal cyst is a common skin condition that forms in the cleft at the top of the buttocks.
  • It’s believed to be caused by a combination of changing hormones (because it occurs after puberty), hair growth, and friction from clothes or from spending a long time sitting.
  • It consists of a small hole or tunnel in the skin that may become infected and fill with fluid or pus.
  • Signs of an infection include pain when sitting or standing, red or sore skin around the area, pus or blood draining from the abscess, causing a foul odor, swelling of the cyst, and hair protruding from the lesion.

Read full article on pilonidal cysts.

Ovarian cyst

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  • Ovarian cysts are fluid-filled sacs that develop on one or both of the ovaries.
  • They may develop as a normal part of the female reproductive cycle or be pathologic.
  • They may be asymptomatic or painful.
  • Symptoms include abdominal bloating or swelling, painful bowel movements, pelvic pain before or during the menstrual cycle, painful intercourse, pain in the lower back or thighs, breast tenderness, nausea, and vomiting.
  • Severe symptoms such as sudden, sharp pelvic pain, fever, faintness, or dizziness are signs of cyst rupture or ovarian torsion.

Read full article on ovarian cysts.

Chalazia

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  • Chalazia is a small, usually painless lump or swelling on your upper or lower eyelid.
  • It’s caused by a blocked meibomian or oil gland.
  • It may be red, swollen, and painful if an infection is present.

Read full article on chalazia.

Baker’s (popliteal) cyst

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  • This fluid-filled swelling causes a lump at the back of the knee, leading to tightness, pain, and restricted movement.
  • This condition is due to a problem that affects the knee joint, such as arthritis, inflammation from repetitive stress, or a cartilage injury.
  • Symptoms include mild to severe pain, stiffness, limited range of motion, swelling behind the knee, bruising on the knee and calf, and rupturing of the cyst.
  • A popliteal cyst often doesn’t need treatment and will go away on its own.

Read full article on Baker’s (popliteal) cysts.

Cystic acne

  • This is the most severe type of acne, and it develops when cysts form deep underneath your skin.
  • It can result from a combination of hormone changes, bacteria, oil, and dry skin cells that get trapped in your pores.
  • Acne cysts may occur on the face, chest, neck, back, and arms. Large, red, painful, pus-filled cysts and nodules may form, rupture, and leave scars.

Read full article on cystic acne.

Ingrown hair cyst

  • These cysts start off as a hair that grows down or sideways instead of out, becoming ingrown.
  • They’re common among people who shave, wax, or use other methods to remove their hair.
  • Ingrown hair cysts may become infected.
  • They appear as pimple-like bumps under the skin that may be red, white, or yellow in color, with or without a central, visible hair.
  • Cysts may become red, warm, and tender to the touch if they are infected.

Read full article on ingrown hair cysts.

Pilar cyst

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  • Pilar cysts are noncancerous, flesh-colored, round bumps that develop under the surface of the skin.
  • This type of cyst is caused by protein buildup in a hair follicle.
  • They’re commonly located on the scalp.
  • They’re also painless, firm, smooth, and slow-growing.

Read full article on pilar cysts.

Mucous cyst

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  • A mucous cyst is a fluid-filled swelling that occurs on the lip or the mouth.
  • They develop when the mouth’s salivary glands become plugged with mucus.
  • They’re commonly caused by trauma to the oral cavity, such as lip biting, piercings, and salivary gland disruption.
  • Mucous cysts are small, soft, pinkish or bluish nodules.

Read full article on mucous cysts.

Branchial cleft cyst

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  • Branchial cleft cyst is a type of birth defect in which a lump develops on one or both sides of a child’s neck or below the collarbone.
  • It occurs during embryonic development when tissues in the neck and collarbone, or branchial cleft, don’t develop normally.
  • In most cases, a branchial cleft cyst isn’t dangerous, but it may cause skin irritation or infection and, in rare cases, cancer.
  • Signs include a dimple, lump, or skin tag on your child’s neck, upper shoulder, or slightly below their collarbone.
  • Other signs include fluid draining from your child’s neck, and swelling or tenderness that usually occurs with an upper respiratory infection.

Read full article on branchial cleft cysts.

Lumps and swellings

When to see your GP

You should see your GP if you develop any growth or swelling on your body. They can examine it and confirm what it is and what’s causing it.

If your GP is uncertain, they may recommend that you have an ultrasound scan or a biopsy. Surgery may be needed to remove certain types of lump.

You should also see your GP urgently if you have a lump that:

  • is getting bigger
  • is painful
  • feels hard
  • grows back after it’s been removed

This is usually the type of lump that needs treatment or investigation due to infection or to rule out cancer.

Common reasons for an unexplained lump or swelling

A painful lump or swelling that appears suddenly over a day or two may be caused by an injury or infection. It’s likely to be an infection if the skin around the lump is red and warm. Your GP can advise you about how to care for this.

Below are some of the most common reasons for an unexplained lump or swelling under the skin in the following areas of the body:

  • face
  • neck or throat
  • breast
  • groin area
  • testicle
  • anus (bottom)
  • hand, wrist or finger
  • shoulders, back, chest or arm
  • armpit

This information may help give you an idea about what your lump or swelling might be. However, don’t use it to diagnose yourself with a condition. Always leave that to your doctor.

Facial swelling or lump

A lump or swelling on the face that wasn’t caused by an injury is most likely to be one of the following:

  • mumps – a viral infection that usually affects children and causes swelling of the glands on the side of the face
  • an allergic reaction – for example to peanuts, which causes swelling in the deeper layers of the skin (angioedema)
  • a dental abscess – that causes the side of the mouth to swell
  • a salivary gland stone – this forms when the chemicals in saliva crystallise and block the flow of saliva from a salivary gland near the jaw, causing pain and swelling around the jaw

See your GP for advice if you have a lump or swelling on your face.

Lump in the neck or throat

A lump in the neck or throat is most likely to be one of the following (although, there are also several other causes):

  • swollen glands (lymph nodes) – usually a sign of infection, such as a cold or glandular fever (the glands tend to go down when you recover)
  • a cyst – a harmless fluid-filled lump that may disappear on its own without treatment
  • a skin tag – a harmless, knobbly wart-like growth that hangs off the skin and can be left alone
  • a goitre – an abnormal swelling of the thyroid gland in the neck that causes a lump to form in the throat

See your GP for advice if you have a lump in the neck or throat.

