Introduction:A spinoglenoid cyst is a ganglion cyst that compresses the suprascapular nerve in the spinoglenoid notch. On failure of the conservative treatment, surgical decompression is the treatment of choice. The arthroscopic method helps to decompress the cyst intra-articularly through the labral tear and also allows repair of the labral tear. This study aims to bring out the functional outcome of arthroscopic Spinoglenoid Cyst Decompression with labral repair.Materials and Methods:This study is a case series of eight symptomatic Spinoglenoid cysts with labral tears which were treated with arthroscopic cyst decompression and labral repair over 5 years from January 2018 to December 2023. The American Shoulder and Elbow Surgeon’s score (ASES), Constant Murley (CM) score, and Visual Analog Score (VAS) were used to assess the patients preoperatively and postoperatively at regular intervals.Results:All the patients had good to excellent results. There was a significant improvement in the ASES from a mean pre-operative 61.5 to a mean 1-year follow-up of 90.3, while the CM score improved from a mean pre-operative 66.8% to a mean 1-year follow-up of 93.4%. The VAS decreased from a mean pre-operative 6.3 to a mean 1-year follow-up of one.Conclusion:Spinoglenoid Cyst is usually seen in individuals and athletes who are involved in an overhead activity. Arthroscopic decompression of the cyst and labral repair is a simple and effective treatment and gives excellent functional outcomes.

Spinoglenoid notch cyst: An unusual cause of atrophy – A case report and literature review

Suprascapular neuropathy caused by spinoglenoid notch cysts (SGNCs) is a rare condition with unclear etiology, typically presenting with significant shoulder pain and weakness. This case report describes two patients who underwent arthroscopic decompression and cyst excision: one with a labral lesion and the other with an isolated cyst. The patient with labral involvement was treated via the labral repair approach, while the patient without labral pathology underwent a direct decompression of the cyst through the subacromial space. Both patients experienced progressive pain relief and functional recovery during follow-up. This study highlights the safety and effectiveness of arthroscopic management for SGNCs and recommends a tailored surgical approach depending on the presence or absence of labral lesions.

Evaluation of the Baseplate Position and Screws in Reverse Total Shoulder Arthroplasty Using 3D Printed Patient‐Specific Instrumentation

Shoulder pain and weakness present a complex clinical landscape, often originating from common aetiologies such as rotator cuff tears, tendinitis and joint osteoarthritis. However, the significance of suprascapular nerve injury, particularly when associated with entrapment by ganglion cysts at specific notches, should not be ignored. This is exemplified by the case of a 22-year-old semiskilled labourer who presented with right shoulder pain for two years, which began after trauma. He experienced muscle weakness and joint line tenderness and was diagnosed with a ganglion cyst in the spinoglenoid notch, causing suprascapular neuropathy. He subsequently underwent open decompression. This case emphasises the need to consider uncommon causes in shoulder diagnostics. Diagnostic tools such as Magnetic Resonance Imaging (MRI), Electromyography (EMG) and Nerve Conduction Studies (NCS) play crucial roles in identifying and evaluating suprascapular nerve dysfunction. While conservative management involving rest, physiotherapy and Non Steroidal Anti-Inflammatory Drugs (NSAIDs) is often the initial approach, surgical interventions, including percutaneous aspiration, open excision, or arthroscopic decompression, may be warranted in cases of non responsivenes or the presence of space-occupying lesions. This positive postoperative outcome underscores the effectiveness of timely surgical intervention when conservative measures prove insufficient. The case contributes valuable insights into the understanding and management of suprascapular nerve injuries, highlighting the necessity of a comprehensive approach for optimal patient outcomes.

