Kystes para-glénoïdiens gléno-huméraux

The correlation of the spinoglenoid ganglion cyst size with the electrophysiological alterations of suprascapular nerve and the rotator cuff muscle power

BACKGROUND

Although various treatment options are available for spinoglenoid cyst, including conservative and surgical methods, there is no standard guideline for its surgical decompression. Thus, the purpose of the study was to correlate the size of the spinoglenoid notch ganglion cyst (GC) as revealed by magnetic resonance imaging (MRI) with electrophysiological alterations, muscle power, and pain severity, and to estimate a cut-off value of cyst size to perform a decompression.

METHODS

Between January 2010 and January 2018, the patients with a GC at the spinoglenoid notch diagnosed on MRI, and who had a minimum follow-up of 2 years after the decompression were included. Maximum cyst diameter as measured on MRI was used for comparison. Electromyography (EMG) and nerve conduction velocity (NCV) studies were performed before the surgery. Peak torque deficit (PTD) percentage compared to opposite shoulder was calculated preoperatively and at 1 year after surgery. Pain severity was estimated using visual analogue scale (VAS) preoperatively.

RESULTS

Ten (50%) of 20 patients with GC > 2.2 cm and 1 (5.9%) of 17 patients with GC < 2.2 cm showed EMG/NCV abnormalities (p = 0.019). There was a correlation between the cyst size and the positive EMG/NCV findings (Correlation coefficient (CC) = 0.535, p < 0.001). The preoperative peak torque deficit on the external rotation was correlated with the positive EMG/NCV findings (CC = 0.373, p = 0.021). The PTD was improved significantly at 1 year postoperatively in patients with a GC size >2.2 cm (p = 0.029). The cyst size was not related to the preoperative pain VAS and muscle power.

CONCLUSIONS

The spinoglenoid cyst size >2.2 cm, but not pain severity or muscle power, correlates with the positive finding of EMG for compressive suprascapular neuropathy. The GC size >2.2 cm can be a reference to decide the need of decompression surgery.

LEVEL OF EVIDENCE

IV, case series.

Ultrasound Imaging of Disorders of Small Nerves of the Extremities: Less Recognized Locations

Ultrasound is a well-proven imaging modality for showing peripheral nerve disorders and guiding perineural injections. The aim of this review is to focus on small peripheral nerve abnormalities, which are usually not recognized by sonologists. In fact, most of these small nerves have a tiny diameter (<2 mm), and their anatomy is less familiar. We describe the most common causes of small peripheral nerve disorders, providing an accurate description of their anatomic locations and relationships with adjacent structures; we also focus on technical hints that may help in their evaluation.

Premature cystic lesions in shoulders of elite junior javelin and volleyball athletes: a comparative evaluation using 3.0 Tesla MRI

BACKGROUND

The purpose of this study was to evaluate clinical and magnetic resonance imaging (MRI) findings in the shoulders of high performance competitive junior javelin athletes and volleyball players. The hypothesis was that structural lesions already exist in young and asymptomatic overhead athletes.

METHODS

Thirty-one healthy high performance junior elite athletes were included. Group 1 consisted of 15 male javelin throwers (mean age, 17.7 ± 0.8 years) and group 2 of 16 male volleyball players (16.9 ± 1.0 years). Questionnaire-based interviews, comprehensive clinical examination, and shoulder scoring systems (visual analog scale [VAS] and Constant-Murley Score) were completed. Bilateral shoulder imaging was performed using a 3.0 Tesla MRI.

RESULTS

The Constant-Murley Score of group 1 was 95.5 ± 3.6 and 94.7 ± 4.6 points for group 2. Group 1 demonstrated a mean VAS of 0.9 ± 1.6 and group 2 a mean of 0.6 ± 0.8 points. Postero-superior intraosseous cysts of the humeral head were detected in 73.3% of all javelin throwers in the dominant shoulder, but only in 13.3% in the nondominant shoulder (P = .008). In the volleyball group, such cyst formation was rarely seen in 12.5% in the dominant versus 6.3% in the nondominant shoulder (P = .66).

CONCLUSION

A high percentage of junior elite athletes already demonstrate osseus signs of overloading especially in the group of javelin athletes, although none had a history of prior shoulder pathology. Therefore, junior overhead athletes might be at risk for the early development of structural lesions at the insertion of the posterior rotator cuff similar to lesions already known for adult athletes, even though they do not present clinical signs of overuse at that age.