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Kim DH, Sohn HJ, Kim JH, Cho CH. Clinical Outcomes Following Arthroscopic Decompression and Repair versus Repair Alone in Patients with a Concomitant Spinoglenoid Cyst and SLAP Lesion: A Systematic Review. Diagnostics (Basel) 2023; 13:2364. [PMID: 37510107 PMCID: PMC10378101 DOI: 10.3390/diagnostics13142364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 07/06/2023] [Accepted: 07/12/2023] [Indexed: 07/30/2023] Open
Abstract
(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.
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Affiliation(s)
- Du-Han Kim
- Department of Orthopedic Surgery, Keimyung University Dongsan Hospital, Keimyung University School of Medicine, Daegu 42601, Republic of Korea
| | - Hyuk-Joon Sohn
- Department of Orthopedic Surgery, Keimyung University Dongsan Hospital, Keimyung University School of Medicine, Daegu 42601, Republic of Korea
| | - Ji-Hoon Kim
- Department of Orthopedic Surgery, Keimyung University Dongsan Hospital, Keimyung University School of Medicine, Daegu 42601, Republic of Korea
| | - Chul-Hyun Cho
- Department of Orthopedic Surgery, Keimyung University Dongsan Hospital, Keimyung University School of Medicine, Daegu 42601, Republic of Korea
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Comparisons between treatment of isolated posterosuperior paralabral cysts and simultaneous treatment of cysts combined with associated shoulder pathologies: arthroscopic treatment of posterosuperior paralabral cysts. Arch Orthop Trauma Surg 2023; 143:665-675. [PMID: 34398279 DOI: 10.1007/s00402-021-04128-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 08/12/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION The purpose of this study is to report the radiologic and clinical outcomes of arthroscopic intervention for isolated posterosuperior paralabral cysts and simultaneous treatment of cysts combined with associated shoulder pathologies. MATERIALS AND METHODS From March 2008 through December 2016, 70 cases (48 males and 22 females) operated on for symptomatic posterosuperior paralabral cysts were included. Mean age was 45 (range 18-69). These patients were classified into two groups depending on if they had accompanying lesions: Group I (isolated group, 27 patients) and Group II (concomitant group, 43 patients). Arthroscopic cyst decompression with a labral repair or posterior capsulotomy for patients without labral tear were performed. All concomitant pathologies were also operated simultaneously. Follow-up MRI were performed at postoperative 6 months and clinical outcomes were evaluated during the follow-up. RESULTS Arthroscopic all intra-articular cyst decompression and labral repair was performed on 67 patients. In three patients, posterior capsulotomy without labral repair was performed for cyst removal. For 43 patients with concomitant lesions, 31 rotator cuff repairs, three SLAP repairs along with biceps tenodesis, two distal clavicle resections due to A-C joint arthritis, one calcific deposit removal, four Bankart repairs, and two acromioplasties were performed. The follow-up MRI showed complete cyst resorption except for two patients. The mean VAS, ASES, UCLA, SST and CS scores significantly improved at the last follow-up. Although both groups showed significantly improved range of motion after the surgery, improvement of ROM in Group II lagged at early periods of the rehabilitation. CONCLUSIONS Arthroscopic labral repair with all intra-articular cysts decompression or simple posterior capsulotomy were both effective treatment modalities. If paralabral cysts were associated with other shoulder lesions, simultaneous treatment of combined lesions could be performed for the improved clinical outcomes at final follow-up with expected lag in the early rehabilitation period. LEVEL OF EVIDENCE Level III, Retrospective Comparative Trial, Treatment Study.
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Chen JF, Wang ZL, Zhang JM, Wang YY, Yang R, Xiang XB. Trans-Rotator Cuff Approach for Spinoglenoid Cysts: Tips and Traps. Arthrosc Tech 2022; 11:e2249-e2253. [PMID: 36632379 PMCID: PMC9827072 DOI: 10.1016/j.eats.2022.08.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 08/17/2022] [Indexed: 11/18/2022] Open
Abstract
In this study, we introduce an arthroscopic technique for posterior-superior capsular fenestration and spinoglenoid cyst resection completely via a trans-rotator cuff approach. This approach can provide a full field of view and allow evaluation of the scope of the cyst under direct vision, which reduces the risk of recurrence and injury to the suprascapular neurovascular bundle.
