Acromioclavicular joint cyst (Geyser sign)

Case contributed by Dr Maulik S Patel

Presentation

C/o swelling overlying the acromioclavicular joint - 6 mths. C/o pain and restricted shoulder movements.

Patient Data

Age: about 70 yrs
Gender: Female
Modality: Ultrasound

Visible swelling above the acromioclavicular (AC) joint.

Nonvisualization of supraspinatus and infraspinatus tendons.

Nonvisualization of the long head biceps tendon.

Thin and abnormal echopattern of the subscapularis tendon.

Acromiohumeral distance of 3 mm (Normal is >6 mm)

Case Discussion

Findings of chronic rotator cuff tear:

  1. Nonvisualization of supraspinatus and infraspinatus tendon. Retraction more than 30-35 mm.
  2. Significant fatty infiltration and volume loss of supraspinatus and infraspinatus muscle bellies.
  3. Acromiohumeral distance 3 mm, which should be more than 6 mm (basically a radiographic measurement).

Due to absent tendons, the deltoid pulls the humeral head up. The humeral head repeated strikes the undersurface of the acromion and acromioclavicular joint. There is sclerosis of the undersurface of the acromion and tearing of the inferior acromioclavicular ligament. Joint fluid escapes into the acromioclavicular joint. Later on there is a tear of the superior acromioclavicular ligament. Joint fluid escapes into subcutaneous tissues, producing swelling. This called the Geyser phenomenon.

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Case Information

rID: 27386
Case created: 1st Feb 2014
Last edited: 18th Dec 2015
Inclusion in quiz mode: Included

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