Spinoglenoid Notch Cyst Research Articles

Shoulder Weakness- Basketball And Weight Lifting

HISTORY: A 32-year-old left handed male with history of two left shoulder dislocations in 2011, managed conservatively, presented to the outpatient sports medicine clinic for evaluation of acute left shoulder weakness. Four days prior he was playing basketball and noted consistently short shots with air balls despite adjustments. Thereafter, he noted left shoulder instability and unsteadiness with front to side lateral shoulder raises, overhead lifting program, and difficulty tightening his belt. The 2-3 months prior he had noted mild dull, achy pain over his left posterolateral shoulder mainly with shoulder presses and running 2-3 miles. PHYSICAL EXAMINATION: Exam demonstrated normal cervical spine range of motion and palpation. Reflexes, sensation, and strength of bilateral upper extremities were normal except for 4-/5 external rotation strength on the left. Bilateral shoulder range of motion was normal. On the left, O’Brien’s, Hawkins, and load and shift were positive. DIFFERENTIAL DIAGNOSIS: . Shoulder labral tear2. Rotator cuff tear3. Brachial neuritis 4. Cervical radiculopathy TESTS AND RESULTS:Left shoulder US:-Glenohumeral joint effusion-Posterior labral tear-Prominent spinoglenoid notch paralabral cyst Left Shoulder MRI:-Posteroinferior glenoid labral tear -Two paralabral cysts. Largest extending into spinoglenoid notch abutting the suprascapular neurovascular bundle, but no supraspinatus or infraspinatus atrophy or edema-Diffuse teres minor muscle edema, which could reflect traction of terminal axillary nerve muscular branch to teres minorLeft upper extremity EMG/NCS-Nerve conduction studies were normal-Needle EMG of deltoid, triceps, biceps, FDI, FCR, and infraspinatus were normal. Teres minor showed evidence of axonal injury, no active denervation, and likely early neurogenic reinnervation. FINAL/WORKING DIAGNOSIS: Neurogenic quadrilateral space syndrome with axillary nerve injury and reinnervation TREATMENT AND OUTCOMES: 1. Meloxicam 15 mg daily for seven days 2. US guided spinoglenoid notch cyst aspiration and steroid injection (done prior to EMG/NCS) 3. Paused upper body weight lifting and running for 1 month 4. Initiated posterior capsule stretching and external rotation strengthening program with improved strength and pain

Do not forget the brachial plexus-prevalence of distal brachial plexus pathology on routine shoulder MRI.

Most of the shoulder magnetic resonance imaging (MRI) examination focuses on internal joint structures but disregarding other structures like the distal brachial plexus, which may miss important findings. Hereby, we attempt to evaluate the prevalence of distal brachial plexus abnormalities and/or muscular denervation changes seen on routine shoulder MRI examinations and discuss common pathologies affecting the distal brachial plexus. A total of 701 routine shoulder MRI studies were evaluated. The evaluation of each exam was focused on the visualized brachial plexus elements and musculature abnormalities in each case. If any abnormalities of plexus and/or musculature were found, potential underlying etiologies such as paralabral or spinoglenoid notch cysts, infiltrative/primary masses on imaging, history of prior viral illness, and radiation therapy were searched. It was then confirmed whether the abnormal findings were mentioned in the exam reports or not. Thirty-four cases (4.85%) demonstrated abnormal findings of the visualized brachial plexus cords or branches and/or musculature. It was observed that in 35.3% of exam reports these findings were not mentioned, mainly missing subtle nerve abnormalities, but correctly reporting and interpreting the encountered muscle abnormalities. The distal brachial plexus and its branches should be included in the search pattern for shoulder MRI examinations. • Normal T2 signal of the brachial plexus is iso- to slightly hyperintense to muscle but less signal intense than fluid. • Diffuse, geographic muscle edema is an indirect sign of brachial plexus pathology. • Increased T2-weighted nerve signal with or without caliber or course change should be reported and followed up to find the underlying etiology.

