The successful arthroscopic treatment of suprascapular intraneural ganglion cysts.
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.
Neurosurgery, Mayo Clinic, Rochester, Minnesota; and.
Nikhil K
NK
Prasad
Departments of 1 Orthopedics.|Neurosurgery, Mayo Clinic, Rochester, Minnesota; and.
Robert J
RJ
Spinner
Physical Medicine.
Jay
J
Smith
Radiology, and.
Benjamin M
BM
Howe
Radiology, and.|Neurosurgery, Mayo Clinic, Rochester, Minnesota; and.
Kimberly K
KK
Amrami
Department of Orthopedics, Cleveland Clinic, Cleveland, Ohio.
Joseph P
JP
Iannotti
Departments of 1 Orthopedics.
Diane L
DL
Dahm
D000328:Adult; D001182:Arthroscopy / Q000379:methods*; D005260:Female; D045888:Ganglion Cysts / Q000601:surgery*; D006801:Humans; D008279:Magnetic Resonance Imaging; D012785:Shoulder Joint / Q000601:surgery*
EMG = electromyography; FSE = fast spin echo; IS = infraspinatus; SLAP = superior labrum anteroposterior; SSN = suprascapular nerve; STIR = short-tau inversion recovery; intraneural ganglion cyst; labral tear; peripheral nerve imaging; shoulder; suprascapular nerve; unified articular (synovial) theory