Background: Suprascapular neuropathy is an uncommon but treatable cause of shoulder pain and dysfunction. The tortuous course of the suprascapular nerve puts it at risk for entrapment, particularly at the suprascapular and spinoglenoid notches. This video presents a reproducible method for suprascapular nerve decompression at the suprascapular notch. Indications: Massive rotator cuff tears, compressive masses, or ligament hypertrophy warrants prompt intervention to prevent subsequent denervation in the face of suprascapular neuropathy. In the absence of these pathologies, a trial of conservative management is advised. Patients who have unsuccessful conservative management and evidence of worsening weakness, atrophy, and denervation by electromyography are indicated for surgical intervention. Technique Description: Standard posterior, anterior, lateral, and anterolateral portals are established. The subdeltoid space is dissected following the coracoacromial (CA) ligament to the base of the coracoid to identify the transverse scapular ligament. In the presented case, the CA ligament has been debrided from a previous surgery, so an intra-articular approach was employed, opening the rotator interval to reach the base of the coracoid. A Neviaser portal is made for blunt dissection around the suprascapular notch, with care taken to protect the neurovasculature. A second medial Neviaser portal is used to pass a Kerrison to release the transverse scapular ligament. Nerve adhesions are then gently released with a probe. Results: A systematic review of 276 suprascapular nerve decompressions demonstrated good outcomes in terms of pain relief and function, and all athletes in the review returned to sport. A case series of 112 arthroscopic decompressions at the suprascapular notch found that patients achieved significant improvement in pain and strength, and none resulted in serious complications. These outcome studies support a level 4 video publication level of evidence. Discussion/Conclusion: The presented arthroscopic decompression technique treats suprascapular nerve entrapment at the suprascapular notch. Patients can expect to achieve a satisfactory outcome. Patient Consent Disclosure Statement: The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.

This study aims to describe and evaluate the arthroscopic technique for decompressing spinoglenoid notch cyst (SGNC) using a single posterior working portal. From January 2010 to March 2022, 20 patients with SGNC who were available for a minimum of 2years of follow-up were included. All surgical procedures involved suprascapular nerve (SSN) decompression via a posterior portal. Preoperative and postoperative assessments included the visual analog scale (VAS), Constant-Murley Shoulder Score (CS), American Shoulder and Elbow Surgeon (ASES) score, magnetic resonance image (MRI) and electromyogram (EMG). MRI and EMG were performed at 6months postoperatively. All 20 patients were included in this study. The mean follow-up period was 32.5 ± 11.71months. The VAS improved from 4.50 ± 3.11 to 1.50 ± 0.50 (P < .001), the mean CS improved from 40.80 ± 14.89 to 88.30 ± 7.51 (P < .001), and the mean ASES score improved from 50.51 ± 10.62 to 87.80 ± 6.95 (P < .001) at the last follow-up. Postoperative MRI and EMG at 6months revealed complete symptomatic remission in all 20 cases. Patient satisfaction with the surgery was good to excellent in 19 patients. Arthroscopic decompression of the SGNC through a single posterior working portal is a simple, straightforward and effective technique that ensures visualization while preventing potential damage to the SSN.

The suprascapular nerve is inherently vulnerable to entrapment, as it is relatively constrained by its surrounding anatomy: proximally crossing the suprascapular notch; or more distally over the spinoglenoid notch. Despite this, suprascapular nerve entrapment is relatively uncommon, and has until recently been an underappreciated cause of shoulder pain and dysfunction. Aetiology is typically due to traction or compression nerve injury, and a number of high-risk variants in anatomy have now been described. The symptoms are best investigated with magnetic resonance imaging and electrodiagnostic evaluation, with X-ray, ultrasound and CT scans useful in excluding common differential diagnoses, and possible future roles for MR neurography and diagnostic suprascapular nerve block. The majority of patients respond well to non-operative management, with a multimodal non-operative approach thought to optimise outcomes. The role of neuromodulation in non-operative management continues to evolve, but has shown promising early results. For patients with a clear compressive structural lesion, or where symptoms are refractory to non-operative management, surgery is required. There are now well-established techniques for both arthroscopic and open approaches to suprascapular and spinoglenoid decompression. Outcomes from isolated suprascapular nerve decompression have been consistently impressive, but the use of suprascapular nerve decompression as an adjunct to associated rotator cuff repair or stabilisation procedures had been observed to attracted a relatively high rate of complication, prompting speculation that it may be advisable to maintain a high threshold for adjunct nerve decompression procedures: where there is known suprascapular nerve neuropathy or the presence of high-risk anatomical variants.

