Sarcoid of the Upper Humerus Found Incidentally on MR Images Obtained for Work-Up of Rotator Cuff Tear Where Compromised Tissue Quality Was a Concern for Surgical Success
Sarcoidosis is an idiopathic systemic inflammatory disorder characterized histologically by noncaseating granulomas. The pathogenesis likely includes genetic, immunologic, and environmental factors. The lungs, skin, and eyes are most commonly affected. Although bone involvement is possible, sarcoido...
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Wiley
2018-01-01
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| Series: | Case Reports in Radiology |
| Online Access: | http://dx.doi.org/10.1155/2018/3579527 |
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| author | Tanner R. Henrie John G. Skedros |
| author_facet | Tanner R. Henrie John G. Skedros |
| author_sort | Tanner R. Henrie |
| collection | DOAJ |
| description | Sarcoidosis is an idiopathic systemic inflammatory disorder characterized histologically by noncaseating granulomas. The pathogenesis likely includes genetic, immunologic, and environmental factors. The lungs, skin, and eyes are most commonly affected. Although bone involvement is possible, sarcoidosis of the humerus is rare, with few cases reported. Furthermore, we are unaware of any reports of sarcoidosis of the upper humerus with a coexisting rotator cuff tear. We report the case of a 50-year-old female with sarcoidosis of the humerus and a coexisting tear of the supraspinatus tendon. Her medical history includes type 2 diabetes, depression, and fatigue. She had chronic shoulder pain that worsened after her dog jerked on the leash. Radiographs were grossly normal. Subsequent magnetic resonance imaging (MRI) demonstrated a possible small full-thickness rotator cuff tear. Multiple rounded lesions were also noted within the proximal humerus. A biopsy demonstrated noncaseating granulomas, confirming the diagnosis of sarcoidosis. There was concern that her sarcoid lesions would compromise bone quality, limiting options for surgical repair of her rotator cuff tear. However, it was determined that her lesion did not involve cortical bone, and surgery was performed. During surgery, the supraspinatus tendon was found to be partially torn and was treated with arthroscopic debridement and acromioplasty. An excellent result was ultimately achieved after her rheumatologist started adalimumab injections. This case demonstrates that there can be a rare incidental finding of osseous sarcoid lesions in the upper humerus where the bone might be compromised in the location of a planned rotator cuff repair. |
| format | Article |
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| institution | Kabale University |
| issn | 2090-6862 2090-6870 |
| language | English |
| publishDate | 2018-01-01 |
| publisher | Wiley |
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| series | Case Reports in Radiology |
| spelling | doaj-art-3bcd4cfb64184ac6af0bf25996fa8fe92025-02-03T05:52:03ZengWileyCase Reports in Radiology2090-68622090-68702018-01-01201810.1155/2018/35795273579527Sarcoid of the Upper Humerus Found Incidentally on MR Images Obtained for Work-Up of Rotator Cuff Tear Where Compromised Tissue Quality Was a Concern for Surgical SuccessTanner R. Henrie0John G. Skedros1Tulane University School of Medicine, New Orleans, LA, USAThe University of Utah Department of Orthopaedic Surgery, Salt Lake City, UT, USASarcoidosis is an idiopathic systemic inflammatory disorder characterized histologically by noncaseating granulomas. The pathogenesis likely includes genetic, immunologic, and environmental factors. The lungs, skin, and eyes are most commonly affected. Although bone involvement is possible, sarcoidosis of the humerus is rare, with few cases reported. Furthermore, we are unaware of any reports of sarcoidosis of the upper humerus with a coexisting rotator cuff tear. We report the case of a 50-year-old female with sarcoidosis of the humerus and a coexisting tear of the supraspinatus tendon. Her medical history includes type 2 diabetes, depression, and fatigue. She had chronic shoulder pain that worsened after her dog jerked on the leash. Radiographs were grossly normal. Subsequent magnetic resonance imaging (MRI) demonstrated a possible small full-thickness rotator cuff tear. Multiple rounded lesions were also noted within the proximal humerus. A biopsy demonstrated noncaseating granulomas, confirming the diagnosis of sarcoidosis. There was concern that her sarcoid lesions would compromise bone quality, limiting options for surgical repair of her rotator cuff tear. However, it was determined that her lesion did not involve cortical bone, and surgery was performed. During surgery, the supraspinatus tendon was found to be partially torn and was treated with arthroscopic debridement and acromioplasty. An excellent result was ultimately achieved after her rheumatologist started adalimumab injections. This case demonstrates that there can be a rare incidental finding of osseous sarcoid lesions in the upper humerus where the bone might be compromised in the location of a planned rotator cuff repair.http://dx.doi.org/10.1155/2018/3579527 |
| spellingShingle | Tanner R. Henrie John G. Skedros Sarcoid of the Upper Humerus Found Incidentally on MR Images Obtained for Work-Up of Rotator Cuff Tear Where Compromised Tissue Quality Was a Concern for Surgical Success Case Reports in Radiology |
| title | Sarcoid of the Upper Humerus Found Incidentally on MR Images Obtained for Work-Up of Rotator Cuff Tear Where Compromised Tissue Quality Was a Concern for Surgical Success |
| title_full | Sarcoid of the Upper Humerus Found Incidentally on MR Images Obtained for Work-Up of Rotator Cuff Tear Where Compromised Tissue Quality Was a Concern for Surgical Success |
| title_fullStr | Sarcoid of the Upper Humerus Found Incidentally on MR Images Obtained for Work-Up of Rotator Cuff Tear Where Compromised Tissue Quality Was a Concern for Surgical Success |
| title_full_unstemmed | Sarcoid of the Upper Humerus Found Incidentally on MR Images Obtained for Work-Up of Rotator Cuff Tear Where Compromised Tissue Quality Was a Concern for Surgical Success |
| title_short | Sarcoid of the Upper Humerus Found Incidentally on MR Images Obtained for Work-Up of Rotator Cuff Tear Where Compromised Tissue Quality Was a Concern for Surgical Success |
| title_sort | sarcoid of the upper humerus found incidentally on mr images obtained for work up of rotator cuff tear where compromised tissue quality was a concern for surgical success |
| url | http://dx.doi.org/10.1155/2018/3579527 |
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