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MR Imaging and MR Arthrography of Paraglenoid Labral Cysts

¹ Department of Diagnostic Imaging, Brown University School of Medicine, Rhode Island Hospital, 593 Eddy St., Providence, RI 02903.
² Department of Orthopedic Surgery, Brown University School of Medicine, Rhode Island Hospital, Providence, RI 02903.
³ Bayside Orthopaedics, 300C Faunce Corner Rd., North Dartmouth, MA 02747.

View larger version (157K): [in a new window]   Fig. 1A. —38-year-old man with shoulder pain and weakness. Oblique coronal T1-weighted MR image (TR/TE, 660/15) shows infraspinatus muscle atrophy and 1.1-cm unilocular paralabral cyst (arrow) in spinoglenoid notch.

View larger version (176K): [in a new window]   Fig. 1B. —38-year-old man with shoulder pain and weakness. Oblique coronal T2-weighted MR image (2052/80) shows cyst (arrow) with greater clarity than in A. Diffusely increased signal intensity in infraspinatus muscle (asterisk) is consistent with muscle denervation.

View larger version (116K): [in a new window]   Fig. 2A. —50-year-old woman with chronic shoulder pain and progressive weakness. Coronal oblique T2-weighted MR image (TR/effective TE, 5000/95) with fat saturation shows multiloculated cyst that tapers toward glenoid labrum. Note distended suprascapular veins adjacent to cyst.

View larger version (167K): [in a new window]   Fig. 2B. —50-year-old woman with chronic shoulder pain and progressive weakness. Sagittal oblique T2-weighted MR image (TR/effective TE, 5000/95) with fat saturation shows cyst (CYST) next to 9-o'clock position of posterior glenoid labrum (g). Note increased signal intensity in teres minor muscle (TM). ISM = infraspinatus muscle, SSM = supraspinatus muscle.

View larger version (141K): [in a new window]   Fig. 2C. —50-year-old woman with chronic shoulder pain and progressive weakness. Coronal oblique T2-weighted MR image (TR/effective TE, 5000/95) with fat saturation through posterior shoulder shows diffuse increased signal intensity in teres minor muscle (arrow). Infraspinatus muscle appears normal.

View larger version (146K): [in a new window]   Fig. 3A. —47-year-old man with shoulder and arm pain after anterior acromioplasty. Oblique sagittal T2-weighted MR image (TR/effective TE, 3465/102) shows small focal tear in inferior labrum (straight arrow). Note atrophy of teres minor muscle (curved arrow).

View larger version (173K): [in a new window]   Fig. 3B. —47-year-old man with shoulder and arm pain after anterior acromioplasty. Contiguous oblique parasagittal T2-weighted MR image shows inferior paralabral cyst (straight arrow) and teres minor muscle atrophy (curved arrow).

View larger version (138K): [in a new window]   Fig. 3C. —47-year-old man with shoulder and arm pain after anterior acromioplasty. Oblique coronal T2-weighted MR image shows cyst (straight arrow) medial to quadrangular space. Note diffuse abnormal signal intensity in atrophied teres minor muscle (curved arrow).

View larger version (115K): [in a new window]   Fig. 4A. —26-year-old man with chronic shoulder pain. Cystograms show tapered lip of cyst (arrow, A) pointing toward superior glenohumeral joint and no contrast opacification of joint space.

View larger version (112K): [in a new window]   Fig. 4B. —26-year-old man with chronic shoulder pain. Cystograms show tapered lip of cyst (arrow, A) pointing toward superior glenohumeral joint and no contrast opacification of joint space.

View larger version (132K): [in a new window]   Fig. 5A. —20-year-old male baseball pitcher with shoulder instability. Coronal oblique T2-weighted MR arthrogram shows anteroinferior labral tear (arrow) and adjacent multilocular cyst.

View larger version (163K): [in a new window]   Fig. 5B. —20-year-old male baseball pitcher with shoulder instability. Coronal oblique fat-saturated T1-weighted MR arthrogram shows gadopentetate contrast material in labral tear (straight arrow), but cyst (curved arrow) is less conspicuous.

View larger version (114K): [in a new window]   Fig. 5C. —20-year-old male baseball pitcher with shoulder instability. Coronal oblique fat-saturated T1-weighted MR arthrogram with shoulder in abducted externally rotated position shows labral tear (straight arrow), but cyst (curved arrow) is not filled with gadopentetate.

View larger version (135K): [in a new window]   Fig. 6A. —31-year-old man with shoulder pain. Axial fat-saturated T1-weighted MR arthrogram shows posterior labral tear (arrow) and capacious posterior joint space (arrowhead).

View larger version (122K): [in a new window]   Fig. 6B. —31-year-old man with shoulder pain. Axial fat-saturated T1-weighted MR arthrogram shows gadopentetate contrast material inside small multiloculated cyst (arrow) in 9-o'clock position.

View larger version (176K): [in a new window]   Fig. 7. —Drawing of posterior aspect of right shoulder shows posterior (p) and inferior (i) paraglenoid labral cysts and their proximity to suprascapular and axillary nerves. Suprascapular nerve (single arrowhead) enters supraspinous fossa through suprascapular notch, passing under superior transverse scapular ligament (single arrow). It supplies two motor branches to supraspinatus muscle (SS) and courses around lateral edge of scapular spine. Inferior transverse scapular ligament (double arrow) spans spinoglenoid notch, and suprascapular nerve passes under it to enter infraspinous fossa. Inferior branch of suprascapular nerve (double arrowhead) provides motor branches to infraspinatus muscle (IS). At lower border of subscapularis muscle, axillary nerve courses inferior to glenohumeral joint capsule to traverse quadrangular space (curved arrow) indicates axillary nerve in quadrangular space). Quadrangular space is bounded by teres minor (TM) and teres major muscles, superiorly and inferiorly, respectively, long head of triceps muscle medially, and humeral neck laterally. Axillary nerve supplies teres minor, part of deltoid muscle (not shown), and ends as upper lateral cutaneous nerve of arm. h = humeral head.

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