Shoulder pain in young patients can be caused by various conditions such as tendinitis, bursitis, capsulitis, and labral tears. Superior labrum anterior to posterior (SLAP) tears can sometimes be associated with a paralabral cyst, which can compress the suprascapular nerve and cause isolated weakness of the infraspinatus muscle and present as shoulder pain. A detailed examination and proper investigation can help in early diagnosis of such cases. Arthroscopic decompression and SLAP repair lead to complete recovery and excellent outcomes in such patients. We had four young patients who presented to our clinic with a history of shoulder pain and difficulty performing overhead activities. Upon examination, all four exhibited painful active shoulder range of motion and isolated infraspinatus muscle weakness. Magnetic resonance imaging (MRI) was obtained as part of a routine investigation, revealing SLAP tears with paralabral glenoid cysts compressing the suprascapular nerve at the spinoglenoid notch. MRI also indicated signs of denervation in the infraspinatus muscle in all patients. All patients underwent arthroscopic labral repair with intra-articular decompression of the paralabral cyst. Post-surgery rehabilitation commenced with simple pendulum exercises, followed by periscapular and rotator cuff strengthening exercises. All four patients showed excellent recovery at follow-up, with painless active shoulder range of motion and regained full power of the infraspinatus muscle with return to sports by 6 months. Labral tears associated with paralabral cysts can present with isolated infraspinatus weakness due to suprascapular nerve compression at the spinoglenoid notch. A high index of suspicion and thorough clinical examination are required to identify these patients. Early detection and treatment with intra-articular cyst decompression with labral repair followed by a thorough rehabilitation program led to complete recovery in these cases.

Introduction: To describe and evaluate the arthroscopic spinoglenoid notch cyst (SGNC) decompression technique through a single posterior working portal. Methods: From January 2010 to March 2022, 20 patients of SGNC were included who were available for minimum of 2 years of follow-up. All surgical procedures were conducted with a suprascapular nerve decompression via posterior portal. For assessments, the visual analog scale (VAS), Constant-Murley shoulder score (CS), American Shoulder and Elbow Surgeon (ASES) score, magnetic resonance image (MRI) and electromyogram (EMG) were used to compare preoperative and postoperative at follow-up. MRI and EMG were taken at 6 months postoperatively. Results: All 20 patients were included in this study. Mean follow-up was 32.5 ± 11.71 months. The VAS improved from 4.5 ± 3.1 to 1.5 ± 0.50 (P &lt; .001), the mean CS improved from 40.8 ± 14.89 to 88.3 ± 7.51 (P &lt; .001), and the mean ASES score improved from 50.5 ± 10.62 to 87.8 ± 6.95 (P &lt; .001) at last follow-up. The postoperative MRI and EGM performed at a mean of 6 months for all 20 cases revealed complete symptomatic remission. The satisfaction level with surgery was good to excellent in 19 patients. Conclusion: For treatment of SGNC, arthroscopic decompression through single posterior portal was found to be a simple and effective method, maximizes visualization and reduces possible damage to the suprascapular nerve.

The suprascapular nerve corresponds to one of the supraclavicular branches of the brachial plexus, and its route exposes it to being injured during some surgical procedures. Morphometric analysis of the scapula has been proposed as a tool for preventing injuries to the suprascapular nerve. The present investigation aimed to determine the safe distances for approaching the suprascapular nerve at the level of the scapular notch (SPN) and spinoglenoid notch, in addition to establishing its relationship with the type of SPN and with two scapular dimensions: major longitudinal axis (MLA) and major transverse axis (MTA). For this purpose, a descriptive-correlative, quantitative, non-experimental and transversal study was carried out, in which 82 dry scapulae from adult individuals of Chilean origin were investigated. The main results of this study found that prevalences were highest for SPNs types II (36.2%), I (29.3%), and III (26.0%), with average distances that were considered safe in all types of SPNs. Furthermore, there was a positive correlation, with P<0.05, between the MTA (r=0.526; r=0.634), MLA (r=0.284) and the safe distances for the suprascapular nerve at the level of the SPN and incisura spinoglenoid of the scapulae studied. Scapular dimensions such as the MTA and the MLA could, therefore, be used to predict a safe zone for the suprascapular nerve, potentially contributing to a reduction in the current rate of injury of the suprascapular nerve in surgical procedures involving the deltoid and scapular regions.