Lump in the breast

Breast lumps are common and have several different causes. While most breast lumps aren’t breast cancer, any unusual changes to the breasts should be checked by a GP as soon as possible.

Common causes of breast lumps include:

  • mastitis – painful, swollen breast tissue that is sometimes caused by an infection
  • enlarged milk ducts
  • a non-cancerous growth (fibroadenoma)
  • a cyst – a harmless fluid-filled lump
  • a lipoma – a harmless fatty lump
  • a skin tag – a harmless, wart-like growth often found underneath the breast

Lump around the groin area

Common causes of a lump or lumps in the groin area include:

  • a cyst – a harmless fluid-filled lump
  • swollen glands – usually a sign of infection, such as a cold or glandular fever; the glands tend to go down when you recover
  • a hernia – where an internal part of the body, such as part of the bowel, pushes through a weakness in the muscle or surrounding tissue wall
  • an enlarged vein – known as a saphena varix, which is caused by a faulty valve inside the vein (the lump often disappears when you lie down)
  • genital warts – small, fleshy growths caused by a sexually transmitted infection (STI)

See your GP for advice if you have a lump or lumps in the groin area.

Lump or swelling in the testicle

Most testicular lumps are harmless and aren’t cancerous. Less than 4 in 100 of testicular lumps turn out to be testicular cancer.

A lump or swelling in the testicle is most likely to be one of the following:

  • swollen and enlarged veins inside the scrotum (varicoceles)
  • swellings caused by a build-up of fluid around the testicle (hydrocele)
  • a cyst in the epididymis (the long, coiled tube behind the testicles)

See your GP for advice if you have a lump or swelling in the testicle.

Lump around the anus (bottom)

Anal swellings or lumps are usually one of the following:

  • a haemorrhoid (pile) –a swollen blood vessel that can hang outside the anus
  • a skin tag – a harmless growth that hangs off the skin and looks similar to a wart
  • an abscess – a painful collection of pus
  • a rectal prolapse – where part of the rectum (the end of the bowel) sticks out of the anus
  • genital warts – small, fleshy growths caused by a sexually transmitted infection (STI)

See your GP for advice if you have anal swellings or lumps.

Lump on the hand, wrist or finger

A lump on the hand, wrist or finger is probably a ganglion cyst. This is a type of cyst that forms around the joints or tendons.

A ganglion cyst usually appears on the back of the wrist. It’s made up of a thick jelly-like fluid and feels like a smooth, soft lump under the skin.

It’s not clear why ganglions form. However, they can be related to ageing or to injury to the joint or tendon.

If the ganglion doesn’t cause any pain or discomfort, it can be left and may disappear without treatment. If it does cause pain or discomfort you may need to have it removed.

Sometimes, small rough lumps called warts develop on the hands. Warts are caused by an infection with the human papilloma virus (HPV) and are very contagious. However, they’re usually harmless and clear up without treatment.

See your GP for advice if you have a lump on the hand, wrist or finger.

Lump on the shoulder, back, chest or arm

A lump on the shoulder, back, chest or arm is most likely to be a lipoma or a cyst.

A lipoma is a soft, fatty lump that grows under the skin. It’s fairly common, harmless and can usually be left alone. When you press a lipoma, it should feel soft and ’doughy’ to touch. It can range from the size of a pea to a few centimetres across.

A cyst is a sac under the skin that contains fluid, usually pus. It can look a bit like a lipoma but is close to the surface of the skin (lipomas are deeper under the skin).

Cysts can be soft or firm to the touch. Pressing on it you may get a sense of being able to squash it, and it then returning to its original shape once you remove your finger. A cyst may disappear without treatment or you may need to have it drained.

See your GP for advice if you have a lump on the shoulder, back, chest or arm.

Lump in the armpit

A lump in the armpit is likely to be a swollen lymph gland, particularly if you also feel unwell and have other signs of an infection.

The glands in the armpit can swell to more than a few centimetres in response to infection or illness. Swollen glands usually go down when you recover.

It’s uncommon for a lump in the armpit to be a lymphoma (cancer of the lymph glands), but you should see your GP if the lump doesn’t go down.

A small, knobbly lump in your armpit that hangs off the skin like a wart is probably a skin tag.

Skin tags grow where skin rubs against skin or clothing, which is why they’re often seen under the arm. They’re very common and harmless, and can be left alone.

8 Possible Shoulder Bump Conditions

The list below shows results from the use of our quiz by Buoy users who experienced shoulder bump. This list does not constitute medical advice and may not accurately represent what you have.

Lipoma

Lipoma is a word that translates as “fatty tumor,” but a lipoma is not cancer. It is simply a growth of fat between the muscle layer and the skin above it.

The exact cause is not known. The condition does run in families and is associated with other unusual syndromes such as adiposis dolorosa, which is similar. Lipomas most often appear after age 40.

Symptoms include a soft, easily moveable lump beneath the skin, about two inches across. A lipoma is painless unless its growth is irritating the nerves around it. They are most often found on the back, neck, and abdomen, and sometimes the arms and upper legs.

It is a good idea to have any new or unusual growth checked by a medical provider, just to make certain it is benign.

Diagnosis is made through physical examination, biopsy, and imaging such as ultrasound or CT scan.

Most of the time, treatment is not necessary unless the lipoma is unsightly or is interfering with other structures. It can be removed through surgery or liposuction.

Rarity: Uncommon

Top Symptoms: skin-colored groin bump, marble sized groin lump, small groin lump

Symptoms that always occur with lipoma: skin-colored groin bump

Urgency: Wait and watch

Skin cyst

A cyst is a small sac or lump, filled with fluid, air, fat, or other material, that begins to grow somewhere in the body for no apparent reason. A skin cyst is one that forms just beneath the skin.

It’s believed that skin cysts form around trapped keratin cells – the cells that form the relatively tough outer layer of the skin.

These cysts are not contagious.

Anyone can get a skin cyst, but they are most common in those who are over age 18, have acne, or have injured the skin.

Symptoms include the appearance of a small, rounded lump under the skin. Cysts are normally painless unless infected, when they will be reddened and sore and contain pus.

Diagnosis is made through physical examination. A small cyst can be left alone, though if it is unsightly or large enough to interfere with movement it can be removed in a simple procedure done in a doctor’s office. An infected cyst must be treated so that the infection does not spread.

