Arthroscopic Management of Spinoglenoid and Suprascapular Notch Cysts


Chapter 52

Arthroscopic Management of Spinoglenoid and Suprascapular Notch Cysts



Yong Girl Rhee, and Jong Hoon Song

Introduction


Ganglion cysts around the shoulder joint can cause shoulder pain, and the symptoms are usually similar to those associated with common shoulder diseases. Since only 1% to 2% of all patients with shoulder pain have neuropathy of the suprascapular nerve, suprascapular nerve compression is not a disease primarily suspected in shoulder patients. Surgical treatment should be considered if patients have persistent pain in spite of appropriate conservative management.

Procedure


Arthroscopic cyst decompression is performed through a glenohumeral or subacromial approach. Each approach has its own pearls and pitfalls. Appropriate treatment for accompanying capsular or labral lesion is also required to prevent postoperative relapse.

Patient History



Patient Examination



Imaging



Treatment Options: Nonoperative and Operative





  1. • As the initial treatment, ganglion cysts of the shoulder should be approached conservatively. Patients are instructed to avoid excessive overhead activity. For physical therapy, scapular stabilizer strengthening exercises in addition to stretching exercises are recommended. The cyst may become enlarged even with appropriate conservative treatment, therefore close follow-up is essential.


  3. image
    FIG. 52.1 Typical magnetic resonance image of a ganglion cyst with a superior labrum anterior to posterior lesion. This T2-weighted coronal image shows a well-marginated, round-shaped lesion with a high signal just medial to the superior labrum, consistent with a ganglion cyst, and an intermediate low signal extending through the superior labrum, consistent with a superior labral tear. G, ganglion.

  4. • Computed tomography– or ultrasound-guided aspiration have been applied as the second step of conservative treatment. However, they may produce inconsistent results. There are often cases of failed aspiration, and it was reported that 48%–75% of patients had a relapsed cyst during follow-up, even when the aspiration was performed well. Since it is ultimately impossible for aspiration to treat a cyst-accompanied labral lesion, it has the disadvantage of a high relapse rate.
  5. • Cyst decompression through an open posterior approach has been widely used for conventional surgical treatment. The advantages of open surgery are that the cyst can be directly observed during removal and also enables direct decompression of the suprascapular nerve. However, it also has disadvantages, such as morbidity resulting from the incision and dissection of the surrounding soft tissue and muscles and difficulty in treating labral lesions.
  6. • The advantages of the arthroscopic technique over the open technique are that it has less postsurgical morbidity and can also treat accompanying intraarticular lesions. However, it may be difficult to remove cysts completely by arthroscopy alone. Because ganglion cysts frequently show multi-lobulation, it may not be easy to examine the entire cyst directly during arthroscopy.

Surgical Anatomy





  1. • The suprascapular nerve exits the posterior triangle of the neck, travels inferiorly to the trapezius muscle, passes the suprascapular notch, and enters the supraspinatus fossa posteriorly. It passes inferiorly to the transverse scapular ligament that covers the suprascapular notch, and the suprascapular artery and vein pass superiorly to the ligament. (Fig. 52.2)

  2. image
    FIG. 52.2 The suprascapular nerve passes through the scapular notch below the transverse scapular ligament. The suprascapular artery and vein pass above the ligament. The suprascapular nerve continues down around scapular spine and through the spinoglenoid notch, where the nerve is relatively constrained by the inferior transverse scapular ligament.

  3. • The shape of the suprascapular notch is different for each individual, and those individual differences determine the size of the space through which the nerve can pass and cause entrapment syndrome. Rengachary et al. classified the suprascapular notch anatomy into six types, depending on the shape of the notch and the ossification of the transverse suprascapular ligament (Fig. 52.3).
  4. • Thereafter it runs along the lateral border of the scapular spine, crosses over the spinoglenoid notch, and enters the infraspinatus fossa. While traversing the spinoglenoid notch, it passes under the inferior transverse scapular ligament, which is also a location where nerve entrapment could occur. According to previous anatomic studies, an inferior transverse scapular ligament exists in about 50%–80% of shoulders. Since this ligament limits movement of the nerve in the spinoglenoid notch, even a small cyst can easily induce compression (Fig. 52.4).

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Mar 28, 2020 | Posted by in ORTHOPEDIC | Comments Off on Arthroscopic Management of Spinoglenoid and Suprascapular Notch Cysts

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