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Affiliation(s)
- Jian-Fa Chen
- Department of Orthopaedics, The First Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine, Guangzhou, China
| | - Zhi-Ling Wang
- Department of Orthopaedic Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Jin-Ming Zhang
- Department of Orthopaedic Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yuan-Yuan Wang
- Department of Orthopaedics, The First Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine, Guangzhou, China
| | - Rui Yang
- Department of Orthopaedic Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Xiao-Bing Xiang
- Department of Orthopaedics, The First Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine, Guangzhou, China
- Address correspondence to Xiao-Bing Xiang, M.D., Ph.D., Department of Orthopedics, The First Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine, Guangzhou, Guangdong 510405, China.
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Jafarnia J, Wininger AE, Holderread BM, Harris JD, Echo A. Acetabular Paralabral Cyst Causing Obturator Nerve Compression in the Setting of Femoroacetabular Impingement Syndrome: A Case Report. JBJS Case Connect 2022; 12:01709767-202212000-00038. [PMID: 36459571 DOI: 10.2106/jbjs.cc.22.00401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 09/01/2022] [Indexed: 12/04/2022]
Abstract
CASE Large acetabular paralabral cysts can cause compression of the surrounding neurovascular structures leading to sensory and motor deficits. We present a 68-year-old man with obturator nerve denervation from a paralabral cyst secondary to a labral tear associated with femoroacetabular impingement syndrome. Resolution of symptoms and return to full activities were achieved at 3 months and maintained beyond 1 year through open cyst excision, obturator neurolysis, arthroscopic femoral osteoplasty, and labral repair in the same surgical setting. The patient had a successful clinical outcome, with pain and dysfunction resolution. CONCLUSION Large paralabral cysts may cause obturator nerve compression, which can be successfully treated with open nerve decompression and arthroscopic treatment of labral pathology.
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Affiliation(s)
- Jordan Jafarnia
- Department of Orthopedics and Sports Medicine, Houston Methodist Hospital, Houston, Texas
| | - Austin E Wininger
- Department of Orthopedics and Sports Medicine, Houston Methodist Hospital, Houston, Texas
| | - Brendan M Holderread
- Department of Orthopedics and Sports Medicine, Houston Methodist Hospital, Houston, Texas
| | - Joshua D Harris
- Department of Orthopedics and Sports Medicine, Houston Methodist Hospital, Houston, Texas
| | - Anthony Echo
- Department of Plastic and Reconstructive Surgery, Houston Methodist Hospital, Houston, Texas
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Maalouly J, Aouad D, Tawk A, El Rassi G. A spinoglenoid cyst compressing on the suprascapular nerve causing supraspinatus and infraspinatus muscle weakness: A case report. Int J Surg Case Rep 2020; 71:266-269. [PMID: 32480335 PMCID: PMC7264009 DOI: 10.1016/j.ijscr.2020.04.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Revised: 03/22/2020] [Accepted: 04/07/2020] [Indexed: 01/02/2023] Open
Abstract
INTRODUCTION Spinoglenoid cysts are a rare cause of suprascapular neuropathy of compressive etiology in which the patient may present with shoulder pain and muscle hypotrophy. MRIs are the imaging modality of choice showing location, size, and extent of the lesion for preoperative assessment. Currently, surgical intervention is the preferred approach for the management of a spinoglenoid cyst with arthroscopy being favored over the open technique. CASE PRESENTATION A 25-year-old male patient presenting with right posterior shoulder pain and decreased range of motion associated with the development of progressive weakness of the supraspinatus and infraspinatus muscles. Right shoulder MRI showed a posterior tear of the glenoid labrum and a spinoglenoid ganglion cyst. Preoperative electroneuromyography was suggestive of a suprascapular nerve impairment. FOLLOW-UP Six months postoperatively, the patient has regained full range of motion of his right shoulder with no residue signs of muscle hypotrophy. CONCLUSION Spinoglenoid cysts can cause compressive neuropathy with associated pain and muscle hypotrophy. MRI and EMG can help in establishing the diagnosis and in the pre-operative assessment. Surgical intervention with arthroscopy is currently the technique preferred by most surgeons.
