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Labral Tears

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Paralabral Cysts

Lennard Funk, 2011

Paralabral cysts are swellings that arise around the socket of the shoulder joint (glenoid). They are pockets of joint fluid that develop outside of the joint under tears of the labrum. These are also known as ganglia (or a ganglion). These may occur anywhere around the glenoid.



The cysts can be diagnosed on an MRI scan, or MR Arthrogram. An MR Arthrogram is more sensitive in detecting the associated labral tear also.

posterior paralabral cyst with labral tear on MR Arthrogram:


Often the cysts themselves don't cause any pain, but the labral tears can cause pain. Treatment will involve repair of the labral tear and drainage of the cyst. This is usually done by arthroscopy (Keyhole). For more details on the labral repair click here.

The cysts may become very large and can press on some of the important nerves around the shoulder. This can cause pain and also weakness of the muscles supplied by the nerve. The commonest nerve affected is the suprascapular nerve. The suprascapular nerve can be compressed at the spinoglenoid notch with a posterior labral tear (reverse Bankar tear) or at the suprascapular notch with a SLAP tear. This can lead to a suprascapular nerve palsy.

posterior paralabral cyst pressing on the suprascapular nerve at the spinoglenoid notch, under the spinoglenoid ligament:


posterior paralabral cyst causing compression of suprascapular nerve with wasting and fluid oedema in the infraspinatus muscle (within green circle):


inferior labral tears can cause inferior paralabral cysts which may press on the axillary nerve, causing weakness of the Teres Minor muscle and Quadrilateral Space syndrome.

Treatment for paralabral cysts causing nerve compression involves arthroscopic repair of the labral tear, as well as decompression of the nerve and drainage of the cyst.


Bibliography:
  1. Bedi, A., C. Dodson, et al. (2010). "Symptomatic SLAP tear and paralabral cyst in a pediatric athlete: a case report." The Journal of bone and joint surgery. American volume 92(3): 721-725.
  2. Ho, J. C. and J. P. Iannotti (2010). "Glenoid labral tear associated paralabral ganglion cyst presenting as a neck mass: a case report." Journal of shoulder and elbow surgery / American Shoulder and Elbow Surgeons ... [et al.] 19(5): e10-13.
  3. Sanders, T. G. and P. F. Tirman (1999). "Paralabral cyst: an unusual cause of quadrilateral space syndrome." arthroscopy : the journal of arthroscopic & related surgery : official publication of the arthroscopy Association of North America and the International arthroscopy Association 15(6): 632-637.
  4. Sheets, J. and K. L. Ford, 3rd (1999). "Aunt Minnie's Corner. Superior labral tear with associated paralabral cyst in the spinoglenoid notch, and infraspinatus denervation myositis." Journal of computer assisted tomography 23(1): 167.
  5. Sherman, P. M., M. W. Matchette, et al. (2003). "Acetabular paralabral cyst: an uncommon cause of sciatica." Skeletal radiology 32(2): 90-94.
  6. Yukata, K., K. Imada, et al. (2002). "Intra-articular ganglion cyst (paralabral cyst) of the shoulder associated with recurrent anterior dislocation: a case report." Journal of shoulder and elbow surgery / American Shoulder and Elbow Surgeons ... [et al.] 11(1): 95-97.

Superior Labral Antero-Posterior lesion - Abbreviated term for an injury to the superior labrum of the glenoid.
at the back; behind
A tough band of connective tissue that connects two bones to each other. "Ligament" is a fitting term; it comes from the Latin "ligare" meaning "to bind or tie."
at the side or outer aspect
A firm, white structure that forms a ring around the glenoid cavity (the cup of the ball and socket shoulder joint). It deepens the socket, providing stability to the joint.
The labrum is a firm, white structure that forms a ring around the glenoid cavity (the cup of the ball and socket shoulder joint). It deepens the socket, providing stability to the joint.
muscle and tendon of the rotator cuff. Externally rotates the arm. Lies between supraspinatus and teres minor.
at the botom; towards the feet
joint comes out of it's socket completely
'key-hole' surgery. Surgery performed via small incisions, using special instruments and a viewing scope..
at the front; in front


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Tags: [Labral Lesions] [ Neuromuscular] [View tag cloud]

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