Poster 95: Ultrasound-Guided Aspiration of a Right Shoulder Spinoglenoid Notch Cyst: A Case Report

Abstract

Setting: Outpatient clinic. Patient: A 35-year-old man with right shoulder pain. Case Description: The patient presented with a 6-week history of achy, nonradiating, posterior right shoulder pain. The pain primarily occurred with running and was limiting his training for an upcoming triathlon. Physical examination demonstrated mild infraspinatus atrophy, 3/5 strength with external rotation, and multidirectional laxity, which was most pronounced posteriorly at 3+. An ultrasound examination of the right shoulder demonstrated a large, well-defined 2.4×1.4×2.4cm simple cyst located in the spinoglenoid notch that deformed the overlying infraspinatus muscle. The cyst appeared to be arising from the posterior glenohumeral joint. Electromyography showed an acute to subacute right suprascapular neuropathy distal to the branch to the supraspinatus. Because the patient was hoping to participate in a triathlon in 1.5 weeks, it was decided to attempt to aspirate the cyst. Therefore, using ultrasound guidance, an 18-gauge spinal needle was advanced from a lateral-to-medial approach and penetrated the cyst. Aspiration produced 3.5mL of typical ganglionic fluid, which resulted in an approximately 50% reduction in the size of the cyst. Assessment/Results: The patient was able to complete the triathlon and was not limited by shoulder pain. Magnetic resonance imaging was performed following the triathlon and showed a 2.5×0.9cm lobulated ganglion cyst in the spinoglenoid notch with a moderate-sized posterior labral tear. The patient subsequently underwent right shoulder arthroscopy with cyst decompression and posterior superior labral repair. Discussion: This case illustrates the use of musculoskeletal ultrasound for both diagnostic and interventional purposes in the shoulder. The use of ultrasound in the presented case helped to provide an accurate, timely diagnosis and treatment of a difficult clinical problem. Conclusions: Musculoskeletal ultrasound is a useful tool for both diagnostic and interventional purposes.