Background: Paralabral cysts at the spinoglenoid notch are rare disorders that can potentially lead to compressive suprascapular neuropathy. Given their infrequency, a standard treatment protocol has not yet been established. Hypothesis/Purpose: This study aimed to assess changes in the infraspinatus muscle using magnetic resonance imaging (MRI) and to compare the outcomes of 2 different surgical methods. It was hypothesized that surgical intervention could alleviate compressive neuropathy, with comparable outcomes between the 2 surgical approaches. Study Design: Cohort study; Level of evidence, 3. Methods: This retrospective review encompassed 43 patients undergoing arthroscopic labral repair for a paralabral cyst at the spinoglenoid notch, with cyst decompression (27 patients; labral repair with cyst decompression [LRCD] group) or without cyst decompression (16 patients; labral repair only [LRO] group). Preoperative MRI focused on evaluating the condition of the infraspinatus and teres minor muscles. Electromyography (EMG) was conducted on 36 patients (21 in LRCD and 15 in LRO) to assess suprascapular nerve function. Postoperative evaluations were performed in 35 patients at postoperative 1 year, excluding those lost to follow-up. Postoperative MRI findings (24 patients in LRCD and 11 patients in LRO) and functional outcome scores including recovery of external rotation power were compared with preoperative status in both groups. Results: Preoperative MRI revealed denervation changes or atrophy of the infraspinatus in 26 of the 43 patients (60.4%). Among the 36 patients who underwent preoperative EMG, 21 patients (58.3%; 13 patients in LRCD and 8 patients in LRO) showed evidence of suprascapular neuropathy. A discrepancy between EMG and MRI findings was noted in 10 patients, with 5 patients showing suprascapular neuropathy according to EMG despite normal muscle status on MRI scans, and the remaining 5 vice versa. Notable atrophy of the infraspinatus was seen in 6 patients and teres minor hypertrophy in 5 patients, all of whom exhibited concurrent infraspinatus atrophy. Postoperatively, cyst disappearance was observed in all cases in both LRCD (24 patients) and LRO (11 patients) groups. Denervation changes in the infraspinatus were resolved in all patients. In patients with infraspinatus atrophy, some improvement was noted. Teres minor hypertrophy persisted in 2 of 4 patients. Improvements were similar in both groups (all P > .05). External rotation power improved postoperatively in both groups (from 39.1 ± 18.6 to 50.6 ± 17.7 N in LRCD, P < .001; from 45.1 ± 16.0 to 54.2 ± 10.7 N in LRO, P = .025). Conclusion: Both LRCD and LRO surgical approaches appear to be effective for paralabral cysts at the spinoglenoid notch. Suprascapular neuropathy can be successfully addressed by both methods. However, conditions with severe infraspinatus atrophy and teres minor hypertrophy warrant further investigation in larger series.

Objective: A spinoglenoid cyst represents a distinctive clinical entity within the realm of shoulder pathology, characterized by the development of a cystic structure in the spinoglenoid notch. Situated in the intricate anatomy of the shoulder, this cyst often involves compression of the suprascapular nerve, introducing a spectrum of symptoms that range from localized discomfort to functional impairment. As an area of increasing interest in orthopedic and neurological literature, the spinoglenoid cyst poses diagnostic and therapeutic challenges. Case: Patient 1: A 31-year-old male presented with right shoulder pain and a positive Hawkins sign. He had a history of bicipital tendinitis. T2-weighted MRI (T2WI) showed a hyperintense 14x16mm spinoglenoid cyst. Patient 2: Another 31-year-old male presented with shoulder pain, positive Hawkins and Neer signs, and pain induced upon shoulder range of motion. T2-weighted MRI (T2WI) revealed a 16x11mm hyperintense ganglion cyst with hypointense septae. Patient 3: A 42-year-old male presented with shoulder pain that started a month ago. He had a history of rotator cuff syndrome, shoulder impingement syndrome, and adhesive capsulitis in the shoulder, along with positive Hawkins and Neer signs. T2-weighted MRI (T2WI) identified a 25x15x28mm hyperintense ganglion cyst. Conclusion: The cases presented highlight the diagnostic challenges posed by spinoglenoid cysts and the importance of advanced imaging techniques, particularly MRI, in confirming their presence and understanding their characteristics. The diverse clinical manifestations, ranging from chronic shoulder pain to neurological deficits, emphasize the need for a nuanced and individualized approach to diagnosis and management.

