Excision of Para-Labral Cyst with Removal of Calcific Loose Bodies and Bankart Repair through Arthroscopy

Dr. Ravi Sankar Kirubanandan^*, Dr. Javed Abdulla¹

1. M.B.B.S Student, Life Line Hospitals, India

Corresponding Author: Dr. Ravi Sankar Kirubanandan, Arthroscopy, Trauma & Joint Replacement surgeon, M.B.B.S, MRCS, D. ORTHO, D. SICOT, FRCS (TRAUMA & ORTHO) Life Line Hospitals, India.

Copy Right: © 2022 Dr. Ravi Sankar Kirubanandan, This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Received Date: May 02, 2022

Published Date: May 15, 2022

DOI: 10.1027/MAROR.2022.0118

Abstract

Suprascapular nerve palsy is a very uncommon condition but occurs only when there is a compression of the suprascapular nerve . Because of the compression the nerve gets blocked and the patient starts to feel pain , movement restricts etc. One of the reason for such compression is para-labral cyst . Para-labral cysts are swellings that arise around the socket of the shoulder joint (glenoid). They are pockets of joint fluid that develop outside of the joint under tears of the labrum. These may occur anywhere around the glenoid. The cysts may become very large and can press on some of the important nerves around the shoulder. The suprascapular nerve can be compressed at the spinoglenoid notch with a posterior labral tear (reverse Bankar tear) or at the suprascapular notch with a SLAP tear. This can lead to a suprascapular nerve palsy.

Case History

The patient had reached out the orthopaedic out-patient department with a complaint of right shoulder pain , discomfort in right shoulder region . On examination no palpable mass , no tenderness. The patient was treated with some NSAIDS , supplements and was on observation for few days. Then later he reached out to the OPD  with same symptoms. So he was further advised to take MRI- right shoulder. We found the patient had acromioclavicular joint arthrosis, right shoulder antero-lateral labral cyst , anterior labral tear (BANKART LESION) , Multiple Large loose bodies. The patient was then advised for surgical management.

Surgical Management

 We administrated GA. The patient was then put in supine position- lateral position.

1. Right shoulder arthroscopy

a. Standard posterior and lateral portal.

2. Decompression/excision of para-labral cyst

a. Using arthrocare – radiofrequency probe -cyst excision done along with the anterior capsule .

b. Thick fibrous tissue removed using shaver blade.

3. Removal of large loose bodies

a. Probed and removed the calcific loose bodies of size 4x4 cm and 3x2 cm. It was very much hard in texture and hard to remove.

4. BANKART repair using Arthrex 2.9mm bio-composite anchors

a. Using spade arthrocare probe  the anterior labrum feed was done .

b. Then reattached it using fiber wire and antrex bio-composite anchors size of 2.9mm x 3mm.

Post-OP Management

Post-operatively, the patient was treated with I.V antibiotics, analgesics, I.V fluids, and other supportive medications. The patient had a relief of pain caused due to the compression of suprascapular nerve by the para-labral cysts.