Rarity: Common

Top Symptoms: skin-colored armpit bump, marble sized armpit lump, small armpit lump

Symptoms that always occur with skin cyst: skin-colored armpit bump

Urgency: Wait and watch

Skin abscess

A skin abscess is a large pocket of pus that has formed just beneath the skin. It is caused by bacteria getting under the skin, usually through a small cut or scratch, and beginning to multiply. The body fights the invasion with white blood cells, which kill some of the infected tissue but form pus within the cavity that remains.

Symptoms include a large, red, swollen, painful lump of pus anywhere on the body beneath the skin. There may be fever, chills, and body aches from the infection.

If not treated, there is the risk of an abscess enlarging, spreading, and causing serious illness.

Diagnosis is made through physical examination.

A small abscess may heal on its own, through the body’s immune system. But some will need to be drained or lanced in a medical provider’s office so that the pus can be cleaned out. Antibiotics are usually prescribed.

Keeping the skin clean, and using only clean clothes and towels, will help to make sure that the abscess does not recur.

Rarity: Common

Top Symptoms: rash with bumps or blisters, red rash, red skin bump larger than 1/2 cm in diameter, pus-filled rash, rash

Symptoms that always occur with skin abscess: rash with bumps or blisters

Urgency: Primary care doctor

Basal cell carcinoma

Basal cell carcinoma is a slow-growing form of skin cancer. Skin cancer falls into two major groups: Non-melanoma and melanoma. Basal cell carcinoma is a type of non-melanoma skin cancer.

Rarity: Uncommon

Top Symptoms: facial skin changes, pink or red facial bump, small facial lump, painless facial bump, growing facial lump

Urgency: Primary care doctor

Shoulder Bump Symptom Checker

Take a quiz to find out what might be causing your shoulder bump

Pimple

Pimples are also called comedones, spots, blemishes, or “zits.” Medically, they are small skin eruptions filled with oil, dead skin cells, and bacteria.

Pimples often first start appearing at puberty, when hormones increase the production of oil in the skin and sometimes clog the pores.

Most susceptible are teenagers from about ages 13 to 17.

Symptoms include blocked pores that may appear flat and black on the surface, because the oil darkens when exposed to the air; blocked pores that appear white on the surface because they have closed over with dead skin cells; or swollen, yellow-white, pus-filled blisters surrounded by reddened skin.

Outbreaks of pimples on the skin can interfere with quality of life, making the person self-conscious about their appearance and causing pain and discomfort in the skin. A medical provider can help to manage the condition, sometimes through referral to a dermatologist.

Diagnosis is made through physical examination.

Treatment involves improving diet; keeping the skin, hair, washcloths, and towels very clean; and using over-the-counter acne remedies.

Rarity: Common

Top Symptoms: pink or red facial bump, small facial lump, painful facial bump, marble sized facial lump

Symptoms that always occur with pimple: pink or red facial bump

Urgency: Self-treatment

Wart

Warts, also called common warts or verrucae, are small, rough, rounded growths on the top layer of the skin. They may appear alone or in clusters. Common warts are caused by the human papillomavirus (HPV) and are contagious through direct contact. They may spread from one place on the body to another simply through touch.

Melanoma

Melanoma is the most serious type of skin cancer. Often the first sign of melanoma is a change in the size, shape, color, or feel of a mole. Most melanomas have a black or black-blue area. Melanoma may also appear as a new mole. It may be black, abnormal, or “ugly looking.”

Rarity: Rare

Top Symptoms: brown-colored skin changes, atypical features of a facial bump, black-colored skin changes, growing facial lump, large facial lump

Symptoms that always occur with melanoma: atypical features of a facial bump

Urgency: Primary care doctor

Atypical mole

Moles are growths on the skin. They happen when pigment cells in the skin, called melanocytes, grow in clusters. Certain moles are considered “atypical” because of their size and characteristics, which require careful watching and possibly even biopsy in order to monitor for development into cancer.

Rarity: Uncommon

Top Symptoms: severe abdominal lump, brown-colored skin changes, moderate abdominal lump, atypical abdominal bump features, growing abdominal bump

Symptoms that always occur with atypical mole: black or brown abdominal bump, atypical abdominal bump features

Urgency: Primary care doctor

A 37-Year-Old Female with A Shoulder Mass and Hypertensive Crisis

Clinical Case Seminar

A 37-yr-old nurse was hospitalized because of weakness, nausea, vomiting, dyspnea, and a right shoulder mass. The patient had been well until 3 months before admission when she developed recurrent sinusitis, which was treated with several courses of Ciprofloxacin and Decadron nasal spray. Two months before admission, she noticed a painful right shoulder mass. Outpatient evaluation of the shoulder mass included computed tomography (CT) of the shoulder (Fig. 1), which revealed a large soft tissue mass destroying a portion of the scapular spine, as well as a portion of the acromion. The patient underwent a biopsy of the shoulder mass, which was complicated by the development of transient hypertension to 160/110 mm Hg and sinus tachycardia. It took several weeks for the pathology to be confirmed, and the patient remained asymptomatic during this time. The final pathologic interpretation was consistent with a paraganglioma of the right shoulder.

Figure 1.

CT scan of the right shoulder. A large, 7.0 × 6.0 cm expansile mass (arrows) is seen destroying a portion of the scapular spine (S) as well as the acromion. The clavicle (C) appears uninvolved.

Figure 1.

CT scan of the right shoulder. A large, 7.0 × 6.0 cm expansile mass (arrows) is seen destroying a portion of the scapular spine (S) as well as the acromion. The clavicle (C) appears uninvolved.

At the time of admission, the patient complained of a dry cough, breathlessness, nausea, and vomiting of 1 week’s duration. In retrospect she had noted generalized weakness and progressive dyspnea over the past month. She also noted new bilateral leg edema and hair loss in the lower extremities. She denied headaches, palpitations, diaphoresis, weight loss, or abdominal pain. She had no history of hypertension.

The past medical history was unremarkable except for congenital absence of the thumbs bilaterally. Her medications at the time of admission included Ciprofloxacin and Decadron nasal spray. The family history was remarkable for scleroderma in the father and a carotid body tumor in the mother. There was no family history of endocrinopathy or endocrine neoplasia.

