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| CASE REPORT |
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| Year : 2015 | Volume
: 4
| Issue : 1 | Page : 44-46 |
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Spinoglenoid notch syndrome
Vemuri Rama Tharaknath, Surath Amarnath, Sushil Kumar Kamaraju, Raja Challapalli
Department of Neurology, Amaravathi Institute of Medical Sciences, Guntur, Andhra Pradesh, India
| Date of Web Publication | 16-Mar-2015 |
Correspondence Address:
Dr. Vemuri Rama Tharaknath
Amaravathi Institute of Medical Sciences, Old Club Road, Kothapet, Guntur - 522 001, Andhra Pradesh
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/2277-8632.153323
Spinoglenoid notch syndrome is due compression of suprascapular nerve, due to a cyst, at the spinoglenoid notch causing pain, which is often mistaken for rotator cuff injury or cervical spondylosis. This patient presented with pain on the back of the right shoulder with weakness of external rotation and abduction. On examination, he had wasting, and weakness of the infraspinatus muscle and rest of the neurological examination was normal. His right shoulder magnetic resonance imaging scan revealed a cystic lesion at the spinoglenoid notch. An ultrasound guided aspiration of the cyst was done. He improved well with physiotherapy. One year later, the bulk and power of his infraspinatus muscle was normal. Keywords: Infraspinatus muscle, periarthritis, rotator cuff injury, spinoglenoid notch, suprascapular nerve
How to cite this article:
Tharaknath VR, Amarnath S, Kamaraju SK, Challapalli R. Spinoglenoid notch syndrome. J NTR Univ Health Sci 2015;4:44-6 |
| Introduction | |  |
Shoulder and arm pain is a very common symptom in clinical practice. The frequent clinical diagnosis made in these patients is cervical spondylosis or periarthritis shoulder. [1],[2],[3] Suprascapular neuropathy is common in athletes' who use their arm overhead. [1],[3],[4] Spinoglenoid notch syndrome shares the same symptoms of suprascapular neuropathy, but it is due to the cyst causing compression at the spinoglenoid notch resulting in weakness and wasting of infraspinatus muscle. [1],[3],[5],[6] The incidence of suprascapular neuropathy is as high as 10-30% in volley ball players. Although, uncommon, the spinogelnoid notch syndrome which shares the same symptoms due to entrapment of suprascapular nerve is potentially treatable cause and completely reversible when recognized and intervened early. The chance of missing this condition is much more particularly when most of the OPD patients are examined in a cursory manner with their clothing intact. Most often the investigation that is done in such patient is magnetic resonance imaging (MRI) of the cervical spine that can be misleading. Instead of open decompression, a simple ultrasound guided aspiration of the cyst is curative followed by physiotherapy.
| Case Report | | |
A 50-year-old male patient presented with a history of pain on the posterior aspect of right shoulder on and off of 3 months duration relieved with NSAIDS. This patient is physically active who regularly swims and exercises at gym. The pain was more during the nights and was relieved on sleeping in the prone position with a pillow under the affected shoulder.
There was a recent history of having difficulty to open heavy doors with his right hand and difficulty in tightening his belt before buckling it with his right upper limb (requiring abduction and external rotation of right shoulder) and to lift a jug of water on the dining table with his right hand.
On examination, he had selective wasting and weakness of right infraspinatus muscle, power and bulk of supraspinatus was normal. There was a tender spot on the scapula laterally just below the spine.
Rest of the neurological exam was normal. Shoulder examination was normal. His MRI of the cervical spine showed mild changes of cervical spondylosis. He refused EMG and NCV studies. His shoulder MRI revealed a small cystic lesion [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5]. | Figure 1: PD fat sat coronal Image shows a lobulated septated hyper intense cystic lesion in spino-glenoid notch
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 | Figure 2: T1 coronal image shows hypo intense cystic lesion in spino-glenoid notch
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 | Figure 3: T2 coronal image shows a lobulated septated hyperintense cystic lesion in spino-glenoid notch
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 | Figure 4: PD sagittal image shows septated hyperintense cystic lesion in spino-glenoid notch
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 | Figure 5: PD fat sat transverse image shows septated hyperintense cystic lesion in spino-glenoid notch
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| Treatment | | |
An ultrasound examination of the region revealed the cyst at the spinoglenoid notch. It was successfully aspirated under ultrasound guidance and at the same time the needle was moved in a different direction to break the cyst wall to prevent re-accumulation. He was subjected to physiotherapy.
His pain subsided within 3 days after the aspiration. One year later, he was asymptomatic, and his bulk and power of right infraspinatus has returned to normal.
| Discussion | | |
Suprascapular nerve neuropathy secondary to ganglion cyst impingement causes shoulder pain and therefore often mistaken as rotator cuff injury or cervical spondylosis and treated by orthopedician until they develop significant wasting and weakness of infraspinatus muscle. [1],[3],[6] Patients typically present with shoulder pain exacerbated by abduction and external rotation. [1],[3],[6]
Suprascapular nerve compression at the spinoglenoid notch results in weakness of only the infraspinatus, but if the involvement is at the suprascapular notch, it can cause weakness of both infra and supraspinati. The nerve can be involved due to overuse, trauma, sol or idiopathic. [1],[2],[3],[4] In some patients, extension of the cyst a little higher can result in wasting of the supraspinatus muscle also. In this case only infraspinatus muscle was involved.
Athletic activities involving forceful contractions of the shoulder musculature of repetitive overhead movements such as those involved in weight lifting, tennis, throwing, swimming and volleyball have been implicated in the development of this neuropathy. [1],[2],[3],[6]
Magnetic resonance imaging is the best imaging modality for lesions around the shoulder. [2],[3] Open surgical decompression, ultrasound guided aspiration and arthroscopic decompression of the cyst. [1],[3],[4]
In our patient, we did ultrasound guided aspiration with good results.
| Conclusion | | |
Suprascapular nerve neuropathy secondary to ganglion cyst impingement is a treatable condition with potentially good results.
| References | | |
| 1. | Diagnosing Suprascapular Neuropathy in Patients with Shoulder Dysfunction: A Report of 5 Cases Diagnosing Suprascapular Neuropathy in Patients Matthew K Walsworth, James T Mills III and Lori A Michener PHYS THER. 2004;84:359-372.  |
| 2. | Shoulder impingement syndromes, European journal of radiology. Volume 27, Supplement 1, Pages S42-S48, May 1998 (Electronic journal). Available at: http://www.ejradiology.com. |
| 3. | Functional Rehabilitation of Sports and Musculoskeletal Injuries. Kibler WB, Herring SA, Press JM, Lee PA, eds. Gaithersburg, Md: Aspen Publishers; 1998. |
| 4. | Injury of the Suprascapular Nerve at the Spinoglenoid Notch. The Natural History of Infraspinatus Atrophy in Volleyball Players. Andrea Ferretti, Angelo De Carli, Michele Fontana. Am J Sports Med November 1998;26:759-763 (Electronic journal). Available at: http://ajs.sagepub.com/ |
| 5. | Lee BCS, Yegappan M, Thiagarajan P. Suprascapular. Nerve Neuropathy Secondary to Spinoglenoid Notch Ganglion Cyst: Case Reports and Review of Literature. Ann Acad Med Singapore 2007;36:1032-5. |
| 6. | Cummins CA, Messer TM, Nuber GW. Suprascapular Nerve EntrapmentFNx01 Investigation performed at the Department of Orthopaedic Surgery, Northwestern University Medical School, Chicago, The journal of bone and joint surgery (American) 2000;82:415-24. |
[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5]
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