Westerheide Kenneth J, Karzel Ronald P
Central Ohio Orthopaedic Group, Columbus, OH, USA.
Orthop Clin North Am. 2003 Oct;34(4):521-8. doi: 10.1016/s0030-5898(03)00102-0.
Ganglion cysts of the shoulder and concomitant suprascapular nerve compression should be considered in the differential diagnosis of shoulder pain. They are associated commonly with labral tears, most commonly SLAP lesions. MRI has become commonplace in evaluating shoulder pain and has led to the increased awareness of shoulder cysts. MRI accurately demonstrates the size and location of ganglions, which is critical when planning surgical intervention. It also has shown the frequent association of intra-articular pathology with these cysts. Despite that MRI can detect atrophy, the diagnosis of suprascapular nerve compression can be confirmed only by EMG/NCS, because the presence of a cyst does not necessarily mean the nerve is compressed. Likewise, a positive EMG does not confirm that the compression is caused by a ganglion cyst. EMG/NCVs are necessary for confirming the diagnosis and evaluating nerve and muscle function. A trial of nonoperative management is warranted; however, this is associated with a high failure rate. Aspiration techniques are successful for decompression of the cysts and initial pain relief; however, the intra-articular pathology is not addressed and there is a higher rate of recurrence. Open resection of the ganglion cyst is successful; however, the intra-articular labral tears are not addressed, which can lead to recurrence and the morbidity of the cyst excision is not warranted. Shoulder arthroscopy has led to the identification of associated intra-articular pathology such as SLAP lesions. These were not appreciated previously with open surgery and therefore were not addressed. Arthroscopic techniques have evolved to allow decompression of the ganglion cysts and repair of the labral lesions. This should decrease the possibility of recurrence of the cyst by eliminating the cyst and the pathologic lesion that created it. Arthroscopic excision also avoids much of the morbidity of the open approach and allows intra-articular pathology to be addressed concomitantly. This point has been emphasized by other investigators also. Furthermore, because of the limited surgical dissection, rehabilitation is able to begin earlier, with less patient discomfort and more prompt return to normal activities.
肩部腱鞘囊肿及合并肩胛上神经受压应列入肩痛鉴别诊断的考虑范围。它们通常与盂唇撕裂相关，最常见的是SLAP损伤。MRI在评估肩痛方面已很常见，这使人们对肩部囊肿的认识有所增加。MRI能准确显示腱鞘囊肿的大小和位置，这在规划手术干预时至关重要。它还显示出这些囊肿常与关节内病变相关。尽管MRI能检测出萎缩，但肩胛上神经受压的诊断只能通过肌电图/神经传导速度检查（EMG/NCS）来确诊，因为囊肿的存在并不一定意味着神经受压。同样，EMG阳性也不能证实压迫是由腱鞘囊肿引起的。EMG/NCV对于确诊和评估神经及肌肉功能是必要的。非手术治疗的尝试是有必要的；然而，其失败率较高。抽吸技术在囊肿减压和初步缓解疼痛方面是成功的；然而，关节内病变未得到处理，复发率较高。腱鞘囊肿的开放切除是成功的；然而，关节内盂唇撕裂未得到处理，这可能导致复发，且囊肿切除的发病率并不合理。肩关节镜检查已能识别相关的关节内病变，如SLAP损伤。这些病变在以往的开放手术中未被发现，因此未得到处理。关节镜技术已发展到可以对腱鞘囊肿进行减压并修复盂唇病变。通过消除囊肿及其产生的病理病变，这应能降低囊肿复发的可能性。关节镜切除还避免了开放手术的许多并发症，并能同时处理关节内病变。其他研究者也强调了这一点。此外，由于手术切口有限，康复能够更早开始，患者不适更少，能更快恢复正常活动。
