Shoulder

Paralabral cyst of the shoulder joint – symptoms, diagnosis, treatment

Paralabral cyst

The paralabral cyst of the shoulder joint is not a common disorder. As a rule it concerns sportspersons, including amateurs, who lift their shoulder, e.g. who throw or work out in the gym.

Symptoms

The pain in the shoulder is accompanied by weak arm (mainly when rotating and lifting) but may subside after suitable exercises. As a rule it recurs if we are overburdened or after we make much effort. Patients often describe it as a “burning pain” in the shoulder. The cyst is formed in the spinal-acetabulum notch and neighboring spaces under supraspinatus and infraspinatus muscles and may press against suprascapular nerve. This in turn causes pain and limb weakness. Additionally, it may also result in a feeling of fear when moving a shoulder joint. This causes discomfort when working physically, e.g. when lifting heavy objects or when making fast movements in the gym. With time the cyst may enlarge. Complaints may subside but the cyst itself will not disappear.

Diagnosis

Considering the clinical symptoms which suggest a likelihood of occurrence of the paralabral cyst, it is necessary to consult an orthopedist. To make a diagnosis, it is necessary to conduct a clinical study and additional examinations, such as magnetic resonance (MR) or ultrasound examination.

Conservative treatment

The paralabral cyst may be pointed under ultrasound examination, and rehabilitation exercises may be implemented. The conservative treatment is usually effective but with time the cyst grows again and pain recurs. Patients claim that when the cyst is pricked they feel like someone took a weight away from their shoulder – this subconscious feeling results from decompressing nerves and muscles. This sort of treatment is often chosen by persons who cannot undergo a surgery for various reasons or is the first stage of the treatment.

Surgical treatment

When pain recurs, particularly when the conservative treatment has been initiated, it is advisable to try a surgical treatment. The treatment method is little-invasive – shoulder arthroscopy (“through the keyhole”). By making minor skin cuts through which a special camera is placed, we can observe a shoulder joint and surrounding soft tissues. We expose the cyst and remove it. As a rule the cyst is formed as a result of damaged labrum (cartilage that surrounds the acetabulum). Therefore, once the cyst has been removed, we repair the damaged labrum. This is possible by sewing the labrum on to the acetabulum by means of special anchor-shaped implants with threads. The threads are sewed through the labrum and this is how it is attached in the place it is supposed to cling. As a rule, before the surgery is started a general anesthesia is provided and a brachial plexus is anesthetized.  A brachial plexus anesthesia assures comfort and painless time after the surgical treatment.

Rehabilitation

Shortly after the surgery the patient’s arm must be partially immobilized with an orthosis. During the first 24 hours after the surgery, it is necessary to start doing active and passive exercises – this process lasts about four weeks. The orthosis must be used for 3-4 weeks after the treatment. The patient may also exercise other parts of the body at this time (walking, keeping straight posture, using an immobile bicycle). It is a very important part of the rehabilitation.

After this period, the orthosis is unnecessary and the intensive rehabilitation program is incorporated. The patient may fully return to sport after 5-6 months when his/her shoulder is ready for considerable loads.

Anatomy, causes, symptoms and methods of treatment discussed by:
MD Joanna Wałecka, Rehasport Clinic orthopedist