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Affiliation(s)
- Joseph Maalouly
- Department of Orthopedic Surgery and Traumatology Saint Georges University Medical Center, Balamand University, P.O. Box 166378, Achrafieh, Beirut, 1100 2807, Lebanon; St Georges University Medical Center, Beirut, Achrafieh, St Georges Street, Lebanon.
| | - Dany Aouad
- Department of Orthopedic Surgery and Traumatology Saint Georges University Medical Center, Balamand University, P.O. Box 166378, Achrafieh, Beirut, 1100 2807, Lebanon; St Georges University Medical Center, Beirut, Achrafieh, St Georges Street, Lebanon.
| | - Antonios Tawk
- Department of Orthopedic Surgery and Traumatology Saint Georges University Medical Center, Balamand University, P.O. Box 166378, Achrafieh, Beirut, 1100 2807, Lebanon; St Georges University Medical Center, Beirut, Achrafieh, St Georges Street, Lebanon.
| | - Georges El Rassi
- Department of Orthopedic Surgery and Traumatology Saint Georges University Medical Center, Balamand University, P.O. Box 166378, Achrafieh, Beirut, 1100 2807, Lebanon; St Georges University Medical Center, Beirut, Achrafieh, St Georges Street, Lebanon.
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Phillips CJ, Field AC, Field LD. Transcapsular Decompression of Shoulder Ganglion Cysts. Arthrosc Tech 2018; 7:e1263-e1267. [PMID: 30591872 PMCID: PMC6305895 DOI: 10.1016/j.eats.2018.08.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Accepted: 08/03/2018] [Indexed: 02/03/2023] Open
Abstract
Paralabral cysts are an increasingly recognized cause of suprascapular nerve (SSN) impingement, often causing insidious weakness in the rotator cuff. Compression at the suprascapular notch is often due to the presence of a SLAP tear and leads to pain, weakness, and atrophy of both the supraspinatus and infraspinatus muscles. Compression of the SSN at the spinoglenoid notch leads to weakness and atrophy of the infraspinatus only. Arthroscopic decompression of cysts with repair of labral pathology is typically performed in a sublabral fashion, which may make visualization of the extent of the cyst difficult and places the SSN at increased risk. With any approach, an intimate knowledge of the anatomy of the SSN is vital to safe decompression. We present a surgical technique for decompression of paralabral cysts using an intra-articular transcapsular approach. This approach maximizes visualization and efficiency and reduces possible damage to the SSN.
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Affiliation(s)
| | | | - Larry D. Field
- Address correspondence to Larry D. Field, M.D., Mississippi Sports Medicine and Orthopaedic Center, 1325 E Fortification St, Jackson, MS 39202, U.S.A.
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Promsang T, Kongrukgreatiyos K, Kuptniratsaikul S. Arthroscopic Decompression of Spinoglenoid Notch Cyst and SLAP Repair Through a Single Working Portal. Arthrosc Tech 2018; 7:e963-e967. [PMID: 30258779 PMCID: PMC6153417 DOI: 10.1016/j.eats.2018.05.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Accepted: 05/25/2018] [Indexed: 02/03/2023] Open
Abstract
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.
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Affiliation(s)
- Trai Promsang
- Department of Orthopaedics, Sikarin Hospital, Bangkok, Thailand
- Address correspondence to Trai Promsang, M.D., M.S., Sikarin Hospital, Department of Orthopaedics, 4/29 Moo 10, Srinakarin road Bang-Na sub-district, Bangkok 10260.
