Suprascapular Nerve Pulsed Radiofrequency for Chronic Shoulder Pain in a Pediatric Patient

Spinoglenoid Notch Ganglion Cyst: A Case Report

Suprascapular nerve dysfunction caused by ganglion cysts is a rare condition that can cause significant pain and weakness in the shoulder. The suprascapular nerve is a branch of the brachial plexus that innervates the supraspinatus and infraspinatus muscles. It is most commonly compressed at the suprascapular notch or the spinoglenoid notch. A 40-year-old male presented with a two-year history of left shoulder pain that was aggravated by overhead activities. Physical examination revealed mild tenderness along the infraspinatus with noticeable atrophy, full range of motion, and mild external rotation weakness. MRI was obtained and confirmed the suspected diagnosis of suprascapular nerve dysfunction caused by a ganglion cyst at the spinoglenoid notch. The patient was initially treated conservatively with physical therapy and non-steroidal anti-inflammatory drugs (NSAIDs), but after completing nine months of conservative management, he showed no improvement. The patient elected to undergo open ganglion cyst excision and decompression of the spinoglenoid notch. Postoperatively, the patient's pain resolved gradually and he regained the full power of external rotation. The patient was followed for one year postoperatively and was satisfied with the outcome with a full range of motion, full power, and a complete return to his baseline level of activity. In conclusion, this case report demonstrates the successful treatment of suprascapular nerve dysfunction caused by a ganglion cyst at the spinoglenoid notch with open ganglion cyst excision and decompression. This procedure is a safe and effective treatment option for patients with this condition who have failed to respond to conservative treatment and emphasizes and signifies the role of eliciting a detailed patient history, conducting a thorough radiographic examination including MRI scans, and planning optimum surgical interventions.

Treatment of suprascapular nerve entrapment syndrome

Suprascapular nerve entrapment syndrome (SNES) is an often-overlooked etiology of shoulder pain and weakness. Treatment varies depending on the location and etiology of entrapment, which can be described as compressive or traction lesions. In some cases, treating the primary cause of impingement (ie. rotator cuff tear, ganglion cyst, etc.) is sufficient to relieve pressure on the nerve. In other cases where impingement is caused by dynamic microtrauma (as seen in overhead athletes and laborers), treatment is often more conservative. Conservative first-line therapy includes rehabilitation programs, nonsteroidal anti-inflammatory drugs, and lifestyle modification. Physical therapy is targeted at strengthening the rotator cuff muscles, trapezius, levator scapulae, rhomboids, serratus anterior, and deltoid muscle(s). If non-operative treatment fails to relieve suprascapular neuropathy, minimally invasive treatment options exist, such as suprascapular nerve injection, neurostimulation, cryoneurolysis, and pulsed radiofrequency. Multiple treatment modalities are often used synergistically due to variations in shoulder anatomy, physiology, pain response, and pathology as a sole therapeutic option does not seem successful for all cases. Often patients can be treated with non-invasive measures alone; however, injuries refractory to conservative treatment may require either arthroscopic or open surgery, particularly if the patient has an identifiable and reversible cause of nerve compression. Indications for invasive treatment include, but are not limited to, refractory to non-operative treatment, have a space-occupying lesion, or show severe signs and symptoms of muscle atrophy. Open decompression has fallen out of favor due to the advantages inherent in the less invasive arthroscopic approach.