The successful arthroscopic treatment of suprascapular intraneural ganglion cysts

Abstract

<jats:sec> <jats:title>OBJECT</jats:title> <jats:p>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.</jats:p></jats:sec> <jats:sec> <jats:title>METHODS</jats:title> <jats:p>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.</jats:p></jats:sec> <jats:sec> <jats:title>RESULTS</jats:title> <jats:p>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.</jats:p></jats:sec> <jats:sec> <jats:title>CONCLUSIONS</jats:title> <jats:p>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.</jats:p></jats:sec>

Shoulder ganglion cysts in MRI: accompanying tendon pathologies and labral lesions

“…Ganglion cysts on the shoulder are secondary clinical findings of compression effect, trapping and degeneration according to their localizations (3,(7)(8)(9)12). In our study, there was a positive correlation between cyst size and the number of accompanying pathologies in the 1st and 2nd groups (r:0.582, p:0.001).…”

“…Treatment methods of ganglion cysts include surgical and non-surgical methods. In symptomatic cases, definitive treatment is surgical (2,12,21,22). Surgical methods include; needle aspiration, arthroscopic and/or open surgical procedures (9,12,22).…”

“…In symptomatic cases, definitive treatment is surgical (2,12,21,22). Surgical methods include; needle aspiration, arthroscopic and/or open surgical procedures (9,12,22). The choice of surgical methods should be based on the localization of the cyst and the accompanying pathologies (12,22).…”

“…Surgical methods include; needle aspiration, arthroscopic and/or open surgical procedures (9,12,22). The choice of surgical methods should be based on the localization of the cyst and the accompanying pathologies (12,22). In our study, shoulder tendon pathologies and labral lesions which frequently accompanied shoulder ganglion cysts were investigated.…”

Clinical anatomy leading the way for solutions: An important paradigm for translational research

“…If one believes and applies the underlying anatomy and science, advances can be anticipated by incorporating new techniques and technologies to address the causative problem: a joint‐based minimally invasive (endoscopic or arthroscopic) procedure to repair the capsular defect, or even a non‐invasive image‐guided (percutaneous or transcutaneous [focused ultrasound]) approach to disconnect the articular branch from the joint. These types of innovative solutions are in development for the treatment of intraneural ganglion cysts (Hwang et al, ; Prasad et al, ) based on their initial and encouraging success for the management of extraneural cysts (He et al, ). Future treatment will be aimed at addressing the cause (joint pathology) and the conduit (an articular branch) and searching for a cure.…”