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Schroeder AJ, Bedeir YH, Schumaier AP, Desai VS, Grawe BM. Arthroscopic Management of SLAP Lesions With Concomitant Spinoglenoid Notch Ganglion Cysts: A Systematic Review Comparing Repair Alone to Repair With Decompression. Arthroscopy 2018; 34:2247-2253. [PMID: 29501216 DOI: 10.1016/j.arthro.2018.01.031] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Revised: 01/17/2018] [Accepted: 01/18/2018] [Indexed: 02/02/2023]
Abstract
PURPOSE To determine if cyst management is necessary in the setting of SLAP lesions with concomitant paralabral ganglion cysts. METHODS We performed a systematic review according to Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines, including all studies that met inclusion criteria from January 1975 to July 2015. We included patients with a SLAP II-VII lesion and a concomitant paralabral ganglion cyst who underwent arthroscopic labral repair with or without cyst decompression. Patients with follow-up of less than 3 months, a SLAP I lesion, or who underwent concomitant cuff repair were excluded. The Methodological Index for Non-randomized Studies (MINORS) scoring system was used to quantify the potential bias in each study. Outcome measures reported were provided in a table format and a subjective analysis was performed. RESULTS Nineteen studies were included yielding a total of 160 patients: 66 patients treated with repair alone [R] and 94 patients with additional cyst decompression or excision [R+D]. The VAS, Rowe, and Constant scores were excellent and similar in both groups. The mean VAS was 0.6 in [R] and ranged between 0 and 2 in [R+D] (0.5, 0, 2, 0.2). The mean Rowe scores were 94 and 98 in [R] and 95 in [R+D]. The mean Constant scores were 97 in [R] and ranged between 87 and 98 in [R+D] (98, 87, 92, 94). In total, 5 of 90 patients were unable to return to work and 2 of 45 were unable to return to sport. All 15 patients who had follow-up electromyographies displayed resolution, and in the 115 patients with follow-up MRIs, 12 did not have complete resolution of the cyst. CONCLUSIONS Despite the lack of high-quality evidence, the studies subjectively analyzed in this review suggest that both groups have excellent results. The results do not show any advantages from performing decompression. LEVEL OF EVIDENCE Level IV, systematic review of Level II and Level IV studies.
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Affiliation(s)
- Amanda J Schroeder
- Department of Orthopaedic Surgery, University of Cincinnati, Cincinnati, Ohio, U.S.A
| | - Yehia H Bedeir
- Department of Orthopaedic Surgery, University of Cincinnati, Cincinnati, Ohio, U.S.A..
| | - Adam P Schumaier
- Department of Orthopaedic Surgery, University of Cincinnati, Cincinnati, Ohio, U.S.A
| | - Vishal S Desai
- Department of Orthopaedic Surgery, University of Cincinnati, Cincinnati, Ohio, U.S.A
| | - Brian M Grawe
- Department of Orthopaedic Surgery, University of Cincinnati, Cincinnati, Ohio, U.S.A
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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; 27:1283-1289. [PMID: 29449084 DOI: 10.1016/j.jse.2017.12.022] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Revised: 12/02/2017] [Accepted: 12/12/2017] [Indexed: 02/01/2023]
Abstract
BACKGROUND Paralabral cysts emanating from posterosuperior labral tears may compress the suprascapular nerve and induce neuropathy. This study prospectively assessed patients with labral tears and symptomatic paralabral cysts treated with isolated labral repair. Pain relief, time to cyst resolution, reversibility of muscular edema, atrophy, fatty infiltration, and bone erosion were evaluated. METHODS Forty-seven patients with symptomatic posterosuperior paralabral cysts were treated with isolated labral repair. Magnetic resonance imaging (MRI) was repeated 6 and 12 weeks postoperatively or until cyst resolution. In a subgroup of 15 patients, MRI was performed the day before the operation, the first postoperative day, and at 2 weeks. RESULTS Median cyst size was 6.8 cm3 (range, 2.1-88.9; standard deviation [SD], 18.3 cm3). Preoperatively, 20 patients (43%) presented clinical muscle atrophy and radiologic edema on MRI, 8 had fatty infiltration, and 3 presented bony scapular erosion caused by cyst compression. Median time to cyst resolution and regression of muscular edema was 11 weeks (range, 3-20; SD, 8.8 weeks) and 14 weeks (range, 3-52; SD 10.6 weeks), respectively. Preoperative fatty infiltration grade I and II of the supraspinatus and infraspinatus muscles was reduced in two patients. Bony erosions remodeled after cyst resolution. Mean pain ratings (1-10 scale) improved from 7.7 (SD, 1.8) to 1.3 (SD, 1.3; 95% confidence interval of difference, 5.5-6.8; P < .001). CONCLUSION Labral repair leads to significant pain relief with cyst resolution within 2 to 3 months in most patients. Secondary muscle pathology (ie, edema, atrophy and fatty infiltration) may be partially or completely reversed. Bony erosion caused by cyst compression may be remodeled after cyst resolution.