Examination revealed a thin, anxious, and restless female. Her weight was 54 kg, and her height was 164 cm. The blood pressure was 118/70 mm Hg, with a pulse of 118 bpm, respirations of 30, and a rectal temperature of 99.0 F. The skin was cold and mottled, with decreased skin turgor. The fundi were normal with no hypertensive retinopathy. Neck exam revealed no jugular venous distension, lymphadenopathy, or thyroid nodules. The chest exam revealed right-sided rales. The cardiac exam revealed a third heart sound and an apical systolic murmur. The abdomen was soft and nontender, with no organomegaly or palpable masses. The extremities revealed trace ankle edema, a fine tremor, and absence of the thumbs bilaterally. A 5 cm soft tissue mass was palpable in the right shoulder. There was no cervical, axillary, or inguinal adenopathy. The neurological exam was nonfocal. Initial laboratory studies are listed in Table 1. A plain chest radiograph demonstrated mild cardiomegaly. An electrocardiogram revealed sinus tachycardia with a rate of 116 bpm, and 2 mm ST segment elevation in leads V3 and V4. An echocardiogram showed top normal left ventricular cavity, moderate global hypokinesis, and mild pulmonary hypertension, consistent with biventricular failure. A radionuclide bone scan revealed an area of increased uptake in the right shoulder and in the left, ninth rib.

Table 1.

Blood chemistry and hematology studies

Table 1.

Blood chemistry and hematology studies

Shortly after admission to the hospital the patient began to experience episodic palpitations and night sweats. She was admitted to a monitored bed and had documented nonsustained ventricular tachycardia.

Differential diagnosis

In summary, this 37-yr-old white female presented with a chief complaint of cough, dyspnea, weakness, nausea, vomiting, and a soft tissue mass in the right shoulder. Manipulation of the shoulder mass provoked transient, severe hypertension. Her later hospitalization was complicated by the development of palpitations, diaphoresis, and nonsustained ventricular tachycardia. The presence of hypertension, coupled with hyperadrenergic symptoms should raise the suspicion of tumors of the adrenal medulla or the extraadrenal paraganglion system. The paraganglion system is composed of chromaffin cells that arise from the neural crest and migrate, along with sympathetic nerve ganglia, to form the adrenal medulla as well as extraadrenal paraganglia (1). Chromaffin cells are characterized by dark brown staining that occurs upon addition of chromium salts. This staining property is due to the presence of catecholamines stored within neurosecretory granules. Although most paraganglion tissue in the newborn involutes, embryologic rests of paraganglion cells are found in the paraaortic areas in conjunction with the sympathetic nerve ganglia from the base of the skull to the pelvis. Functional tumors arising from these extraadrenal rests of paraganglion cells are known as paragangliomas, or extraadrenal pheochromocytomas. These tumors are most commonly found within the abdomen and pelvis, in the organ of Zuckerkandl or in the urinary bladder (1).

The key feature of this patient’s presentation is that paraganglia cells are normally absent in the extremities. For a paraganglioma to be present in the shoulder signifies that the lesion is metastatic. The malignancy rate of paraganglion tumors varies with the site of origin of the primary tumor. Extraadrenal paragangliomas have a reported malignancy rate of up to 45% (1). In comparison, adrenal pheochromocytomas have a reported malignancy rate of 10%.

Many of the patient’s signs and symptoms can be explained on the basis of excess catecholamines. Pheochromocytomas can be remembered by the pneumonic “the 5 Ps ” for pressure, pain, (i.e. headaches), palpitations, perspiration, and pallor. Conspicuously absent in this patient’s history were headaches or hypertension, which are present in over 70% of cases of pheochromocytoma. However, multiple other hyperadrenergic symptoms were manifest in this patient including: anxiety, tremulousness, breathlessness, nausea, vomiting, and diaphoresis. Her physical exam was remarkable for tachycardia, tachypnea, a low grade fever and cold, mottled extremities. Many of these signs can be attributed to the pharmacologic effects of excess catecholamines. The congenital thumb agenesis was most likely an unrelated finding, as there is no reported association between pheochromocytomas and thumb agenesis. The history, physical exam, and ancillary studies suggested a diagnosis of congestive heart failure. A specific catecholamine cardiomyopathy has been described and may present in the form of congestive heart failure in patients with pheochromocytoma (2). The cardiomyopathy is multifactorial and secondary to both catecholamine induced vasospasm as well as direct myocardial toxicity. Histologically, excess catecholamines have been shown to cause focal myocardial necrosis (2). The cardiomyopathy is often reversible with surgical resection of the tumor.

Many of the patient’s laboratory findings can similarly be explained by excess catecholamines. Laboratory evaluation revealed evidence of an increased anion gap metabolic acidosis. As there was no history to suggest toxin ingestion, diabetic ketoacidosis, or uremic acidosis, lactic acidosis is most likely. Lactic acidosis has been described as a complication of pheochromocytoma in the absence of obvious infection (3, 4). Lactic acidosis may result from impaired tissue perfusion secondary to the profound vasoconstrictive effects of norepinephrine as well as from the metabolic effect of excess catecholamines on intermediary metabolism. Fever and neutrophilia, in the absence of infection, can also be explained by excess catecholamines (4).

The patient’s corrected calcium was elevated. Hypercalcemia is associated with pheochromocytoma in approximately 5% of cases. This may be due either to parathyroid hyperplasia, as in multiple endocrine neoplasia (MEN) type II A syndrome or, secondarily, to liberation of parathyroid hormone-like protein (PTH-rP) (5). Pheochromocytomas have the ability to synthesize and release multiple peptide hormones including PTH-rP, calcitonin gene-related protein, adrenocorticotropic hormone (ACTH), endorphins, enkephalins, erythropoietin, and vasoactive intestinal polypeptide (6). Local osteolytic hypercalcemia, secondary to bony metastases was also a possibility in this case.

Lastly, the family history deserves mention, as it is suggestive of a familial syndrome. The patient’s mother had a history a carotid body tumor, also known as a chemodectoma. The carotid body is the single largest extraadrenal collection of paraganglia cells in the adult. Carotid body tumors have been reported in association with familial pheochromocytomas and, rarely, as part of the MEN type II syndrome (7). Although there was no family history to suggest a diagnosis of MEN II A, MEN II B, von Hippel-Lindau, or neurofibromatosis, further genetic testing of family members may be indicated.

