Shoulder osteoarthritis - geyser sign

Case contributed by Dr Mostafa El-Feky


Chronic degenerative disease of the right shoulder joint with limited movement, presented with right shoulder swelling

Patient Data

Age: 70 years
Gender: Female

Marked osteoarthritic changes of the right shoulder joint with marked narrowing of joint space and upward subluxation of the right humeral head. There is an oval-shaped soft tissue swelling noted above the acromion delineated by the artifact made by clothes.

Marked acromio-clavicular osteoarthrosis is noted.  This is associated with a sizable ( 5.6 x 3.7 x 2.3 cm ) related cystic lesion, superior to the articulation, expressing T1 hypo, T2 and T2 fat sat hyperintense signal with thickened lining, reflecting large synovial cyst.

Advanced degenerative osteoarthrosis of the right glenohumeral joint manifested as narrowed joint space, extensive subarticular cystic changes with marginal osteophytes. Mild effusion and synovitis are also noted.

Full-thickness tear of the supraspinatus tendon with retraction by a 4 cm gap. This is associated with marked atrophy of the corresponding muscle belly ( Goutallier grade 4).

Focal interruption of the synovial surface of the infraspinatus tendon, reflecting high-grade partial tear. This is associated with moderate atrophy of the corresponding muscle belly.

Ill-definition of the intra-articular portion of the long head of the biceps tendon is noted, reflecting underlying tear. Focal interruption of the synovial surface of the subscapularis tendon, reflecting partial tear.

Case Discussion

The main radiological features are:

  • marked acromio-clavicular osteoarthrosis with a large related synovial cyst (Geyser sign).  
  • Advanced degenerative osteoarthrosis of the right glenohumeral joint.
  • rotator cuff degenerative tears.

The geyser sign refers to the supra-acromial synovial cyst that appears as a shoulder pseudotumor associated with long-standing rotator cuff tear and advanced osteoarthritis of the shoulder. The synovial cyst is formed by the glenohumeral joint fluid that erupts superiorly through the AC interval into the subdeltoid bursa 1.


Case courtesy; Dr Rim Bastawy, Lecturer of radiodiagnosis, Alexandria University, Egypt.

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Case information

rID: 65244
Published: 16th Jan 2019
Last edited: 14th Aug 2019
Inclusion in quiz mode: Included
Institution: Dar El Ashaa Center

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