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Affiliation(s)
- Cecilie P Schrøder
- Department of Orthopedic Surgery, Lovisenberg Diaconal Hospital, Oslo, Norway.
| | - Kirsten Lundgreen
- Department of Orthopedic Surgery, Lovisenberg Diaconal Hospital, Oslo, Norway
| | - Rune Kvakestad
- Department of Radiology, Lovisenberg Diaconal Hospital, Oslo, Norway
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Wee TC, Wu CH. Ultrasound-Guided Aspiration of a Paralabral Cyst at the Spinoglenoid Notch with Suprascapular Nerve Compressive Neuropathy. J Med Ultrasound 2018; 26:166-167. [PMID: 30283206 PMCID: PMC6159318 DOI: 10.4103/jmu.jmu_39_18] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Accepted: 03/14/2018] [Indexed: 11/15/2022] Open
Affiliation(s)
- Tze-Chao Wee
- Department of Rehabilitation Medicine, Changi General Hospital, Singapore
| | - Chueh-Hung Wu
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
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Perry NPJ, Wolfe JA, Nguyen-Ta K, Christensen D, McDonald LS, Dickens JF, LeClere LE. Biceps Tenodesis and Intra-articular Decompression for Treatment of Superior Labral Tear from Anterior to Posterior and Associated Paralabral Cyst in Active Duty Military. Mil Med 2018; 183:e194-e200. [PMID: 29420745 DOI: 10.1093/milmed/usx019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2017] [Accepted: 10/20/2017] [Indexed: 01/02/2023] Open
Abstract
Background To examine the outcomes of combined biceps tenodesis and indirect, intra-articular arthroscopic paralabral cyst decompression for the treatment of active duty military patients with superior labral from anterior to posterior tears and associated paralabral cysts. Methods Retrospective chart review of all active duty patients at our institution from 2011 to 2014 with superior labral from anterior to posterior tears and associated paralabral cysts at the spinoglenoid notch treated with biceps tenodesis and indirect arthroscopic cyst decompression. Patient charts were examined for pre- and post-operative parameters including strength, range of motion, visual analog scale pain score, American Shoulder and Elbow Surgeon Score, and Single Assessment Numeric Evaluation Score. Results Seven patients met study criteria. All patients presented with chronic shoulder pain and decreased external rotation strength, and three patients had clinically apparent muscular atrophy. Pre- and post-operative assessment showed external rotation strength increased from a median of 4 (range 4-4) to 5 (range 4-5; p-value = 0.014), Single Assessment Numeric Evaluation increased from a median of 50 (range 0-70) to 75 (range 30-95; p-value = 0.031), American Shoulder and Elbow Surgeon increased from a median of 46.0 (range 32.0-58.0) to 66.5 (range 58.0-98.0; p-value = 0.068), and visual analog scale pain score decreased from a median of 3 (range 1-8) to 0 (range 0-5; p-value = 0.017). Median follow-up was 66 wk (range 36-138 wk). The change was statistically significant (p <0.05) for external rotation strength, Single Assessment Numeric Evaluation, and VAS reduction. Post-operatively, all patients returned to full duty at a median of 20 wk (range 12-36 wk). Conclusion The use of biceps tenodesis in conjunction with indirect, intra-articular arthroscopic paralabral cyst decompression is an effective technique in an active patient population with superior labral from anterior to posterior tear with associated paralabral cyst.