In summary, this patient had evidence of malignant pheochromocytoma complicated by a catecholamine cardiomyopathy. The bone scan was worrisome for metastatic disease in both the left rib and right shoulder. In series of malignant pheochromocytomas, bone lesions are often the first site of metastases. Bone metastases to the ribs, pelvis, spine and proximal, long bones occur in order of decreasing frequency (8). To confirm biochemical evidence of excess catecholamines, plasma and urine catecholamines should be obtained. No single test has perfect sensitivity and specificity, thus combination testing is often utilized. To localize the site of the primary lesion, computed tomography (CT) of the abdomen would be the procedure of choice, as most functional chromaffin tumors arise below the diaphragm. Lastly, nuclear medicine scans such as 131I-met-iodobenzylguanidine scintigraphy (MIBG) or indium-111-labeled octreotide scanning would be helpful to define the extent of disease and to localize metastatic deposits.

Clinical course

Because of the history of a right shoulder paraganglioma and signs of adrenergic excess, plasma and urine catecholamines were obtained (Table 2). A subsequent CT scan of the abdomen and pelvis (Fig. 2) revealed an 11×9×8 cm left adrenal mass. An indium labeled octreotide scan (Fig. 3) confirmed uptake in the left adrenal and right shoulder. No uptake was seen in the rib cage to correspond to that seen on bone scan. The patient was started on alpha blockade with phenoxybenzamine and alpha methyl-paratyrosine. The use of beta blockers repeatedly resulted in profound hypotension. Surgical resection of the primary adrenal lesion was attempted. Laparotomy revealed an 11 cm pheochromocytoma of the left adrenal gland with invasion of the pancreatic parenchyma. On the fifth post-operative day, the patient developed an episode of acute cardiovascular collapse. She was resuscitated and maintained for 49 days before she expired.

Table 2.

Plasma and urine catecholamines

Value (SI Units) Normal range (SI Units) Value (Conventional) Normal range (Conventional)
Plasma Catecholamines
Norepinephrine 95,387 pmol/L 650–2,423 16,140 pg/mL 110–410
Epinephrine 142 pmol/L <273 26 pg/mL <50
Dopamine 4,950 nmol/L <568 758 pg/mL <87
Urine Catecholamines
Norepinephrine 18,459 nmol/24 hr 65–505 3,142 mcg/24 hr 11–86
Epinephrine none detected <87 nmol/24 hr 0 mcg/24 hr <16
Dopamine 6,112 nmol/24 hr 653–2,873 936 mcg/24 hr 100–440
Urine VMA 570 μmol/24 hr 10.1–50.5 112.9 mg/24 hr 2–10
Urine Total Metanephrines 290 μmol/24 hr <6.6  57.1 mg/24 hr <1.3

Value (SI Units) Normal range (SI Units) Value (Conventional) Normal range (Conventional)
Plasma Catecholamines
Norepinephrine 95,387 pmol/L 650–2,423 16,140 pg/mL 110–410
Epinephrine 142 pmol/L <273 26 pg/mL <50
Dopamine 4,950 nmol/L <568 758 pg/mL <87
Urine Catecholamines
Norepinephrine 18,459 nmol/24 hr 65–505 3,142 mcg/24 hr 11–86
Epinephrine none detected <87 nmol/24 hr 0 mcg/24 hr <16
Dopamine 6,112 nmol/24 hr 653–2,873 936 mcg/24 hr 100–440
Urine VMA 570 μmol/24 hr 10.1–50.5 112.9 mg/24 hr 2–10
Urine Total Metanephrines 290 μmol/24 hr <6.6  57.1 mg/24 hr <1.3

Table 2.

Plasma and urine catecholamines

Value (SI Units) Normal range (SI Units) Value (Conventional) Normal range (Conventional)
Plasma Catecholamines
Norepinephrine 95,387 pmol/L 650–2,423 16,140 pg/mL 110–410
Epinephrine 142 pmol/L <273 26 pg/mL <50
Dopamine 4,950 nmol/L <568 758 pg/mL <87
Urine Catecholamines
Norepinephrine 18,459 nmol/24 hr 65–505 3,142 mcg/24 hr 11–86
Epinephrine none detected <87 nmol/24 hr 0 mcg/24 hr <16
Dopamine 6,112 nmol/24 hr 653–2,873 936 mcg/24 hr 100–440
Urine VMA 570 μmol/24 hr 10.1–50.5 112.9 mg/24 hr 2–10
Urine Total Metanephrines 290 μmol/24 hr <6.6  57.1 mg/24 hr <1.3
Value (SI Units) Normal range (SI Units) Value (Conventional) Normal range (Conventional)
Plasma Catecholamines
Norepinephrine 95,387 pmol/L 650–2,423 16,140 pg/mL 110–410
Epinephrine 142 pmol/L <273 26 pg/mL <50
Dopamine 4,950 nmol/L <568 758 pg/mL <87
Urine Catecholamines
Norepinephrine 18,459 nmol/24 hr 65–505 3,142 mcg/24 hr 11–86
Epinephrine none detected <87 nmol/24 hr 0 mcg/24 hr <16
Dopamine 6,112 nmol/24 hr 653–2,873 936 mcg/24 hr 100–440
Urine VMA 570 μmol/24 hr 10.1–50.5 112.9 mg/24 hr 2–10
Urine Total Metanephrines 290 μmol/24 hr <6.6  57.1 mg/24 hr <1.3

Figure 2.

CT scan of the abdomen. A large (11.0× 9.0 × 8.0 cm) heterogeneous mass (arrows) with central necrosis is seen in the left upper quadrant, displacing the spleen superiorly and the left kidney inferiorly.

Figure 2.

CT scan of the abdomen. A large (11.0× 9.0 × 8.0 cm) heterogeneous mass (arrows) with central necrosis is seen in the left upper quadrant, displacing the spleen superiorly and the left kidney inferiorly.

Figure 3.

Whole-body Indium-111 Octreoscan. Focal uptake is seen in the right shoulder and adjacent scapula. Abnormal uptake is also seen in the left upper quadrant (arrow) between the spleen and upper pole of the left kidney, corresponding to the mass seen on CT scan.

Figure 3.

Whole-body Indium-111 Octreoscan. Focal uptake is seen in the right shoulder and adjacent scapula. Abnormal uptake is also seen in the left upper quadrant (arrow) between the spleen and upper pole of the left kidney, corresponding to the mass seen on CT scan.

