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, 4 (4), e371-4
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Arthroscopic Marginal Resection of a Lipoma of the Supraspinatus Muscle in the Subacromial Space

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Arthroscopic Marginal Resection of a Lipoma of the Supraspinatus Muscle in the Subacromial Space

Alejandro Pagán Conesa et al. Arthrosc Tech.

Abstract

Subacromial impingement syndrome is a common cause of shoulder pain in young adults and seniors at present. The etiology of this syndrome is associated with several shoulder disorders, most related to aging, overhead activities, and overuse. The subacromial space is well circumscribed and limited in size, and soft-tissue growing lesions, such as tumors, can endanger the normal function of the shoulder girdle. We present a case of shoulder impingement syndrome caused by an intramuscular lipoma of the supraspinatus muscle in the subacromial space in a 50-year-old male bank manager. Radiographs, magnetic resonance imaging, and a computed tomography scan showed a well-circumscribed soft-tissue tumor at the supraspinatus-musculotendinous junction. It was arthroscopically inspected and dissected and complete marginal excision was performed through a conventional augmented anterolateral portal, avoiding the need to open the trapezius fascia or perform an acromial osteotomy. Microscopic study showed a benign lipoma, and the shoulder function of the patient was fully recovered after a rehabilitation period of 4 months. This less invasive technique shows similar results to conventional open surgery.

Figures

Fig 1
Fig 1
(A) Sagittal and (B) coronal magnetic resonance imaging (MRI) scans of the right shoulder showing a homogeneous mass inside the muscle belly of the supraspinatus just below the acromial process (arrows). (A) The sagittal T2-weighted MRI signal shows a low–signal intensity mass similar to subcutaneous fat, whereas (B) the coronal T1-weighted MRI signal shows high signal intensity of the fatty mass.
Fig 2
Fig 2
(A) Coronal and (B) sagittal computed tomography scans of the right shoulder showing a well-defined hypodense mass of the supraspinatus muscle belly under the acromion (arrows). The attenuation pattern within the tumor is equal to the adipose tissue.
Fig 3
Fig 3
Photograph taken at the end of the procedure showing the 4 portals established for the procedure, as well as an arthroscopic image taken at the same time (inset). The first portal, a posterior portal (PP) 1 cm below the posterolateral corner of the acromion, serves primarily as a viewing portal and secondarily as an instrumentation portal. The second portal, lateral to the posterior one-third of the acromial border, serves as a viewing portal (VP) for the rest of the procedure. The third portal, an anterolateral portal (AL) lateral to the anterior one-third of the acromial border, is used for instrumentation. The fourth portal serves as the excision channel (EC), just lateral to the lateral border of the acromion, for removal of the tumor.
Fig 4
Fig 4
An arthroscopic image from the posterolateral portal showing the bulging aspect of the supraspinatus muscle after bursal resection, with palpation with a radiofrequency probe.
Fig 5
Fig 5
A Wissinger rod, a grasper for arthroscopy, and a radiofrequency ablator probe are used to bring the yellowish lipoma into view by longitudinally transecting the muscle fibers of the supraspinatus. The surgeon uses both hands during this thorough step, and the assistant holds the camera through the viewing portal.
Fig 6
Fig 6
A yellowish fatty lesion is excised with a Kocher clamp through a previous anterolateral portal augmented by 2 cm.

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