Diagnosis and Treatment of Ganglion Cysts about the Shoulder:

Management and Outcomes of 42 Surgical Suprascapular Nerve Injuries and Entrapments

OBJECTIVE:

Retrospective chart reviews of 42 patients with surgical suprascapular nerve (SSN) injury/entrapment were performed. Presenting symptoms, findings, operative approach, and results are documented.

METHODS:

Forty-two patients with SSN injuries/entrapments underwent operations between 1970 and 2002. Charts were retrospectively reviewed for the presence of shoulder pain; spinati muscle function was evaluated with the Louisiana State University Health Sciences Center grading system. Side of lesion and sex were equally represented; mean follow-up was 18 months (range, 12–48 mo). SSN injuries/entrapments were associated with occupational overuse (19), sports-related injury (16), direct trauma (4) and ganglion cysts (3). Thirty-one (79%) of 39 patients with suprascapular notch SSN injuries/entrapments, excluding ganglion cysts, presented with mild to moderate shoulder pain and spinati weakness.

RESULTS:

Motor function for these 31 patients was graded on a scale of 0 to 5. Preoperatively, patients had supraspinatus function Grades 0 to 2 and infraspinatus function Grades 0 to 2. Supraspinatus function improved postoperatively to Grade 4 or better in 28 patients (90%) and to Grades 2 to 3 in 3 patients (10%). Infraspinatus function improved to better than Grade 3 in 10 patients (32%), to Grades 2 to 3 in 14 patients (45%), and to Grade 1 in 7 patients (23%). Preoperatively, eight (21%) of 39 patients presenting with persistent severe pain had Grade 3 spinati strength. Of these eight patients, seven (88%) had an improvement in pain postoperatively. Strength in this group remained the same or improved to Grade 4. Postoperatively, three patients with ganglion cysts had good improvement in spinati function.

CONCLUSION:

Although SSN injury/entrapment is rare, 42 patients are presented who responded well to SSN release. Supraspinatus muscle improvement was as good as or better than that achieved in the infraspinatus.