Arthroscopic Decompression of Spinoglenoid Notch Cyst and SLAP Repair Through a Single Working Portal

A SLAP lesion can be found with a concomitant spinoglenoid notch cyst. The cyst can cause suprascapular nerve compression, resulting in shoulder pain and weakness of external rotation. Their management varies from conservative treatment to operative treatment. Cyst decompression through the labral tear is our preferred treatment. Previous studies demonstrated a good result after arthroscopic decompression of the cyst through the labral tear combined with SLAP repair. Many surgeons usually use 3 portals to perform this procedure. However, we prefer to use only 2 portals, 1 anterior viewing portal and 1 posterior working portal. This strategy is more time and cost efficient. The patient is positioned in lateral decubitus. The SLAP lesion is demonstrated by using a probe. Tissue elevator is inserted into the labral lesion to penetrate into the cyst wall. A soft anchor is placed. A birdbeak suture passer penetrates the posterior labrum. Then knot tying is done. The advantages of this single working portal technique are short operative time, a decreased risk of iatrogenic rotator cuff injury from accessory anterolateral portal or posterior labral injury from posterolateral portal, and avoiding unnecessary superior capsule incision for cyst exposure.

Clinical treatment of suprascapular nerve compression syndromes via posterior portal by arthroscopic decompression of spinoglenoid notch cysts and release of suprascapular nerve

Objective To investigate the clinical outcomes of arthroscopic decompression of spinoglenoid notch cysts and release of suprascapular nerve in treating suprascapular nerve compression syndromes via posterior portal. Methods Eleven patients from January 2010 to January 2017 with spinoglenoid notch cysts complicated suprascapular nerve compression syndromes were included. There were 7 males and 4 females with the average age of 41.5±5.3 years old (range 29-56 years) with 3 patients left side involved and 8 right side. All patients were diagnosed with MRI and EMG. The surgical procedure began with posterior capsule arthroscopic releasement from the labrum, then found the spinoglenoid notch cyst. Split of the cyst was made for internal drainage, then found the suprascapular nerve and vessel bundle for clearing the bursal tissue with probe, decompressed the suprascapular nerve finally. Mecobalamin was taken (0.5 mg, tid) until 3 months postoperatively. The patients were evaluated by functional scores from American Shoulder Elbow Surgeons (ASES) and Constant-Murley preoperatively and postoperatively. Statistical analysis was conducted by student t-test. Results All patients were followed up at 7-15 months (with an average of 10 months). The mean preoperative ASES score increased from 46.5±3.7 to 93.8±2.2 at the time of final follow-up with the significant difference (t=3.359, P<0.05). Preoperative ASES score were good in 5 cases, fair in 4 cases and poor in 2 cases. The postoperative score were excellent in all patients. The Constant-Murley score was 47.3±4.2 preoperatively and 94.0±1.8 postoperatively with significant difference (t=4.776, P<0.05). Preoperative score were good in 6 cases and fair in 5 cases. The postoperative score were excellent in all patients. These patients had no recurrence of cyst after surgery and returned to work. Conclusion Arthroscopic decompression of spinlglenoid notch cyst and suprascapular nerve release via posterior portal can successfully treat suprascapular nerve compression syndrome resulting in spinoglenoid notch cyst. Key words: Shoulder; Arthroscopy; Cysts; Nerve compression syndromes

Outcomes of Arthroscopic Decompression of Spinoglenoid Cysts Through a Subacromial Approach