Literature Review

Malignancy has been reported in approximately 10% of patients with pheochromocytomas. Many studies have tried to define factors predictive of malignancy, but the only definite criterion is still the presence of metastases in sites where chromaffin tissue is normally absent. Common sites of metastases include; bones, lungs, liver, and regional lymph nodes (9). Histologic features are not specific for malignancy, but vascular and capsular invasion favor malignancy and are associated with a poor prognosis. DNA flow cytometry studies suggest that nondiploid tumors are more likely to be aggressive and therefore should be monitored more carefully (6). Biochemically, norepinephrine excretion predominates in malignant as well as benign pheochromocytomas. Dopamine excretion is frequently associated with malignancy, possibly due to cellular dedifferentiation. Dopamine excretion is also more frequent in patients with large tumor masses or at the end stage of their disease, thus portending an unfavorable prognosis (10). Elevated serum levels of neuroendocrine tumor markers, such as neuron specific enolase, neuropeptide Y and chromogranin A have all been linked to malignancy (10), although their usefulness in predicting malignancy has not been proven. Finally, the extraadrenal presence of chromaffin tissue is highly suspicious for malignancy because as many as 50% of extraadrenal pheochromocytomas have been reported to be malignant.

Malignant pheochromocytomas occur mostly between the third and fifth decade and have been associated with other conditions like Von Recklinghausen’s disease (neurofibromatosis), von Hippel-Lindau disease, MEN type II, and multiple neuroectodermal tumors. Treatment should consist of aggressive surgical resection, and symptoms should be controlled with alpha and beta blockers as needed. Radiation therapy to bony metastases is palliative. MIBG was originally promising as a new mode of treatment for malignant pheochromocytomas, but reports indicate that less than 50% of patients derive a beneficial effect (6). Chemotherapy with cyclophosphamide, vincristine, and dacarbazine has been shown to induce a partial remission in some patients, but it is not curative and is only effective for a finite period (11). For this reason, chemotherapy should be reserved for patients with surgically inaccessible metastatic disease that is producing symptoms of excess catecholamines that cannot be controlled pharmacologically.

The progression of malignant pheochromocytomas is variable, with survival ranging from months to decades. Metastases to lungs and liver are generally more aggressive than metastases to bones and lymph nodes. Overall median survival is 5 yr, but prolonged survival even with widely metastatic disease has been reported.

1 Whalen RK , Althausen AF , Daniels GH. 1992 Extraadrenal pheochromocytoma. J Urol. 147:1–10. 2 Sardesai SH , Mourant AJ , Sivathandon Y , et al. 1990 Phaeochromocytoma and catecholamine induced cardiomyopathy presenting as heart failure. Br Heart J. 63:234–237. 3 Bornemann M , Hill SC , Kidd GS. 1986 Lactic acidosis in pheochromocytoma. Ann Intern Med. 105:880–882. 4 Case Records of the Massachusetts General Hospital 1989 (Case 45–1989). New Engl J Med. 312:568–575. 5 Stewart AF , Hoecker JL , Mallette LE , et al. 1985 Hypercalcemia in pheochromocytoma; evidence for a novel mechanism. Ann Intern Med. 102:776–779. 6 Werbel SS , Ober KP. 1995 Pheochromocytoma; update on diagnosis, localization and management. Med Clin Nor Am. 79:131–153. 7 Jensen JC , Choyke PL , Rosenfeld M , et al. 1991 A report of familial carotid body tumors and multiple extraadrenal pheochromocytomas. J Urol. 145:1040–1042. 8 McCarthy EF , Bonfiglio M , Lawton W. 1977 A solitary functioning osseous metastasis from a malignant pheochromocytoma of the organ of Zuckerkandl. Cancer. 40:3092–3096. 9 Mornex R , Badet C , Peyrin L. 1992 Malignant pheochromocytoma: a series of 14 cases observed between 1966 and 1990. J Endocrinol Invest. 15:643–649. 10 Schlumberger M , Gicquel C , Lumbroso J , et al. 1992 Malignant pheochromocytoma: clinical, biological, histologic, and therapeutic data in a series of 20 patients with distant metastases. J Endocrinol Invest. 15:631–642. 11 Averbuch SD , Steakley CS , Young R. et al. 1988 Malignant pheochromocytoma: effective treatment with a combination of cyclophosphamide, vincristine, and dacarbazine. Ann Intern Med. 109:267–273. Copyright © 1997 by The Endocrine Society

What’s Causing the Lump on My Shoulder, and When Should I See a Doctor?

The causes of shoulder lumps vary in type and severity. To determine what you might have, take note of other symptoms.

Lipoma

A lipoma is a lump of fat tissue underneath the skin. It’s a benign (noncancerous) soft tissue tumor. Scientists don’t know why they occur.

Lipomas are common. About 1 in every 1,000 people have one. Often, lipomas show up on the shoulders, trunk, neck, and armpits.

They’re usually:

  • rubbery, soft, and doughy
  • movable
  • usually less than 2 inches, but may be bigger
  • occasionally painful

Usually, the lipoma itself doesn’t cause pain. But if it presses on nerves or has blood vessels, it can hurt.

Cyst

Your shoulder lump might be a cyst, or a closed sac of tissue. Depending on the type of cyst, it might contain air, pus, or fluid. Cysts are usually benign.

There are many kinds of cysts. But some types can appear on the shoulder, including the following:

  • Epidermoid cyst. An epidermoid cyst, also called a sebaceous cyst, is a painless flesh-colored sac under the skin. It’s filled with a protein called keratin, a thick, yellowish material that may drain from the bump.
  • Paralabral cyst. This cyst contains joint fluid and develops around the shoulder joint. While it’s usually painless, it can hurt if it presses against nearby nerves or tears the surrounding cartilage.
  • Ganglion cyst. Ganglion cysts usually form on the hands or wrists, but in rare cases, they can occur near other joints, like the shoulders. A ganglion cyst is often round or oval and painless.
  • Bone cyst. A bone cyst is a fluid-filled pocket in the bone. It usually isn’t painful, though it can get big enough to cause a fracture.

Abscess

Another cause is a skin abscess, or a pus-filled lump deep under the skin. It’s typically caused by a bacterial infection.

An abscess might look like a big pimple. Other symptoms include:

  • round shape
  • firm, yet squishy
  • pain
  • redness
  • pus draining from the center
  • warm to the touch

Since an abscess is caused by a bacterial infection, you may also have a fever and chills.

