Right Shoulder Paralabral Cyst

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Right Shoulder Paralabral Cyst

Authors, Editors, Case Information Author: Cameron Taylor, DO Affiliation: Inspira Physical Medicine & Rehabilitation Residency/Rowan-Virtua School of Osteopathic Medicine Co Author(s): Tamzid Hassan, DO; Altamash Raja, DO, RMSK, CSCS Senior Editor: Nicholas Moore, MD Clinical Vignette: A 27-year-old swimmer presented with right anterolateral shoulder pain, weakness, numbness, burning, and paresthesias radiating down the anterior upper arm and medial forearm into the fourth and fifth digits. Pain was exacerbated by shoulder extension and abduction with difficulty engaging periscapular muscles while swimming. On exam, atrophy of the infraspinatus was noted. Type of Probe Used: 15-4 MHz Linear Transducer Unlabeled Long Axis View of the Spinoglenoid Notch Unlabeled Long Axis View of the Spinoglenoid Notch Unlabeled Long Axis View of the Paralabral Cyst Unlabeled Long Axis View of the Paralabral Cyst within the spinoglenoid notch measuring approximately 1.18 cm by 1.64 cm. Unlabeled Long Axis View of the Spinoglenoid Notch with Doppler Unlabeled Long Axis View of the Spinoglenoid Notch with Doppler showing no flow within the cyst. Labeled Long Axis View of the Spinoglenoid Notch Labeled Long Axis View of the Spinoglenoid Notch with hypoechoic lesion consistent with a paralabral cyst (). Unlabeled Short Axis View of the Paralabral Cyst Unlabeled Short Axis View of the Paralabral Cyst within the spinoglenoid notch measuring approximately 3.23 cm. Labeled Short Axis View of the Paralabral Cyst Labeled Short Axis View of the Paralabral Cyst at the spinoglenoid notch measuring approximately 3.23 cm. Unlabeled Long Axis View of the Suprascapular Nerve at the Spinoglenoid Notch Unlabeled Long Axis View of the Suprascapular Nerve at the Spinoglenoid Notch Labeled Long Axis View of the Suprascapular Nerve at the Spinoglenoid Notch Labeled Long Axis View of the Suprascapular Nerve at the Spinoglenoid Notch. Note the honeycombing structure that is the suprascapular nerve (SSN) Interpretation Image Interpretation:* A well-circumscribed, anechoic mass, measuring approximately 1.18 cm x 1.64 cm x 3.23 cm is appreciated within the spinoglenoid notch. The mass is noncompressible and without internal Doppler flow. By sliding the transducer slightly more proximal, the suprascapular nerve is visualized and appears grossly enlarged, however, still has preservation of the characteristic honeycomb appearance. These findings are suggestive of a paralabral cyst causing suprascapular neuropathy. Teaching Pearl: Paralabral cysts are commonly associated with glenoid labral tears and are often found near the spinoglenoid notch, although cyst fluid can also track toward the suprascapular notch. Ultrasound often shows a well-circumscribed, avascular cyst. It's important to assess the nearby suprascapular nerve for enlargement or compression. Location of the cyst can determine clinical symptoms. A cyst at the suprascapular notch may affect both supraspinatus and infraspinatus, while a spinoglenoid notch cyst more selectively affects the infraspinatus; MRI or MR arthrography is often needed to define the labral tear. References: 1. Wee TC, Wu CH. Ultrasound-guided aspiration of a paralabral cyst at the spinoglenoid notch with suprascapular nerve compressive neuropathy. J Med Ultrasound. 2018;26(3):166-167. doi:10.4103/JMU.JMU_39_18 2. Moen TC, Babatunde OM, Hsu SH, Ahmad CS, Levine WN. Suprascapular neuropathy: what does the literature show? J Shoulder Elbow Surg. 2012;21(6):835-846. doi:10.1016/j.jse.2011.11.033 3. Schrøder CP, Lundgreen K, Kvakestad R. Paralabral cysts of the shoulder treated with isolated labral repair: effect on pain and radiologic findings. J Shoulder Elbow Surg. 2018;27(7):1283-1289. doi:10.1016/j.jse.2017.12.022
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Authors, Editors, Case Information

Unlabeled Long Axis View of the Spinoglenoid Notch

Unlabeled Long Axis View of the Paralabral Cyst

Unlabeled Long Axis View of the Spinoglenoid Notch with Doppler

Labeled Long Axis View of the Spinoglenoid Notch

Unlabeled Short Axis View of the Paralabral Cyst

Labeled Short Axis View of the Paralabral Cyst

Unlabeled Long Axis View of the Suprascapular Nerve at the Spinoglenoid Notch

Labeled Long Axis View of the Suprascapular Nerve at the Spinoglenoid Notch

Interpretation

UPCOMING EVENTS

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