2024 FSA Podium and Poster Abstracts
P081: ULTRASOUND-GUIDED ASPIRATION: AN ALTERNATIVE MANAGEMENT APPROACH FOR PARALABRAL CYSTS - A CASE REPORT
Karthik Sriganeshan1; Trellane Willis1; William Bonner, MD2; 1FIU Herbert Wertheim College of Medicine; 2ProFormMD
Paralabral cysts of the shoulder joint, a rare complication of underlying shoulder pathologies (labral tears and posterior shoulder capsule instability), present an intriguing yet complex challenge with respect to treatment options. The mucin-filled cysts often compress surrounding nerves, most notably the suprascapular nerve, leading to muscle weakness, joint instability, and limited range of motion. Current first-line management includes diagnosis via magnetic resonance imaging (MRI) followed by surgical intervention to repair the underlying pathology and remove the cyst, but less invasive treatment options such as ultrasound-guided aspiration of the cyst have provided promising results.
Our patient, a 48-year-old male with a history of myasthenia gravis and chronic bilateral shoulder pain presented with worsening right shoulder pain and weakness exacerbated during exercise. The patient had an extensive history of treatment for his shoulder pain including orthopedic surgical intervention on his left shoulder and multiple trials of Platelet-Rich-Plasma injections which provided temporary relief. Following MRI confirmation of a paralabral cyst compressing the suprascapular nerve, the patient opted for a less invasive method of treatment due to his previous surgical history and unresolved shoulder pain. Following collaborative discussions between the patient, pain management physicians, and the orthopedic surgeon, it was decided to proceed with ultrasound-guided aspiration to alleviate the compression caused by the cyst. Subsequent follow-up revealed the patient experienced complete resolution of symptoms, alongside regained full muscle strength and range of motion in the shoulder.
While surgical intervention remains the gold standard, this case highlights the efficacy of minimally invasive techniques like ultrasound-guided aspiration, offering comparable outcomes with similar if not lower recurrence potential. Studies have been found to support the effectiveness of image-guided cyst aspiration in symptom resolution, emphasizing its cost-effectiveness and patient preference for non-surgical interventions.
In conclusion, paralabral cysts are rare complications that present a complex clinical challenge that requires an individualized treatment management plan. In addition to highlighting the importance of interprofessional communication and patient-centered care, this case provides evidence that minimally invasive techniques, such as ultrasound-guided aspiration, offer viable alternatives to surgery, providing significant symptom relief and functional improvement.