Suprascapular intraneural ganglia and glenohumeral joint connections

Spinner, Robert J.; Amrami, Kimberly K.; Kliot, Michel; Johnston, Shawn P.; Casanas, J.

doi:10.3171/jns.2006.104.4.551

Cited by 51 publications

(44 citation statements)

References 35 publications

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“…The cyst extended longitudinally toward the retroclavicular brachial plexus. Given our experience with this case and others, 30,31,33 we were able to reinterpret the imaging findings of Case 2. The cyst in Case 2 followed the same course as in Case 1, but it extended even more proximally along the brachial plexus (Fig.…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

“…The strength of the association between labral tears and both paralabral (extraneural) 7-10,17,21,36,39 and intraneural ganglion cysts 30 has been established. We have also previously demonstrated 30 and herein confirmed a similar association between posterosuperior labral tears and intraneural ganglion cysts. The intraneural ganglion cysts in Cases 1 and 2 obey the same principles of formation as previously reported suprascapular intraneural ganglia: 20,22,24,25,29-31,37 1) They originate from the articular nerve branch that supplies a synovial joint; 2) they follow the path of least resistance; and 3) the size, extension, and compressive effect of the cyst fluctuates based on dynamic joint pressures.…”

Section: Discussionmentioning

confidence: 99%

“…We believe that suprascapular intraneural ganglia are always associated with labral tears, but certain authors have reported otherwise. 35 Until now, open surgery has been used to resect intraneural ganglion cysts of the SSN, 20,22,24,25,[29][30][31]37 and if the associated labral tear is not identified or treated, it is imperative to resect the articular nerve branch. However, failure to address the labral tear may result in suboptimal recovery and recurrence.…”

Section: Discussionmentioning

confidence: 99%

“…However, failure to address the labral tear may result in suboptimal recovery and recurrence. 30 In summary, the therapeutic objectives in decreasing order of importance are repair of labral pathology, resection of the cystic articular nerve branch, and decompression of the cyst. Cyst decompression, by itself, may be performed before, during, or after surgery to provide symptomatic relief and reduce pressure on the nerve, but it does not address the primary pathology or prevent recurrence.…”

Section: Discussionmentioning

confidence: 99%

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The successful arthroscopic treatment of suprascapular intraneural ganglion cysts

Prasad

Spinner

Smith³

et al. 2015

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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.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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The successful arthroscopic treatment of suprascapular intraneural ganglion cysts

Prasad

Spinner

Smith³

et al. 2015

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Cross‐over: A generalizable phenomenon necessary for secondary intraneural ganglion cyst formation

et al. 2008

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The appearances of intraneural ganglion cysts are being elucidated. We previously introduced the cross-over phenomenon to explain how a fibular (peroneal) or tibial intraneural ganglion cyst arising from the superior tibiofibular joint could give rise to multiple cysts: cyst fluid ascending up the primarily affected nerve could reach the level of the sciatic nerve, fill its common epineurial sheath and spread circumferentially (cross over), at which time pressure fluxes could result in further ascent up the sciatic or descent down the same parent nerve or the opposite, previously unaffected fibular or tibial nerves. In this study, we hypothesized that cross-over could occur in other nerves, potentially leading to the formation of more than one intraneural ganglion cyst in such situations. We analyzed the literature and identified a single case that we could review where proximal extension of an intraneural ganglion cyst involving a nerve at a different site could theoretically undergo cross-over in another major nerve large enough for available magnetic resonance images to resolve this finding. A case of a suprascapular intraneural ganglion cyst previously reported by our group that arose from the glenohumeral joint and extended to the neck was reanalyzed for the presence or absence of cross-over. An injection of dye into the outer epineurium of the suprascapular nerve in a fresh cadaveric specimen was performed to test for cross-over experimentally. Retrospective review of this case of suprascapular intraneural ganglion cyst demonstrated evidence to support previously unrecognized cross-over at the level of the upper trunk, with predominant ascent up the C5 and the C6 nerve roots and subtle descent down the anterior and posterior divisions of the upper trunk as well as the proximal portion of the suprascapular nerve. This appearance gave rise to multiple interconnected intraneural ganglion cysts arising from a single distant connection to the glenohumeral joint. The injection study also demonstrated the cross-over phenomenon and produced a similar pattern as the cyst dissection. This article illustrates that cross-over can occur in another nerve (apart from the prototype fibular nerve). Furthermore, understanding the more complex anatomic nature of the upper trunk cross-over model provides insight into important mechanistic information regarding the bidirectional propagation patterns and formation of primary and secondary intraneural ganglion cysts not afforded by the previously described sciatic nerve cross-over model.

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Patterns of intraneural ganglion cyst descent

et al. 2008

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On the basis of the principles of the unifying articular theory, predictable patterns of proximal ascent have been described for fibular (peroneal) and tibial intraneural ganglion cysts in the knee region. The mechanism underlying distal descent into the terminal branches of the fibular and tibial nerves has not been previously elucidated. The purpose of this study was to demonstrate if and when cyst descent distal to the articular branch-joint connection occurs in intraneural ganglion cysts to understand directionality of intraneural cyst propagation. In Part I, the clinical records and MRIs of 20 consecutive patients treated at our institution for intraneural ganglion cysts (18 fibular and two tibial) arising from the superior tibiofibular joint were retrospectively analyzed. These patients underwent cyst decompression and disconnection of the articular branch. Five of these patients developed symptomatic cyst recurrence after cyst decompression without articular branch disconnection which was done elsewhere prior to our intervention. In Part II, five additional patients with intraneural ganglion cysts (three fibular and two tibial) treated at other institutions without disconnection of the articular branch were compared. These patients in Parts I and II demonstrated ascent of intraneural cyst to differing degrees (12 had evidence of sciatic nerve cross-over). In addition, all of these patients demonstrated previously unrecognized MRI evidence of intraneural cyst extending distally below the level of the articular branch to the joint of origin: cyst within the proximal most portions of the deep fibular and superficial fibular branches in fibular intraneural ganglion cysts and descending tibial branches in tibial intraneural ganglion cysts. The patients in Part I had complete resolution of their cysts at follow-up MRI examination 1 year postoperatively. The patients in Part II had intraneural recurrences postoperatively within the articular branch, the parent nerve, and the terminal branches, although in three cases they were subclinical. The authors demonstrate that cyst descent distal to the take-off of the articular branch to the joint of origin occurs regularly in patients with fibular and tibial intraneural ganglion cysts. The authors believe that parent terminal branch descent follows ascent up the articular branch from an affected joint of origin. This mechanism for bidirectional flow explains cyst within terminal branches of the fibular and tibial nerves and is dependent on pressure fluxes and resistances. This new pattern is consistent with principles previously described in a unified (articular) theory, is generalizable to other intraneural ganglion cysts arising from joints, and has important implications for pathogenesis and treatment of these intraneural cysts.

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Suprascapular intraneural ganglia and glenohumeral joint connections

Cited by 51 publications

References 35 publications

The successful arthroscopic treatment of suprascapular intraneural ganglion cysts

The successful arthroscopic treatment of suprascapular intraneural ganglion cysts

Cross‐over: A generalizable phenomenon necessary for secondary intraneural ganglion cyst formation

Patterns of intraneural ganglion cyst descent

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