Disclosures: Ike B. Hasley, MD: No financial relationships or conflicts of interest

Case Diagnosis: 69-year-old male with shoulder pain and weakness caused by a paralabral cyst-related suprascapular neuropathy was successfully treated with ultrasound-guided aspiration and corticosteroid injection.

Case Description: The patient presented for 8 weeks of right shoulder pain and weakness after a day of activity without specific injury. Pain described as sharp, rated 0-10/10, worse with activity. Examination notable for atrophy in the supraspinatus/infraspinatus regions, decreased external rotation strength and active range of motion. MRI demonstrated multilobulated suprascapular/spinoglenoid notch cyst arising from glenoid labral tear causing supraspinatus and infraspinatus denervation change, as well as rotator cuff tendinosis and glenoid cartilage loss. We treated with physical therapy and glenohumeral joint injection. 6-week follow-up revealed improved pain but ongoing weakness causing functional limitation. EMG confirmed suprascapular neuropathy with severe denervation changes to infraspinatus, mild changes to supraspinatus. Neurosurgical and orthopedic surgery consults recommended against surgical decompression due to pain improvement, consideration of percutaneous cyst aspiration, and future reverse total shoulder arthroplasty if symptoms worsened.

Setting: Tertiary care hospitalAssessment/

Results: Using ultrasound guidance, the complex cyst was confirmed, each chamber was fenestrated and aspirated, and anesthetic/corticosteroid was injected into the cyst and posterior glenohumeral joint. At 1-month follow-up, patient reported resolution of pain, 90% improvement in strength and function. After 1 year, patient reported 2 flares of pain and occasional mild fatigue-type weakness, and requested a repeat procedure.

Discussion: Shoulder paralabral cysts may cause suprascapular neuropathy, an etiology that accounts for 1-4% of shoulder pain cases and is often underdiagnosed. MRI and EMG are used to confirm the diagnosis. Referral for more invasive treatments may be considered after conservative methods have failed. Ultrasound-guided aspiration of a paralabral cyst may provide effective relief for patients not amenable to surgery.

Conclusion: This case demonstrates the utility of ultrasound-guided paralabral cyst aspiration in a patient with suprascapular neuropathy causing functional limitation.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/shoulder-pain-and-weakness-caused-by-a-paralabral-cyst-related-suprascapular-neuropathy/