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Affiliation(s)
- Nicholas P J Perry
- Department of Orthopaedics, Naval Medical Center San Diego, 34800 Bob Wilson Drive, San Diego, CA 92134-3300
| | - Jared A Wolfe
- Department of Orthopaedics, Walter Reed National Military Medical Center, 8901 Rockville Pike, Bethesda, MD 20889
| | - Kim Nguyen-Ta
- Medical Education and Telemedicine 120, UC San Diego School of Medicine, 9500 Gilman Drive, La Jolla, CA 92093
| | - Daniel Christensen
- Department of Orthopaedics, Walter Reed National Military Medical Center, 8901 Rockville Pike, Bethesda, MD 20889
| | - Lucas S McDonald
- Department of Orthopaedics, Naval Medical Center San Diego, 34800 Bob Wilson Drive, San Diego, CA 92134-3300
| | - Jonathan F Dickens
- Department of Orthopaedics, Walter Reed National Military Medical Center, 8901 Rockville Pike, Bethesda, MD 20889
| | - Lance E LeClere
- United States Naval Academy, Naval Health Clinic Annapolis, Annapolis, MD, 626 MacCubbin Ln, Gambrills, MD 21054
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C.K. S, Varshney A, Yoo YS, Lee SJ. Arthroscopic Intra-articular Spinoglenoid Cyst Resection Following SLAP Repair. Arthrosc Tech 2017; 6:e1795-e1799. [PMID: 29416967 PMCID: PMC5797713 DOI: 10.1016/j.eats.2017.06.056] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Accepted: 06/28/2017] [Indexed: 02/03/2023] Open
Abstract
Spinoglenoid cyst (SGC) is a ganglion arising in the spinoglenoid notch and is thought to be related to SLAP lesion. This cyst often compresses the suprascapular nerve in the spinoglenoid notch. Symptomatic cysts require surgical treatment when conservative treatment fails. In particular, arthroscopic decompression through the torn labral tissue when the cyst is extending into the joint cavity is easy and convenient. However, if the cyst is confined to the spinoglenoid notch, arthroscopic approach through the torn labral tissue is challenging. Thus, we present our preferred technique of addressing the SGC through an additional superior capsular window after completing SLAP repair. We believe that our technique is easy, reproducible, and reasonable.
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Affiliation(s)
- Sreehari C.K.
- Address correspondence to Sreehari C.K., M.S., Department of Orthopaedic Surgery, Hallym University Dongtan Sacred Heart Hospital, Dongtan, Republic of Korea.Department of Orthopaedic SurgeryHallym University Dongtan Sacred Heart HospitalDongtanRepublic of Korea
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Pierce JL, Nacey NC, Jones S, Rierson D, Etier B, Brockmeier S, Anderson MW. Postoperative Shoulder Imaging: Rotator Cuff, Labrum, and Biceps Tendon. Radiographics 2017; 36:1648-1671. [PMID: 27726742 DOI: 10.1148/rg.2016160023] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Imaging interpretation of the postoperative shoulder is a challenging and difficult task for both the radiologist and the orthopedic surgeon. The increasing number of shoulder rotator cuff, labrum, and biceps tendon repairs performed in the United States also makes this task a frequent occurrence. Whether treatment is surgical or conservative, imaging plays a crucial role in patient care. Many imaging findings can be used to predict prognosis and functional outcomes, ultimately affecting treatment. In addition, evolving surgical techniques alter the normal anatomy and imaging appearance of the shoulder such that accepted findings proved to be pathologic in the preoperative setting cannot be as readily described as pathologic after surgery. An understanding of common surgical procedures of the shoulder can aid in recognizing normal expected postoperative findings and discerning common complications. Although magnetic resonance (MR) imaging and MR arthrography are widely used, implementing a multimodality imaging approach for evaluation of the postoperative shoulder can provide additional imaging information that may be decisive and vital to diagnosis. The high spatial resolution of both computed tomography with arthrography and ultrasonography makes them additional modalities to consider, especially when dealing with metal artifact. To provide an accurate radiologic interpretation of high clinical value, radiologists should approach the postoperative shoulder comprehensively with knowledge of the anatomy, surgical techniques and complications, clinical outcomes, and imaging pitfalls. ©RSNA, 2016.
