30 yr old male with complains of shoulder pain while throwing the ball

30 yr old male with complains of shoulder pain while throwing the ball

  • 30 yr old male with complains of shoulder pain while throwing the ball.
  • No history of trauma as per the patient.
  • A and B. Axial and Sagittal PDFS images show Ganglion Cyst in the Spino-Glenoid Notch. No denervation edema/ atrophy in the infraspinatus muscle.
  • A and B. Axial and Sagittal PDFS images show associated superior/posterior-superior labral tear.

DIAGNOSIS

  • SPINOGLENOID CYST ASSOCIATED WITH  SUPERIOR/POSTERIOR SUPERIOR LABRAL TEAR.

DISCUSSION
SPINOGLENOID NOTCH ANATOMY

  • Located between the base of the spine of scapula and the glenoid process of the scapula.
  • Connects the infraspinatus fossa with the supraspinatus fossa.
  • Passage for the suprascapular nerve and artery.

SUPRASCAPULAR NERVE ANATOMY

  • Arises from the upper trunk of the brachial plexus.
  • On entering the suprascapular fossa, the nerve supplies the supraspinatus muscle.
  • Nerve then passes through the spinoglenoid notch to enter the infraspinatus fossa, and supplies  the infraspinatus muscle.

SPINOGLENOID CYST

  • Ganglion cyst located in the spinoglenoid notch.
  • They are thought to be paralabral cysts.

IMPORTANCE

  1. Association with Labral Tear, especially Superior and Posterior tears.
  2. Resultant Entrapment Neuropathy of the Suprascapular nerve.

IMAGING FINDINGS

  • Vary in size from tiny, unilocular to large and multiloculated.
  • Typically hypointense on T1 and hyperintense on T2-weighted MR images.
  • If compressive suprascapular neuropathy ;
  1. Acute denervation: Hyperintensity of the infraspinatus muscle on T2-weighted images due to denervation myoedema.
  2. Chronic compressive suprascapular neuropathy : Infraspinatus atrophy and hyperintense fatty changes in T1-weighted images

PEARLS

  • Spinoglenoid notch cyst cause suprascapular neuropathy affecting only the infraspinatus muscle.
  • Supraspinatus notch cysts cause more proximal suprascapular neuropathy affecting both the supraspinatus and infraspinatus muscles.

REFERENCES

  • Kim DS, Park HK, Park JH, Yoon WS. Ganglion cyst of the spinoglenoid notch: comparison between SLAP repair alone and SLAP repair with cyst decompression. Journal of shoulder and elbow surgery. 2012 Nov 1;21(11):1456-63.
  • Inokuchi W, Ogawa K, Horiuchi Y. Magnetic resonance imaging of suprascapular nerve palsy. Journal of Shoulder and Elbow Surgery. 1998 May 1;7(3):223-7.
  • Lee BC, Yegappan M, Thiagarajan P. Suprascapular nerve neuropathy secondary to spinoglenoid notch ganglion cyst: case reports and review of literature. ANNALS-ACADEMY OF MEDICINE SINGAPORE. 2007 Dec 1;36(12):1032.
  • Fritz RC, Helms CA, Steinbach LS, Genant HK. Suprascapular nerve entrapment: evaluation with MR imaging. Radiology. 1992 Feb;182(2):437-44.
  • Dogan E, Aydo?mu? H, Aydo?mu? S. Spinoglenoid notched ganglion cyst with a subtle SLAP tear, and acromio-humeral impingement findings veiling the real radiological picture: An MRI lesson.

Dr. DEEPTI H V
CONSULTANT RADIOLOGIST
MANIPAL HOSPITAL , YESHWANTHPUR, BENGALURU

Dr. JOMON SUNNY
FELLOW IN CROSS SECTIONAL IMAGING
MANIPAL HOSPITAL , YESHWANTHPUR, BENGALURU