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Review Question - QID 1436

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QID 1436 (Type "1436" in App Search)
A 34-year-old competitive weightlifter presents with increasing pain during bench pressing. Despite modifications in his workout, he is unable to compete. His physical exam demonstrates weakness in external rotation. Radiographs are unremarkable. His MRI findings are seen in Figure A. Treatment should include which of the following?
  • A

Refrain from weightlifting for a minimum of 6 weeks

5%

124/2720

Physical therapy with rotator cuff strengthening

8%

220/2720

Suprascapular cyst decompression

6%

176/2720

Infraspinatus rotator cuff repair and acromioplasty

4%

99/2720

Spinoglenoid cyst decompression with posterior labral repair

77%

2089/2720

  • A

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The clinical and MRI findings in the stem are consistent with a posterior labral tear and associated spinoglenoid cyst. A spinoglenoid cyst could cause nerve compression on the suprascapular nerve before its innervation to the infraspinatus, thus causing weakness in external rotation. In contrast, compression at the suprascapular notch would affect both the supraspinatus and infraspinatus muscles. The suggested treatment in a young and competitive athlete with a spinoglenoid cyst would be spinoglenoid cyst decompression with posterior labral repair.

Cummins et al studied suprascapular nerve entrapement and concluded that treatment should be directed toward the underlying cause of the nerve injury. Nonoperative management showed a high rate of failure in the treatment of ganglion cysts. Operative decompression of the suprascapular nerve was associated with a high rate of pain relief and functional improvement. However, resolution of muscle atrophy was less predictable.

Martin et al looked at the results of nonoperative treatment for suprascapular neuropathy confirmed by EMG. Their results suggest that in the absence of a well defined lesion producing mechanical compression of the suprascapular nerve, suprascapular neuropathy could be treated non-operatively.

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