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Affiliation(s)
- Jennifer L Pierce
- From the Departments of Radiology and Medical Imaging (J.L.P., N.C.N., S.J., D.R., M.W.A.) and Orthopedic Surgery (B.E., S.B.), University of Virginia, 1215 Lee St, Charlottesville, VA 22908
| | - Nicholas C Nacey
- From the Departments of Radiology and Medical Imaging (J.L.P., N.C.N., S.J., D.R., M.W.A.) and Orthopedic Surgery (B.E., S.B.), University of Virginia, 1215 Lee St, Charlottesville, VA 22908
| | - Stephen Jones
- From the Departments of Radiology and Medical Imaging (J.L.P., N.C.N., S.J., D.R., M.W.A.) and Orthopedic Surgery (B.E., S.B.), University of Virginia, 1215 Lee St, Charlottesville, VA 22908
| | - Davis Rierson
- From the Departments of Radiology and Medical Imaging (J.L.P., N.C.N., S.J., D.R., M.W.A.) and Orthopedic Surgery (B.E., S.B.), University of Virginia, 1215 Lee St, Charlottesville, VA 22908
| | - Brian Etier
- From the Departments of Radiology and Medical Imaging (J.L.P., N.C.N., S.J., D.R., M.W.A.) and Orthopedic Surgery (B.E., S.B.), University of Virginia, 1215 Lee St, Charlottesville, VA 22908
| | - Stephen Brockmeier
- From the Departments of Radiology and Medical Imaging (J.L.P., N.C.N., S.J., D.R., M.W.A.) and Orthopedic Surgery (B.E., S.B.), University of Virginia, 1215 Lee St, Charlottesville, VA 22908
| | - Mark W Anderson
- From the Departments of Radiology and Medical Imaging (J.L.P., N.C.N., S.J., D.R., M.W.A.) and Orthopedic Surgery (B.E., S.B.), University of Virginia, 1215 Lee St, Charlottesville, VA 22908
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14
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Kim SJ, Choi YR, Jung M, Park JY, Chun YM. Outcomes of Arthroscopic Decompression of Spinoglenoid Cysts Through a Subacromial Approach. Arthroscopy 2017; 33:62-67. [PMID: 27474106 DOI: 10.1016/j.arthro.2016.05.034] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Revised: 05/21/2016] [Accepted: 05/24/2016] [Indexed: 02/02/2023]
Abstract
PURPOSE To describe a spinoglenoid cyst decompression technique through a subacromial approach and its clinical outcomes after 2 years of follow-up. METHODS 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 2 years 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 6 months postoperatively to evaluate incomplete decompression or recurrence of the cyst. RESULTS 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. CONCLUSIONS For spinoglenoid cyst decompression, the subacromial approach was found to be effective, yielding satisfactory clinical outcomes without recurrence. LEVEL OF EVIDENCE Level IV, therapeutic case series.
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Affiliation(s)
- Sung-Jae Kim
- Department of Orthopaedic Surgery, Arthroscopy and Joint Research Institute, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Yun-Rak Choi
- Department of Orthopaedic Surgery, Arthroscopy and Joint Research Institute, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Min Jung
- Department of Orthopaedic Surgery, Arthroscopy and Joint Research Institute, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jun-Young Park
- Department of Orthopaedic Surgery, Arthroscopy and Joint Research Institute, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Yong-Min Chun
- Department of Orthopaedic Surgery, Arthroscopy and Joint Research Institute, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.
