Disclosures: Rosa M. Pasculli, MD, MBA: Nothing to disclose

Case Description: The patient initially presented with acute left shoulder weakness that started during an overhead press 2 weeks earlier. He reported weakness worsened with external rotation movements. Denied neck pain, numbness, tingling, or distal weakness. On exam of the left shoulder, there was no atrophy or asymmetry, and no tenderness to palpation. Patient had full range of motion in all planes. Strength testing was significant for 4/5 left external rotation, with 5/5 abduction, flexion, and internal rotation. Hornblower’s and O’Brien’s tests were positive. Ultrasound of the left shoulder revealed a paralabral cyst extending from the glenohumeral joint to the spinoglenoid notch.

Setting: Outpatient sports practice

Patient: 40-year-old right handed male physical therapist with 2 weeks of left shoulder weakness.

Assessment/Results: Patient underwent left shoulder MRI without contrast which showed small nondisplaced type 2 superior labral anterior to posterior (SLAP) tear and associated 2.4-cm paralabral cyst with suggestion of minimal infraspinatus muscle edema. One month later, patient returned to the office after completing a strengthening program targeting the infraspinatus with no improvement in symptoms. He underwent uncomplicated ultrasound-guided percutaneous aspiration of the cyst. Two weeks later, patient reported his strength had returned to baseline and exam demonstrated 5/5 strength in external rotation. Patient was referred to Orthopedics for evaluation of his SLAP tear.

Discussion: Paralabral cysts are commonly associated with type 2 SLAP lesions, and in rare circumstances, they cause compression of the suprascapular nerve at the spinoglenoid notch. Traditional management includes arthroscopic decompression of the cyst with SLAP lesion repair. To our knowledge, this is the first documented case report of infraspinatus weakness that improved after ultrasound-sound guided aspiration of a paralabral cyst.

Conclusion: In patients with compressive suprascapular neuropathy from a paralabral cyst at the spinoglenoid notch, ultrasound-guided aspiration may be considered as part of the treatment plan for rapid symptom relief.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/improvement-of-infraspinatus-weakness-after-aspiration-of-a-paralabral-cyst-a-case-report/