Bilateral Suprascapular Nerve Entrapment by Ganglion Cyst Associated with Superior Labral Lesion
A 35-year old cleaning woman presented with a one year history of bilateral shoulder pain and weakness in the scapular girdle. She was managed conservatively for both shoulder with nonsteroidal anti-inflammatory drugs, physiotherapy, rest and local injections of corticosteroids with no benefits. Clinical examination showed tenderness and pain in the suprascapular and subscapular spaces and subspinosus hypotrophy in both shoulders. O’Brien test and Speed test were positive. Plain radiographs were unremarkable. Magnetic resonance imaging scans of the right shoulder revealed a 4 x 2.5 cm mass with low signal intensity on T1-weighted sequences and high signal intensity on T2-weighted sequences, just below the supraspinatus muscle. Magnetic resonance imaging scans of the left shoulder revealed a 3 x 1.5 cm well-defined mass involving the spinoglenoid notch. Bilateral electromyography was performed showing signs of bilateral suprascapular nerve entrapment neuropathy. Arthroscopy of her right shoulder was performed showing a type II SLAP lesion associated with a cyst into the spinoglenoid notch. A blunt probe was used for dissection to the spinoglenoid notch. A digital pressure over the infraspinatus fossa was associated to decompress the cyst into the joint through the labral defect. Labral repair was then performed. Postoperatively the arm was hold in a sling with an abduction pillow for 4 weeks. Passive exercises were allowed after the 2° week and active exercises were allowed after the 3° week. Six months later the patient underwent arthroscopy of her left shoulder. Intraoperative findings showed a type I SLAP lesion and a ganglion cyst in the spinoglenoid notch. The same surgical management was performed. MRI scans of both shoulders performed 1 year after the first arthroscopy showed that the cystic masses had dissolved and electromyographic findings showed suprascapular reinnervation signs.