Submit
Symptomatic spinoglenoid ganglion cyst is a rare cause of shoulder pain and disability. Surgical treatment, which may be considered after failed nonoperative treatment, includes open or arthroscopic cyst debridement. Arthroscopic treatment is less invasive and has the advantage of addressing intraarticular pathologies; however, exposure of the cyst may be deemed difficult. Furthermore, the suprascapular nerve is susceptible to iatrogenic injury owing to its close proximity to the posterior glenoid rim. The purpose of this article is to present our technique for arthroscopic spinoglenoid cyst decompression after preoperative ultrasound-guided methylene blue injection.
Preoperative Ultrasound-Guided Methylene Blue Injection
After the administration of a regional interscalene block and the induction of general anesthesia, the patient is positioned in lateral decubitus position and the skin is prepared. A linear array transducer (CX50, 5 to 15 mHz; Philips, Bothell, WA) is placed over the scapular spine, and the infraspinatus fossa is identified. While imaging the infraspinatus muscle and the bony fossa underneath, the ultrasound transducer is moved laterally to locate the spinoglenoid notch cyst. With a linear probe used to visualize the cyst in the axial plane, an 18-gauge needle is directed into the cyst in an in-plane manner. Once the location of the needle tip has been confirmed to be inserted into the cyst with real-time imaging, 2 to 3 ml of methylene blue is injected into the cyst, paying attention to the underlying SSN
Maintaining the patient in the lateral decubitus position, the operative extremity is draped free under sterile conditions with the arm secured in lateral traction. A standard posterior viewing portal is established and, under direct visualization, an anterosuperior portal is created with a 5.75-mm cannula (Crystal Cannula; Arthrex, Naples, FL). Diagnostic arthroscopy is then performed to identify and address any concomitant pathology. The long head of biceps tendon, superior labrum, rotator cuff, cartilage surfaces, and surrounding structures are evaluated thoroughly.12 Arthroscopic Decompression of the Spinoglenoid Cyst.
The arthroscope is switched to the anterosuperior portal to assess the posterior labrum. An 8.25-mm cannula (Twist-In Cannula; Arthrex) is inserted into the posterior portal. An accessory posterosuperior portal is established with a 5.75-mm cannula to be used as a working portal. A liberator is introduced through the posterior portal, and the torn or frayed labrum is elevated gently to visualize the spinoglenoid cyst lying beneath . Next, a 5.0-mm shaver (Arthrex) is introduced from the posterior portal. After careful debridement of the soft tissue posterior to the scapular spine, the cyst can be distinguished as a bulging structure with a bluish reflection . The cyst can then be decompressed safely using the shaver . Viscous and bluish fluid egress into the joint cavity confirms decompression of the cyst . To avoid neurovascular injury, neither the shaver nor any instruments are advanced beyond 1 cm medial to the posterior border of the glenoid. Continuing debridement until the washout of methylene blue confirms the adequate decompression of the cyst.