Korean J Sports Med.  2015 Jun;33(1):34-39. 10.5763/kjsm.2015.33.1.34.

Compressive Partial Neuropathy of Axillary Nerve Resulting from Antero-Inferior Paralabral Cyst in an Adolescent Overhead Athlete

• Park JY
• Jeon SH
• Oh KS
• Chung SW
• Lim JJ
• Bang JY

• KMID: 2054039
• DOI: http://doi.org/10.5763/kjsm.2015.33.1.34

Abstract

Paralabral cysts of the shoulder are rare, and there are few reports available that describe anteroinferior paralabral cysts arising from a detached antero-inferior glenoid labral tear without shoulder instability. We report an antero-inferior labral tear without shoulder instability in adolescent overhead athlete associated with paralabral cyst that leads to axillary nerve neurapraxia. Although nonoperative management of such labral lesions may provide symptoms of relief, it may not be enough for the athlete to return to the game. However, surgical treatment in this case provides successful recovery and rapid return to playing baseball play without having to worry about the progression of muscle denervation.

Keyword

Shoulder; Labrum; Paralabral cyst; Overhead athletes; Axillary nerve

MeSH Terms

Adolescent*
Athletes*
Baseball
Humans
Muscle Denervation
Shoulder

Figure

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  Fig. 1. Axial T2-weighted fat-suppressed (A, B), coronal T2-weighted fat-suppressed (C) and sagittal T2-weighted fat-suppressed (D) magnetic resonance images of the right shoulder. They are demonstrating an antero-inferior labral tear (from the 4-o’clock to 5-o’clock position) with adjacent 13 mm×15 mm×12 mm multiloculated paralabral cyst (from the 5-o’clock to 6-o’clock position) not extending into the quadrilateral space.

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  Fig. 2. Coronal T2-weighted fat-suppressed (A) and sagittal T2-weighted fat-suppressed (B) magnetic resonance images of the right shoulder. Where denervation edema or teres minor mild atrophy was appreciated due to mild increased signal intensity (white arrows).

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  Fig. 3. Arthroscopic view of the right shoulder with use of the superior portal (lateral decubitus position). (A) Arthroscopic findings showed that the antero-inferior capsule-labral complex had partial detachment (from the 4-o’clock to 6-o’clock position) from the glenoid. (B) The cyst and its multiloculated subcompartments were thoroughly decompressed under direct vision with blunt instruments and a shaver device. Then the anteroposterior margin of the glenoid was freshened and decorticated with the use of a shaver device. (C) Anatomic arthroscopic repair of the antero-inferior labral complex to the glenoid margin was performed with the use of two Bio Mini-Revo suture anchors (ConMed Linvatec, Largo, FL, USA) with one placed at the 4:30-clock position and one placed at the 5:30-clock position. A simple suture configuration was utilized.

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  Fig. 4. (A, B) The twelve-month follow-up MRA (magnetic resonance arthrography) showed complete resolution of the paralabral cyst.

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