New Treatment for Shoulder Cysts: A Case Report

If a patient has a ganglion cyst, or small tumor, pressing on the nerve above the shoulder blade (the suprascapular nerve), diffuse shoulder pain and loss of shoulder strength may result. The symptoms are similar to a rotator cuff tear. Cysts of this kind are most often seen in men in their 30s or 40s who do manual labor or play sports involving a lot of overhead movements, such as volleyball or tennis.Until now, treatment for this problem has usually involved surgery. Doctors can either do open surgery to remove the cyst, or they can use an arthroscope to take out the cyst without making big incisions in the skin. Sometimes nerve problems that come from these kinds of cysts can be managed without surgery.These authors report on a case that was treated a different way. A 33-year-old man with a history of playing tennis and handball came to the doctor with weakness and pain in his right (dominant) shoulder. The symptoms had lasted nine months. The patient said pain increased with overhead movements, such as serving in tennis.A physical exam showed muscle weakness as well as tenderness in the deep notch in the upper part of the shoulder blade (the suprascapular notch). An MRI revealed a ganglion cyst, and mild tendinitis in the rotator cuff. Instead of opening the shoulder or doing arthroscopy, the doctors aspirated or “deflated” the cyst using suction. While the shoulder was numb from anesthesia, the doctors used ultrasound to find the cyst. They inserted a large needle that sucked out the contents of the cyst. Then they injected a small amount of anesthetic, to ease discomfort. Within six months of the procedure, the patient’s shoulder was as strong as his other shoulder. He was able to get back to tennis without pain. Up to a year after the procedure, the cyst had not come back.This procedure is less invasive than surgery. There is less risk of complication, such as injury to the suprascapular artery and vein. The authors believe this method may be an alternative for patients who don’t want to have surgery or arthroscopy for cysts compressing the suprascapular nerve in the shoulder.