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Symptoms
Shoulder pain is accompanied by weakness of the shoulder (mainly rotation and elevation), and may resolve after improvement exercises. As a rule, they recur after overloading or greater exertion. Patients often describe it as a "burning pain" in the shoulder.
The cyst forms in the supraspinatus notch and adjacent spaces under the supraspinatus and subscapularis muscles and can press on the suprascapular nerve. This in turn causes pain, as well as weakness in the limb. In addition, there may also be a sense of apprehension when moving the shoulder joint. It causes discomfort during physical work, such as lifting weights or fast repetitive movements during gym exercises. Over time, the cyst may grow larger. The discomfort may subside, however, the cyst itself will not disappear.
Diagnostics
In case of clinical symptoms indicating the possibility of a perimembranous cyst, one should visit an orthopedist. A clinical examination and additional tests, such as magnetic resonance (MR) or ultrasound, are important to make the diagnosis.
Conservative treatment
A periradicular cyst can be scored under ultrasound guidance and rehabilitation exercises can be implemented. Conservative treatment usually brings improvement, but as a rule, the cyst also begins to grow again after some time and the discomfort returns. Patients report that after puncturing the cyst they feel as if someone took a weight off their shoulder - this subconscious feeling is the result of decompression of the nerve and muscles. This method of treatment is often chosen by people who cannot be operated on for various reasons, or is the first stage of treatment.
Operative treatment
In the case of recurrent pain conditions, especially when conservative treatment has been undertaken, surgical treatment is suggested. The method of treatment is minimally invasive - shoulder arthroscopy ("through the keyhole"). Using small incisions on the skin, through which a special camera is inserted, we view the shoulder joint and surrounding soft tissues. We visualize the cyst and remove it. As a rule, a cyst is caused by a damaged annulus (cartilage surrounding the acetabulum). So after removing the cyst, we repair the damaged casing. This is done by sewing the casing to the acetabulum using special anchor-shaped implants with threads. The threads are sewn through the casing and in this way it is attached to the place where it is to adhere. As a rule, the operation is carried out under general anesthesia and the brachial plexus is anesthetized at the same time. Brachial plexus anesthesia gives pain-free comfort to the patient after surgery.
Rehabilitation
Immediately after surgery, the patient's arm is partially stabilized with an orthosis. On the first postoperative day, active-passive exercises are started - they last about four weeks. The orthosis must be used for 3-4 weeks after surgery. During this time, the patient can also exercise other parts of the body (walking, maintaining an upright posture, stationary bicycle). This is a very important part of rehabilitation. After this period, already without the orthosis, an intensive rehabilitation program is introduced, while the return to full sports usually takes place after 5-6 months, when the shoulder is already prepared for considerable loads.
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Bibliography:
- National Library of Medicine - Paralabral cysts of the shoulder treated with isolated labral repair: effect on pain and radiologic findings - Cecilie P Schrøder 1, Kirsten Lundgreen 2, Rune Kvakestad 3 - 2018
- MR Imaging and MR Arthrography of Paraglenoid Labral Cysts - Glenn A. Tung1, Dirk Entzian1, Jeremy B. Stern2 and Andrew Green3 - American Journal of Roentgenology. 2000;174: 1707-1715. 10.2214/ajr.174.6.1741707