The open Trillat Procedure described to treat recurrent shoulder instability, has a renewed interest with the advent of arthroscopy. The suprascapular nerve (SSN) is theoretically at risk during the drilling of the scapula near the spinoglenoid notch. The purpose of this study was to assess the relationship between the screw securing the coracoid transfer and the SSN during open Trillat Procedure and define a safe zone for the SSN. In this anatomical study, an open Trillat Procedure was performed on ten shoulders specimens. The coracoid was fixed by a screw after partial osteotomy and antero-posterior drilling of the scapular neck. The SSN was dissected with identification of the screw. We measured the distances SSN-screw (distance 1) and SSN-glenoid rim (distance 2). In axial plane, we measured the angles between the glenoid plane and the screw (α angle) and between the glenoid plane and the SSN (β angle). The mean distance SSN-screw was 8.8mm +/-5.4 (0-15). Mean α angle was 11°+/-2.4 (8-15). Mean β angle was 22°+/-6.7 (12-30). No macroscopic lesion of the SSN was recorded but in 20% (2 cases), the screw was in contact with the nerve. In both cases, the β angle was measured at 12°. During the open Trillat Procedure, the SSN can be injured due to its anatomical location. Placement of the screw should be within 10° of the glenoid plane to minimize the risk of SSN injury and could require the use of a specific guide or arthroscopic-assisted surgery.

BACKGROUND: Distal suprascapular nerve blocks (SSNB) can be performed at the level of the suprascapular notch (the preferred site) or at the level of the spinoglenoid notch. OBJECTIVES: To compare the efficacy and safety of spinoglenoid versus suprascapular notch approaches for ultrasound (US)-guided distal SSNB in patients with chronic shoulder pain. STUDY DESIGN: Prospective randomized controlled trial. SETTING: Outpatient physical medicine and rehabilitation outpatient clinic of a tertiary center. METHODS: Eighty patients with chronic unilateral shoulder pain were included in this study. Patients were randomized into 2 groups: group 1 (SSNB at the level of the spinoglenoid notch) and group 2 (SSNB at the level of the suprascapular notch). The patients were evaluated for pain according to the Shoulder Pain and Disability Index (SPADI) and a secondary visual analog scale (VAS), as well as for the outcome measures of range of motion (ROM) and pain pressure threshold (PPT) at baseline and at one, 4, and 12 weeks after the injection. RESULTS: Statistically significant improvement was observed in the SPADI and VAS scores and ROM measurements, and the PPT measurements were similar at all post-injection follow-ups in both groups. Changes in outcome measures were similar between the groups, except for some ROM measurements at the post-injection follow-ups. LIMITATIONS: Heterogeneity of shoulder pain etiologies. CONCLUSION: Both distal SSNB approaches significantly improved pain and disability scores in patients with chronic shoulder pain, with no observable differences in the short-to-medium term. SSNB performed at the level of the spinoglenoid notch is therefore not inferior in efficacy and safety to SSNB performed at the level of the suprascapular notch. KEY WORDS: Shoulder pain, suprascapular nerve block, spinoglenoid notch, suprascapular notch, ultrasound

