Ultrasound-Guided Aspiration of a Paralabral Cyst: A Novel Technique for Management

Paralabral cysts of the shoulder joint, though rare, often arise from underlying shoulder pathologies such as labral tears and posterior shoulder capsule instability. These mucin-filled cysts can compress surrounding nerves, particularly the suprascapular nerve, leading to muscle weakness, joint instability, and limited range of motion (ROM). Traditionally, management involves magnetic resonance imaging (MRI) diagnosis followed by surgical repair of the underlying pathology and cyst removal. However, less invasive treatments like ultrasound-guided cyst aspiration have shown promising results. In this case, a 48-year-old male with a history of myasthenia gravis (MG) and chronic bilateral shoulder pain presented with worsening right shoulder pain and weakness during exercise. His extensive treatment history included orthopedic surgery on his left shoulder and multiple Platelet-Rich-Plasma (PRP) injections, which offered only temporary relief. After an MRI confirmed a 2.5 cm paralabral cyst compressing the suprascapular nerve, the patient, opting for a non-surgical approach, underwent ultrasound-guided aspiration. The procedure involved a single aspiration session using a 22-gauge needle under real-time ultrasound guidance, with the complete evacuation of cystic fluid. Follow-up at three and six months revealed complete symptom resolution, with a full recovery of muscle strength and shoulder mobility. No complications were observed, and there was no recurrence of the cyst on follow-up imaging. While surgery remains the gold standard, this case underscores the effectiveness of minimally invasive techniques like ultrasound-guided aspiration, which can offer comparable outcomes with potentially lower recurrence rates and reduced morbidity. Studies support image-guided cyst aspiration as a cost-effective, patient-preferred alternative to surgery, with broader implications for clinical practice in managing similar cases. In summary, paralabral cysts present a complex clinical challenge that benefits from individualized treatment plans. In addition, this case highlights the importance of inter-professional communication and patient-centered care in exploring viable alternatives to surgery, such as ultrasound-guided aspiration, which provides significant symptom relief and functional improvement.