Suprascapular Neuropathy Due to a Spinoglenoid Notch Cyst

A 37-year-old reconstruction worker presented with a stabbing pain, hyperesthesia, and dysesthesia around his right scapular region for the last 6 months. His past medical history was otherwise unremarkable. On physical examination, shoulder external rotation strength was decreased on the right side (4/5), and he had significant tenderness upon palpation on the infraspinatus fossa. Ultrasound (US) examination revealed a 1 × 1-cm cystic lesion compressing the suprascapular nerve around the spinoglenoid notch (Video 1, https://links.lww.com/PHM/C602). Under US guidance and using an 18-gauge needle, the cyst (3-ml viscous fluid) was aspirated and 2 ml (40 mg) of prilocaine hydrochloride was injected (Video 2, https://links.lww.com/PHM/C603). Ten minutes after the procedure, the patient reported near-complete pain relief. The patient is still under follow-up with full resolution of his findings. Spinoglenoid notch cyst is a rare cause of suprascapular neuropathy, which may result in shoulder pain, paresthesia, and muscle atrophy whereby the diagnosis/treatment can really be difficult for clinicians.1 It is commonly associated with superior labral anterior tears2 and the differential diagnosis also needs to include rotator cuff pathology, adhesive capsulitis, cervical radiculopathy, and brachial plexopathy. While clinical suspicion is always the requisite, the diagnosis of spinoglenoid notch cyst and/or suprascapular neuropathy can be confirmed by imaging as well as electrophysiological tests. Conservative treatment is that of non-steroidal anti-inflammatory drugs and physical therapy. Cyst aspiration and suprascapular nerve blockade are also very effective/practical methods and surgery is only preferred in complicated cases.2 Reporting this otherwise trivial shoulder pain scenario, we aimed to showcase the ‘extended guidance’ of US. Because of its well-known advantages, that is, low cost, short examination time, radiation-free imaging, convenience, and easy accessibility, US outperforms other modalities during the diagnosis, treatment, and follow-up of relevant cases. In addition to its uncomparable guidance during interventions, it is also noteworthy that the diagnostic role of US would simply not be confined to cyst detection but may also include the assessment of denervated muscle(s) morphology.3