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15
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Kabuto Y, Morihara T, Furukawa R, Kida Y, Sukenari T, Onishi O, Minami M, Arai Y, Fujiwara H, Kubo T. Arthroscopic decompression with indigo carmine for treating paralabral cysts in the shoulder. Orthop Traumatol Surg Res 2016; 102:1109-1111. [PMID: 27816608 DOI: 10.1016/j.otsr.2016.09.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Revised: 07/24/2016] [Accepted: 09/05/2016] [Indexed: 02/02/2023]
Abstract
Paralabral cysts in the shoulder are a relatively rare pathology. It is sometimes difficult to detect the location of a paralabral cyst in the shoulder using arthroscopy, and it can be difficult to confirm sufficient decompression by arthroscopy. We describe the case of a 64-year-old woman who underwent arthroscopic decompression for a paralabral cyst in the shoulder. Indigo carmine was injected into the cyst under ultrasonography guidance just before the operation. The leakage point of indigo carmine was detected using arthroscopy. Arthroscopic decompression was performed until the indigo carmine was completely discharged. Her shoulder pain, limited range of motion, and muscle weakness during abduction and external rotation improved postoperatively. Magnetic resonance imaging confirmed the disappearance of the cyst. Arthroscopic decompression using an ultrasonography-guided injection of indigo carmine is a useful treatment for a paralabral cyst in the shoulder.
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Affiliation(s)
- Y Kabuto
- Department of Orthopedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - T Morihara
- Department of Orthopedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - R Furukawa
- Department of Orthopedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Y Kida
- Department of Orthopedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - T Sukenari
- Department of Orthopedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - O Onishi
- Department of Orthopedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - M Minami
- Department of Orthopedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Y Arai
- Department of Orthopedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - H Fujiwara
- Department of Orthopedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan.
| | - T Kubo
- Department of Orthopedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
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16
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Prasad NK, Spinner RJ, Smith J, Howe BM, Amrami KK, Iannotti JP, Dahm DL. The successful arthroscopic treatment of suprascapular intraneural ganglion cysts. Neurosurg Focus 2016; 39:E11. [PMID: 26323813 DOI: 10.3171/2015.6.focus15201] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECT High-resolution magnetic resonance imaging (MRI) can distinguish between intraneural ganglion cysts and paralabral (extraneural) cysts at the glenohumeral joint. Suprascapular intraneural ganglion cysts share the same pathomechanism as their paralabral counterparts, emanating from a tear in the glenoid labrum. The authors present 2 cases to demonstrate that the identification and arthroscopic repair of labral tears form the cornerstone of treatment for intraneural ganglion cysts of the suprascapular nerve. METHODS Two patients with suprascapular intraneural ganglion cysts were identified: 1 was recognized and treated prospectively, and the other, previously reported as a paralabral cyst, was identified retrospectively through the reinter-pretation of high-resolution MR images. RESULTS Both patients achieved full functional recovery and had complete radiological involution of the intraneural ganglion cysts at the 3-month and 12-month follow-ups, respectively. CONCLUSIONS Previous reports of suprascapular intraneural ganglion cysts described treatment by an open approach to decompress the cysts and resect the articular nerve branch to the glenohumeral joint. The 2 cases in this report demonstrate that intraneural ganglion cysts, similar to paralabral cysts, can be treated with arthroscopic repair of the glenoid labrum without resection of the articular branch. This approach minimizes surgical morbidity and directly addresses the primary etiology of intraneural and extraneural ganglion cysts.
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Affiliation(s)
| | - Robert J Spinner
- Departments of 1 Orthopedics.,Neurosurgery, Mayo Clinic, Rochester, Minnesota; and
| | | | | | - Kimberly K Amrami
- Radiology, and.,Neurosurgery, Mayo Clinic, Rochester, Minnesota; and
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