Trauma or injury

A shoulder lump can form after hurting your shoulder. Potential causes include:

  • Fracture. A shoulder fracture, or broken shoulder, involves a break in one of your shoulder bones. Symptoms include pain, swelling, and a lump where the bone broke.
  • Separation. A separated shoulder occurs when the ligaments between the collarbone and shoulder blade tear. The shoulder blade can move downward, which forms a bump on top of your shoulder.
  • Muscle contusion. A muscle contusion, or an injury to the muscle fibers, causes swelling and bluish discoloration. If blood collects within the tissue, it can form a bump called a hematoma.

Muscle knot

A muscle knot is a group of tense muscle fibers. It happens when muscle tissue contracts, even when you’re relaxing.

Also called myofascial trigger points, muscle knots can affect any part of the body. They commonly form on the neck and shoulders.

Symptoms include:

  • aching and pain
  • sensitivity when touched
  • hardness
  • swelling

Muscle knots are often caused by inactivity or overuse. Regular exercise and therapeutic massages can help get rid of them.

Large pimple or wart

Your shoulder lump might be a big pimple or wart. These skin conditions are usually harmless, though they can cause discomfort and pain.

Pimples, or acne, happen when your pores are clogged with oil and dead skin cells. They often form on the shoulders, face, upper back, and chest.

Larger pimples are most likely:

  • Cystic acne. Cystic acne are painful bumps filled with pus. They form underneath the skin.
  • Nodular acne. Nodules are harder lumps. Like cystic acne, they develop beneath the skin and are painful.

On the other hand, warts are caused by a human papilloma virus (HPV) infection. They usually show up on the hands, but they can appear anywhere, including the shoulders.

Warts might be:

  • small or big
  • rough or smooth
  • white, brown, pink, or flesh-colored
  • itchy

Arthritis

Arthritis, or joint inflammation, can lead to shoulder lumps. The characteristics of the lump will depend on the kind of arthritis you have.

Rheumatoid arthritis (RA), a type of autoimmune arthritis, can cause rheumatoid nodules. These nodules form under the skin and usually appear on bony areas, like the shoulders.

A rheumatoid nodule can be as big as a lemon. They are:

  • flesh-colored
  • hard or dough-like
  • movable or connected to underlying tissue

Osteoarthritis (OA), or degenerative arthritis, can cause bone spurs called osteophytes. These bony lumps grow around joints affected by osteoarthritis.

Osteophytes often appear on the shoulders, neck, knees, fingers, and feet. They don’t always cause symptoms. If a lump presses against nerves or other tissues, you may have pain or loss of joint motion.

Cancer

A shoulder lump might indicate soft tissue sarcoma. This is a rare cancer that forms a tumor in the connective tissue, including the muscle, tendons, and nerves.

The tumor is typically painless. It most often affects the:

  • shoulders
  • thighs
  • pelvis
  • abdomen
  • chest

As the tumor progresses, it may cause pain and restrict your movement.

Squamous cell carcinoma, as type of skin cancer, can also cause shoulder lumps. These bumps are rough scaly patches that may look like warts.

But a bad stomach bug this past winter sent me to my doc, and I happened to be rubbing the cyst when she walked into the exam room. I told her about it, and she offered to refer me to a surgeon named Alan Schuricht, M.D., who is a clinical professor of GI surgery at the University of Pennsylvania’s Perelman School of Medicine.

My first appointment with Dr. Schuricht lasts about two minutes. He looks at my bump and confirms Friedman’s over-the-phone diagnosis of a benign epidermoid cyst. He explains that, during my next visit, he would apply local anesthetic and cut the cyst out.

“They’ll be a small scar,” he said, “but I’ll make the incision along the natural folds on the back of your neck, so it should be almost invisible.”

What it’s like to have a benign cyst removed

A week later, I’m back in his office and lying face down on an exam table as he explains to me that the prick from the anesthetic syringe will be the only pain I’ll feel during the procedure. He jabs the needle into the area around my cyst, which feels about as pleasant as you would expect. (Not bad, but not nice either.)

We start BS’ing about golf—about Sergio Garcia’s recent win at the Master’s—and I almost don’t notice that he’s started working on me.

“Are you in there already?” I ask.

“Yep, about halfway through.”

I can feel only a very dull sort of pressure—like he’s gently prodding the back of my neck through several layers of thick clothing. From start to finish, the entire procedure takes less than 5 minutes. (If you like gore, Dr. Sandra “Pimple Popper” Lee has posted a video of a similar procedure on Youtube.)

After bandaging my neck, Dr. Schuricht explains that he’s closed his incision with two sutures hidden below the skin. He tells me to keep the area bandaged for 7 to 10 days.

“If it hurts, you can take aspirin or ibuprofen,” he says.

He adds that the first year is the most crucial time for the scar’s healing, and so I should be extra diligent about using sunscreen whenever I’m outside. “If you don’t, you’ll have to come up with a cool lie to explain the little scar on your neck.”

Flash forward to now, 2 weeks later, and the surgical cut is already inconspicuous—a thin red line surrounding by a couple small bruises. Even the day after the surgery, I’d experienced almost zero pain.

The whole process has been so easy that I keep wondering why I didn’t do it years ago. My only worry now: that the cyst might grow back.

“Regrowth is possible,” Dr. Schuricht had said. “But don’t worry, it won’t.”

My dad was less optimistic. I told him after the fact about the surgery, and he said, “I’ve had two of those cut out, but they came back again.”

We’ll see. For now, I’m cyst free and looking forward to T-shirt weather.

Ganglion Cyst

The exact cause of a ganglion cyst is unknown, but many paralabral cysts develop after a labral tear. Many medical professionals believe a ganglion cyst is formed when the natural joint lubricating fluid, known as synovial fluid, leaks or is pushed out into the common stalk, causing a fluid-filled sac to form. Many ganglion and paralabral cysts increase and decrease in size. In certain patients, the cyst will even disappear only to reappear at another time.

Symptoms of a Shoulder Ganglion Cyst

Many ganglion cysts associated with the shoulder joint cause patients to experience zero pain or discomfort. In cases of a paralabral cyst, patients may experience pain from the labral tear but not the cyst itself. A cyst may become large enough in certain patients to compress on surrounding nerves of the shoulder joint, causing pain and weakness of the muscles supplied by the nerve. When a nerve is acutely compressed, there can be significant shoulder pain followed by shoulder weakness and muscle atrophy.