To describe a spinoglenoid cyst decompression technique through a subacromial approach and its clinical outcomes after 2years of follow-up. From March 2008 to October 2013, 26 patients underwent arthroscopic decompression of a spinoglenoid ganglion cyst with and/or without superior labral anterior to posterior repair, and patients who were available for minimum of 2years of follow-up were included. For functional assessments, the visual analog scale (VAS) pain score, subjective shoulder value (SSV), University of California at Los Angeles (UCLA) shoulder score, American Shoulder and Elbow Surgeon (ASES) score, and shoulder active range of motion were used to compare preoperative and postoperative follow-up values. Follow-up magnetic resonance arthrography was taken at 6months postoperatively to evaluate incomplete decompression or recurrence of the cyst. In total, 21 patients were included in this study. At the 2-year follow-up, the VAS, SSV, ASES, and UCLA shoulder scores significantly improved compared with preoperative values (P < .001): VAS improved from 3.5 to 0.7 (P < .001); SSV improved from 62.9 to 93.1 (P < .001); ASES score improved from 64.3 to 94.4 (P < .001); UCLA shoulder score improved from 21.6 to 32.9 (P<.001). Also, active forward flexion improved from 153° to 158° (P= .014), and external rotation improved from 55° to 57° (P= .042) significantly, with the exception of internal rotation. The follow-up magnetic resonance arthrography was performed in 18 patients (86%), and there was no recurrence of the spinoglenoid notch cyst. For spinoglenoid cyst decompression, the subacromial approach was found to be effective, yielding satisfactory clinical outcomes without recurrence. Level IV, therapeutic case series.

The effect of infraspinatus hypotrophy and weakness on the arthroscopic treatment of spinoglenoid notch cyst associated with superior labrum anterior-to-posterior lesions

Patients with spinoglenoid notch cyst associated with superior labrum anterior-to-posterior (SLAP) lesions were evaluated. The patients were all treated by arthroscopic cyst decompression combined with SLAP repair. The hypothesis of the study was that the patients who underwent prolonged conservative treatment period prior to surgery would exhibit significant infraspinatus hypotrophy and weakness, and their postoperative clinical and functional outcomes would be less satisfactory. Sixteen patients exhibited positive MRI and EMG findings with clinical signs of weakness and pain. The median age was 40.5years (range 32-52), and the study group consisted of 11 males and 5 females with a median follow-up period of 26months (12-48). The median duration of symptoms and conservative treatment prior to the surgical intervention was 3.5months (1-14). Seven patients in group A exhibited infraspinatus hypotrophy. Group B comprised 9 patients without infraspinatus hypotrophy. The results of the pre- and postoperative Constant scores, visual analogue scale (VAS) scores, and external rotation strength test rates were compared between groups. They all improved in terms of pain, strength, and function (P<0.05). Significant differences were observed between the pre- and postoperative external rotation strengths and Constant scores (P<0.05). However, no significant difference was observed between the pre- and postoperative VAS scores (n.s.). A significant correlation was observed in group A between surgical timing, the preoperative external rotation strength ratio (P=0.04) and the postoperative VAS scores (P=0.013). The arthroscopic treatment was satisfactory with good clinical outcomes. Infraspinatus hypotrophy occurred in cases of prolonged surgical duration and significantly affected external rotation strength and functional outcomes. Retrospective comparative study, Level III.

Arthroscopic Decompression of the Suprascapular Nerve at the Spinoglenoid Notch and Suprascapular Notch Through the Subacromial Space

Suprascapular nerve entrapment can cause disabling shoulder pain. Suprascapular nerve release is often performed for compression neuropathy and to release pressure on the nerve associated with arthroscopic labral repair. This report describes a novel all-arthroscopic technique for decompression of the suprascapular nerve at the suprascapular notch or spinoglenoid notch through a subacromial approach. Through the subacromial space, spinoglenoid notch cysts can be visualized between the supraspinatus and infraspinatus at the base of the scapular spine. While viewing the subacromial space through the lateral portal, the surgeon can use a shaver through the posterior portal to decompress a spinoglenoid notch cyst at the base of the scapular spine. To decompress the suprascapular nerve at the suprascapular notch, a shaver through the posterior portal removes the soft tissue on the acromion and distal clavicle to expose the coracoclavicular ligaments. The medial border of the conoid ligament is identified and followed to its coracoid attachment. The supraspinatus muscle is retracted with a blunt trocar placed through an accessory Neviaser portal. The transverse scapular ligament, which courses inferior to the suprascapular artery, is sectioned with arthroscopic scissors, and the suprascapular nerve is decompressed.

Shoulder Pain - Triathlon

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).

