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Review Question - QID 1088

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QID 1088 (Type "1088" in App Search)
A patient is scheduled to undergo arthroscopy for a SLAP tear of his shoulder. Based on the sagittal images of the right shoulder MRI shown in Figure A, what additional physical exam finding is the patient likely to display?
  • A

Weakness in forward elevation

3%

50/1433

Weakness in internal rotation

11%

156/1433

Weakness in external rotation

80%

1145/1433

Positive impingement maneuver

4%

55/1433

Scapular winging

1%

18/1433

  • A

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The MRI shows a cyst in the spinoglenoid notch, which is important to differentiate from a cyst in the suprascapular notch.

A suprascapular cyst can impinge upon the suprascapular nerve prior to innervation of the supraspinatus and infraspinatus muscle, leading to weakness in both muscles. Prolonged impingement on the suprascapular nerve by a spinoglenoid cyst can result in atrophy of the infraspinatus muscles. This would show up as weakness in external rotation on exam. These cysts are associated with SLAP lesions and per literature are formed by a one-way valve effect, where synovial fluid can exit the joint into the cyst but not drain spontaneously.

Chen et al describe 3 cases in which preoperative and postoperative EMG's and MRI imaging documented cyst resolution and return of suprascapular nerve function after arthroscopic spinoglenoid cyst excision and labral repair.

Figure A and Illustration A shows a cyst in the spinoglenoid notch, where it may impinge on the suprascapular nerve as it travels around the glenoid and under the spine of the scapula on its way to innervate the infraspinatus muscle. Illustration B shows the anatomic locations of the suprascapular notch and the spinoglenoid notch and the course of the suprascapular nerve.

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