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This patient's MRI is remarkable for a spinoglenoid notch cyst. The suprascapular nerve is likely to be compressed at the spinoglenoid notch, leading to isolated weakness of the infraspinatus.The suprascapular nerve branches off the superior trunk (C5,C6) of the brachial plexus. Suprascapular nerve compression is most often secondary to a ganglion cyst (associated with labral tears) and may occur either at the suprascapular notch, leading to weakness of both the supraspinatus and infraspinatus muscles, or at the spinoglenoid notch, leading to isolated weakness of the infraspinatus. Kim et al. describe a spinoglenoid cyst decompression technique through a subacromial approach and the resulting clinical outcomes. The authors reported significantly improved functional outcomes, active forward flexion and external rotation, and no recurrence of the spinoglenoid notch cyst on imaging. They concluded that for spinoglenoid cyst decompression, the subacromial approach was found to be effective, yielding satisfactory clinical outcomes without recurrence.Schroder et al. prospectively assessed whether labral repair alone would lead to cyst resolution and pain relief. They found that 88% of the cysts resolved completely following isolated labral repair. The authors concluded that most spinoglenoid cysts resolve, and patient satisfaction can be expected to be high after labral fixation without cyst decompression.Shon et al. reported on the outcomes of all-intra-articular arthroscopic decompression and labral repair in patients with symptomatic paralabral cysts. The authors reported improved clinical outcomes and complete cyst resolution in 90% of cases. They concluded that an arthroscopic all-intra-articular decompression and labral repair of paralabral cysts resulted in complete resolution of the cyst at an average 6-months post-operative follow-up. Figure A is the MRI image of a shoulder demonstrating a spinoglenoid notch cyst. Figure B is an illustration of the rotator cuff musculature, including the supraspinatus (A), infraspinatus (B), teres minor (C), teres major (D), and triceps (E).Incorrect Answers:Answers 1,3-5 : A spinoglenoid notch would lead to infraspinatus weakness while sparing the remaining rotator cuff muscles.
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