Diagnosis of a Shoulder Ganglion Cyst

In order to diagnose a shoulder ganglion cyst or a paralabral cyst, Dr. Ticker will perform a thorough medical review and physical examination. An MRI is often utilized to detect the presence and location of a cyst and any associated labral pathology. An ultrasound may be performed to determine if the mass is solid or fluid-filled, as well as to determine if a blood vessel or artery is causing the cyst to form.

Treatment of a Shoulder Ganglion Cyst

Non-Surgical

Non-surgical treatment is the most common treatment approach in patients with ganglion cysts. If the ganglion cyst is not causing pain, Dr. Ticker may recommend no treatment but to watch the mass closely. If the cyst causes shoulder pain, weakness or discomfort, Dr. Ticker will advise relatively rest, exercises, and physical therapy. He may also recommend aspirating the cyst.

Surgical

Dr. Ticker may recommend an arthroscopic surgical procedure to remove the ganglion cyst if there is acute nerve compression and nerve in jury, or if other treatment options have failed. Surgical treatment for paralabral cysts involves an arthroscopic repair of the labral tear, as well as decompression of the nerve and drainage of the cyst. When the cyst is superficial, he will utilize a local or regional anesthesia, make a small incision over the ganglion cyst and common stalk and remove the fluid-filled sac completely.

For additional resources on a ganglion cyst of the shoulder, or to learn more about treatment for a paralabral cyst, please contact Dr. Jonathan Ticker, orthopedic shoulder surgeon serving the greater geo areas.

A lump keeps swelling on my shoulder blade

Dear doctor;

I have a lump that keeps growing on the back around the shoulder blade. It hurts real bad when I take long without a massage. I usually think it is due to using a computer mouse but recently someone suggested it could be due to ulcers. What are the signs and symptoms of ulcers? Eric, 27.

Dear Eric,

How long has the lump been present, how does it look and feel like, does it pain on touching or is painful all the time, does massage reduce the pain only or also the lump? These questions, if answered, can help to answer your query better.

Bacterial infections of the skin or underlying soft tissues can cause painful swellings, which are cured completely by antibiotics and anti-inflammatory drugs. Surgical incision and drainage of these swelling also helps in healing. Cysts (fluid filled swellings) can occur anywhere in body, including on the back due to infection, blocking of oil glands ducts. A cyst can get infected causing redness and pain on touching. Cysts are completely cured by surgical removal involving a prick.

Tuberculosis can cause a slow growing painless swelling. There would be associated symptoms of a chronic infection like low grade fever, night sweats, anorexia and loss of weight. Similarly, if the swelling would be a tumor, there would be overshadowing symptoms of a slowly growing malignancy.

Soft tissue injuries of the muscles, cartilage, among others, supporting a joint can also lead to swelling over that part. If the pain is relieved by massage, that is one possible reason for the swelling. Using a computer mouse for long hours can cause pain around shoulder joints but not a swelling. Ulcer around the shoulder blades would be a visible ulcer, that is, denuded skin over some area.

Diagnosis of the swelling can be made by doing a CT scan of affected part and taking a biopsy. Treatment of the cause will cure the swelling completely.

I realize thread is old but wanted to add that my dad got a lump by the left shoulder blade but thought it was just pain from putting away Christmas decor.
He tried his chiro but that didn’t help so went to see my mom’s pain doc. The lump was found and biopsied. It was cancerous and a pet scan then showed cancer in his lungs, bone, lymphs, and soon liver and more.
The lump got really large in the next six weeks that Dad had left to live. He didn’t get any treatment because it was so advanced. Went straight to home hospice care.
My dad was also the tyoe who didn’t go to the doctor much. I know he had been more tired than usual and had a cough a few months earlier that they only gave z-pack for. His labs were all normal, too. He wasn’t one to push for his health and instead would push himself to keep going and drive the little old ladies from church to their doc appts. He was 82.
So I’m going to say to anyone with a lump on your back from out of the blue, get it checked asap and make them do thorough tests and not just the usual ridiculously limited amount of levels they check.
My dad was loved by all. He wasn’t ready to leave but accepted death with so much grace and spent those weeks tying up loose ends to ease things for my mom and having so many visitors saying goodbye, despite exhaustion.
I’ve seen so many doctors in the past 5 years and know more than ever that you must find your own answers and connect dots in addition to what a doctor believes. There are too many bad ones out there (same ratio of bad docs, bad hairdressers, bad plumbers, bad contractors, etc), but there is no way to weed out bad doctors. And when they don’t help your problem, or make it worse, you don’t get your money back and there’s no manager to complain to. And most often, people don’t even realize they’ve gotten bad service via no diagnosis when more suspicion and thought should have been exersized. I have found that sites like Healthgrades are pretty darn good at identifying the dogs or the real good docs, because they get the most ratings and comments. More people are leaving ratings now so you can get enough info on more and more doctors. This is our only way, as patients, to protect ourselves.

Paralabral Cysts

Lennard Funk, 2011

Paralabral cysts are swellings that arise around the socket of the shoulder joint (glenoid). They are pockets of joint fluid that develop outside of the joint under tears of the labrum. These are also known as ganglia (or a ganglion). These may occur anywhere around the glenoid.

The cysts can be diagnosed on an MRI scan, or MR Arthrogram. An MR Arthrogram is more sensitive in detecting the associated labral tear also.

Posterior paralabral cyst with labral tear on MR Arthrogram:

Often the cysts themselves don’t cause any pain, but the labral tears can cause pain. Treatment will involve repair of the labral tear and drainage of the cyst. This is usually done by arthroscopy (Keyhole). For more details on the labral repair .

The cysts may become very large and can press on some of the important nerves around the shoulder. This can cause pain and also weakness of the muscles supplied by the nerve. The commonest nerve affected is the suprascapular nerve. The suprascapular nerve can be compressed at the spinoglenoid notch with a posterior labral tear (reverse Bankar tear) or at the suprascapular notch with a SLAP tear. This can lead to a suprascapular nerve palsy.

Posterior paralabral cyst pressing on the suprascapular nerve at the spinoglenoid notch, under the spinoglenoid ligament:

Posterior paralabral cyst causing compression of suprascapular nerve with wasting and fluid oedema in the infraspinatus muscle (within green circle):

Inferior labral tears can cause inferior paralabral cysts which may press on the axillary nerve, causing weakness of the Teres Minor muscle and Quadrilateral Space syndrome.

Treatment for paralabral cysts causing nerve compression involves arthroscopic repair of the labral tear, as well as decompression of the nerve and drainage of the cyst.

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