Spontaneous resolution of spinoglenoid ganglion cyst: a case series

Shoulder dislocation represents a prevalent category within joint dislocation, accounting for about 40% of all joint dislocations, and anterior dislocation stands out as the prevailing type. It has been reported that in 1.6% of patients, the Latarjet procedure performed under arthroscopy involves transferring the coracoid process to the anterior-inferior aspect of the glenoid and fixing it with two bicortical screws. The tip of the screws may impinge the suprascapular nerve located behind the scapula, resulting in shoulder pain and weakness. This study was performed to analyze the risk of suprascapular nerve (SSN) injury caused by bicortical screws during arthroscopic Latarjet surgery and to identify reliable anatomical landmarks for Latarjet surgery. Dissection was conducted on 23 fresh adult intact shoulder joint specimens, and the experimental protocol complied with the hospital's ethical requirements for research. Using the glenoid clock face as a reference, the distances between the suprascapular nerve and the anterior edge of the glenoid were measured at the 12:00, 11:00, 10:00, and 9:00 positions, as well as at the level of the suprascapular notch and the level of the spinoglenoid notch. The distances between the suprascapular nerve and the narrowest point of the glenoid rim and the clock scale were recorded. The scapula was divided into three zones, and the number of nerve branches in each zone was recorded. The collected data were subjected to statistical analysis. The suprascapular nerve trunk and branches were marked using radiopaque lines, and measurements were taken at three positions in computed tomography horizontal scans: the suprascapular foramen, the spinoglenoid notch, and the point of entry of the outermost nerve branch into the muscle. The suprascapular nerve originates from the brachial plexus, passes downward and backward through the suprascapular foramen, closely adheres to the bone surface, and runs outward and downward deep to the supraspinatus muscle. The distances between the suprascapular nerve and the glenoid rim at the 12:00, 11:00, 10:00, and 9:00 positions were 335.18±2.31 mm, 28.23±3.47 mm, 22.32±2.78 mm, and 22.12±2.07 mm, respectively. There was a mean of 1.12 nerve branches in zone 1, 2.86 in zone 2, and 3.64 in zone 3. In the neutral position of the shoulder joint, the horizontal distance between point A and the axillary nerve was 27.37 (19.80, 34.55) mm, and the vertical distance was 16.67 (12.85, 20.35) mm. The use of bicortical screws, especially upper screws, for Latarjet fixation at the level of the spinoglenoid notch, is associated with the risk of suprascapular nerve injury. The narrowest distance between the glenoid rim and the suprascapular nerve was found between 9:00 and 9:30 at the glenoid clock surface. Therefore, caution should be exercised when performing any procedure related to this area. Overall, the Latarjet procedure is a reliable and effective surgical technique, providing benefits such as favorable positioning of the coracoid graft and low bone absorption rate, while also avoiding the potential for suprascapular nerve injury.

Assessment of Two Distinct Anatomical Landmarks for Suprascapular Nerve Injection: A Cadaveric Study.

BackgroundSuprascapular nerve entrapment is a rare disorder that is frequently misdiagnosed as another disease. The suprascapular nerve is commonly entrapped at the following two sites: the suprascapular and spinoglenoid notches. Nerve entrapment at the spinoglenoid notch causes infraspinatus muscle weakness and atrophy. Patients present with posterior shoulder pain and weakness. Magnetic resonance imaging is used to confirm the diagnosis of a spinoglenoid cyst and nerve compression. Open or arthroscopic aspiration or decompression is indicated for patients with cysts in whom conservative treatment has failed and those with cysts associated with suprascapular nerve compression.Case presentationHerein, we describe the case of a 49-year-old man with suprascapular nerve entrapment caused by a large cyst, namely, a hematoma, in the superior scapular and spinoglenoid notches. Open surgical decompression of the suprascapular nerve was performed owing to an intact rotator cuff and glenoid labrum.ConclusionPosterior shoulder pain promptly resolved without complications.

(1) Background: Patients with a superior-labrum-from-anterior-to-posterior (SLAP) tear associated with a spinoglenoid ganglion cyst have undergone various procedures. The purpose of this study is to evaluate clinical outcomes following arthroscopic treatment in patients with a concomitant spinoglenoid ganglion cyst and SLAP lesion. (2) Methods: This study followed PRISMA (preferred reporting items for systematic reviews and meta-analyses) guidelines, utilizing the PubMed, EMBASE, Cochrane Library, and Scopus databases. The keywords included shoulder, SLAP, labral tear, spinoglenoid notch, paralabral cyst, arthroscopy, and treatment. (3) Results: A total of 14 articles (206 patients) were included. Repair alone was administered in 114 patients (Group R), and 92 patients underwent additional cyst decompression (Group RD). Both groups showed excellent and similar clinical scores. The rate of the complete resorption of the cyst was 95.5% in Group RD, and 92.2% in Group R. The complication rate was 3.5% in Group RD, and 11.4% in Group R. The reoperation rate was 0% in Group RD, and 5.3% in Group R. (4) Conclusion: Reliable clinical outcomes without serious complications were obtained from the use of both procedures. The decompression of the cyst is a safe method that will alleviate pressure on the suprascapular nerve.