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
- Association with Labral Tear, especially Superior and Posterior tears.
- 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 ;
- Acute denervation: Hyperintensity of the infraspinatus muscle on T2-weighted images due to denervation myoedema.
- 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