Spontaneous resolution of a spinoglenoid notch cyst and associated suprascapular nerve palsy: A case report

Spontaneous resolution of a spinoglenoid notch cyst and associated suprascapular nerve palsy: A case report

Arthroscopy Effectively Treats Ganglion Cysts of the Shoulder

In the hands of an experienced arthroscopist, arthroscopic decompression of a spinoglenoid notch cyst can lead to resolution of a patient's symptoms and complete functional recovery. In our study, we hypothesized that patients with a spinoglenoid notch cyst who were treated arthroscopically would have return to near normal function of their shoulders and that the outcomes for patients with a spinoglenoid notch cyst and associated labral tears would be no different than the outcomes for patients with a spinoglenoid notch cyst without associated labral tears. We retrospectively evaluated 18 consecutive patients who were treated arthroscopically for a spinoglenoid notch cyst. Nine had isolated arthroscopic decompression, and nine arthroscopic decompression with a labral repair. We used the validated American Shoulder and Elbow Society (ASES) and University of Pennsylvania (Penn) shoulder scores to evaluate patients' outcomes. We found improvements in the postoperative ASES and Penn shoulder scores for all outcomes measured including pain, satisfaction, and function. However, there were no differences in outcome when comparing the group that had decompression with the group that had decompression and labral repair for an associated superior labral anterior posterior tear. Therapeutic study, Level III (retrospective cohort study). See the Guidelines for Authors for a complete description of levels of evidence.

Clinical evaluation and treatment of spinoglenoid notch ganglion cysts

Spinoglenoid notch cysts were identified by magnetic resonance imaging in 73 patients. Posterosuperior labral tears were identified in 65 patients who had spinoglenoid notch cysts. Patient follow-up was available on 88% of patients at a mean of 20.5 months after treatment. There were 52 men and 11 women, with a mean age of 39 years (range, 19-76 years). All patients reported shoulder pain. Infraspinatus atrophy occurred in 25 patients, weakness with external rotation in 43, and posterior shoulder tenderness in 30. Nineteen patients underwent nonoperative management of the cyst (group I). Eleven underwent attempted needle aspiration of the cyst (group II). Six had isolated arthroscopic treatment of a labral defect with no cyst excision (group III). Twenty-seven were treated with surgical cyst excision with the cyst and superior labral tear fixed arthroscopically or with an open approach in various combinations (group IV). Of the patients, 53% were satisfied in group I, 64% in group II, 67% in group III, and 97% in group IV. (J Shoulder Elbow Surg 2002;11:600-4)

Suprascapular Neuropathy

The functional outcome of operative and nonoperative treatment of suprascapular neuropathy was compared to determine the preferred method of treatment for each etiology of nerve injury. The predictive value of preoperative electromyography also was studied. Fifty-three patients were evaluated at least 1 year (average, 28 months) from the time of operative (n = 36) or nonoperative (n = 17) treatment. A modified American Shoulder and Elbow Surgeons self-assessment score was obtained at presentation and at final followup. Electromyography data were obtained at initial presentation. Minimal electromyographic changes associated with denervation were associated with a limited response to treatment, especially in patients with nerve compression secondary to spinoglenoid notch cysts. Pretreatment electromyographic findings, therefore, were predictive of treatment response. Overall, operative and nonoperative treatment of these suprascapular nerve injuries resulted in significant functional improvement, but the results varied depending on the etiology of the injury. Spinoglenoid notch cysts responded significantly better to operative treatment, with the results for open surgery being the same as the results for arthroscopic decompression. In addition, compressive lesions attributable to suprascapular notch entrapment had the best improvement with surgical decompression. Traumatic lesions, including traction and direct closed injuries, had an equal response to operative and nonoperative treatment. Overuse injuries did not improve with operative treatment. Viral neuritis improved with nonoperative treatment and never was treated with surgery. Overall, traumatic injuries resulted in significantly worse final outcomes than any other etiologic processes. In the nonoperative group, neuropathy secondary to spinoglenoid cysts resulted in significantly worse function. The outcome of treatment is dependent on the severity and etiology of the nerve injury, and the method of treatment.