Shoulder Pain - Triathlon

Abstract

HISTROTY: A 35-year-old male triathlete presented with a six-week history of right posterior shoulder pain and weakness. He had originally injured his shoulder while reaching behind his head to elevate the head-rest on a car seat. At that time, he experienced the sudden onset of posterior shoulder pain, which has continued with minimal improvement. He has been training for an upcoming triathlon and notices the pain most when running. He is relatively pain-free with cycling and swimming, though he feels the shoulder is weak during swimming. He has also noted profound weakness with external rotation of the right shoulder during daily activities. He denies previous shoulder problems, numbness/tingling, or other weakness in the right upper limb. PHYSICAL EXAMINATION: Slight infraspinatus atrophy. Mild tenderness over the posterior glenohumeral joint. Shoulder motion was normal and non-provocative. Moderate (3/5) weakness with resisted external rotation. Negative Hawkins Neer's, O'Brien's, Speed's, and Scarf tests. Negative Spurling's maneuver. Multidirectional laxity present in the shoulders bilaterally. Neurovascular examination was normal. DIFFERENTIAL DIAGNOSIS: Spinoglenoid notch cyst (secondary to labral tear) causing partial suprascapular neuropathy Infraspinatus tear Cervical radiculopathy Parsonage Turner Syndrome/Brachial plexopathy TEST AND RESULTS: Ultrasound of right shoulder: -Moderate spinoglenoid notch cyst deforming the infraspinatus. No evidence of rotator cuff tear. EMG: -Subacute right suprascapular neuropathy distal to the branch to the supraspinatus, with minimal uncompensated denervation. MRI (post-triathlon): -Moderate-sized posterior labral tear with a small adjacent paralabral cyst. 2.5 × 0.9 cm lobulated ganglion cyst in the spinoglenoid notch with mild edema along the anterior belly of the infraspinatus muscle. FINAL WORKING DIAGNOSIS: Right posterior shoulder spinoglenoid notch cyst (secondary to posterior labral tear) with suprascapular neuropathy. TREATMENT AND OUTCOMES: Ultrasound-guided aspiration of right shoulder spinoglenoid notch cyst for symptomatic relief prior to triathlon. Subsequent right shoulder arthroscopic cyst decompression with posterior superior labral repair (after triathlon).