Attending Memorial Regional Hospital Hollywood, Florida, United States
Case Diagnosis: Right sided paralabral cyst of the spinoglenoid notch
Case Description: 58-year-old male presented for chronic right shoulder pain with remote history of trauma. Right shoulder examination was notable for full range of motion, 4/5 strength with resisted external rotation, positive empty can test, and positive o’brien test. Extensive workup, including diagnostic ultrasound and MRI, identified a posterior superior labral tear with a 3.4x2.5x2.4 multi-lobulated paralabral cyst extending into the spinoglenoid notch and early denervation changes of the infraspinatus muscle.The patient elected to pursue non-surgical treatment with physical therapy and an ultrasound guided aspiration of paralabral cyst was performed. This treatment plan resulted in 100% improvement of symptoms at follow up.
Discussions: Nerve entrapments can sometimes be misdiagnosed as pathology including rotator cuff tears or other musculoskeletal disease. Suprascapular nerve entrapment can present with posterolateral shoulder pain with common entrapment sites at either the suprascapular or spinoglenoid notch causing shoulder weakness. One of the causes of compression of the suprascapular nerve can occur from paralabral cysts associated with labral tears. In this case presentation, a paralabral cyst was localized at the spinoglenoid notch causing distal compression of the suprascapular nerve and isolating infraspinatus weakness. In addition to clinical evaluation, an appropriate diagnosis can be made with electrodiagnostic study or diagnostic imaging such as ultrasound or MRI should be performed.
Conclusions: When evaluating posterior shoulder pain, a differential diagnosis including suprascapular nerve entrapment should be considered especially if a patient has findings of provocative labral testing and experiencing external rotation weakness. This case report underscores the importance of recognition and prompt referral for either ultrasound aspiration or arthroscopic decompression which can help prevent the advancement of irreversible denervation or atrophy of muscle. Through physiatry care, we helped diagnose and manage this patient in the most efficient and cost-effective manner.
