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| IMAGE QUIZ ARCHIVE | ||||||
| Image Quiz | ||
| Pain and Weakness of the Shoulder in a Young Man1 (continued) |
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 Fig. 1 |
Answer: Fig. 1. An axial T2-weighted fast-spin-echo image, with the patient lying prone, demonstrated a 1.3-cm glenoid labral cyst (open arrow) in the spinoglenoid notch. Note the abnormal signal in the denervated infraspinatus muscle (closed arrow). H = humeral head, C = coracoid process, and S = scapular spine. For larger view, click on image |
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| Discussion | ||
| Suprascapular neuropathy is an uncommon cause of shoulder discomfort and disability. It most commonly results from acute trauma or from overuse of the shoulder due to repetitive movements that exert traction on the suprascapular nerve as it passes through the suprascapular or the spinoglenoid notch. Less commonly, mass lesions at either the suprascapular or the spinoglenoid notch may compress the nerve as it passes through these locations. | ||
| Glenoid labral cysts, which are ganglion cysts of the shoulder, can cause entrapment of the suprascapular nerve, resulting in shoulder pain and muscle weakness. Treatment for compression of the infraspinatus branch of the suprascapular nerve has included rest, nonsteroidal anti-inflammatory medication, and physical therapy; open excision of the cyst; arthroscopic decompression of the ganglion and repair of the posterior-superior capsulolabral complex; and ultrasound or computed tomography-guided aspiration. | ||
| While mass lesions are an uncommon cause of suprascapular nerve compression, glenoid labral cysts are the most common of the mass lesions reported to cause this abnormality. Antoniadis et al., in a report of twenty-eight consecutive cases of suprascapular neuropathy in twenty-seven patients who were seen over a ten-year period, described only three cases of mass lesions causing nerve compression; all of the lesions were ganglia and were in the spinoglenoid notch. Fritz et al. reported on twenty-six patients who had suprascapular nerve compression caused by mass lesions that were identified by magnetic resonance imaging. Twenty patients (77%) had a glenoid labral cyst, five (19%) had a malignant soft-tissue mass, and one (4%) had a hematoma secondary to a scapular fracture. Glenoid labral cysts may also be present without suprascapular nerve compression. Fritz et al. found one glenoid labral cyst in twenty-five asymptomatic, healthy subjects who had unilateral magnetic resonance imaging. | ||
| A total of sixty-three glenoid labral cysts were reported in sixty-two patients in three series. The mean age of the patients was thirty-six years (range, sixteen to sixty-eight years). The cysts were much more common in men (89%) than they were in women (11%). In two of these studies, the maximum cyst diameter was between 3 and 70 mm. The mean cyst diameter, reported in one study, was 11 mm. Forty-nine cysts (78%) were located in the spinoglenoid notch; three (5%), in the suprascapular notch; four (6%), in both the suprascapular and the spinoglenoid notch; and seven (11%), at another site. | ||
| Some authors have suggested that there may be a causal relationship between glenoid labral cysts and glenoid labral tears. | ||
| References | ||
| 1. Winalski CS, Robbins MI, Silverman SG, Davies JAK. Interactive magnetic resonance image-guided aspiration therapy of a glenoid labral cyst: a case report. J Bone Joint Surg Am. 2001;83:1237-42. | ||
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