Spinoglenoid notch cysts and suprascapular nerve compression: a new meta-analysis

Polish version: Torbiel uciskająca nerw nadłopatkowy — co wynika z nowej metaanalizy?

In a meta-analysis of spinoglenoid notch cysts, the lowest recurrence rate followed arthroscopic decompression combined with repair of an associated labral tear. The evidence was mainly small retrospective case series, however, and technique selection depended on cyst size, labral pathology and neuropathy. The result does not establish one best treatment for everyone.

Why this study matters

A spinoglenoid notch cyst can compress the suprascapular nerve, causing posterior shoulder pain, external rotation weakness and infraspinatus atrophy. An associated posterosuperior labral tear may act as a one-way channel for joint fluid, promoting refilling.

Management options include observation, image-guided aspiration, isolated arthroscopic labral repair, arthroscopic decompression with repair and open treatment. The systematic review published on 4 August 2026 compared their reported outcomes while illustrating the limitations of nonrandomized comparisons.

Review methods

PubMed, Scopus and Embase were searched for operative and nonoperative treatment studies. Thirty-two studies included 562 shoulders. Combined arthroscopic decompression and labral repair was the most common treatment, used in 271 shoulders. Function, pain, recurrence, reoperation and complications were assessed.

Risk of bias was moderate, and the overall evidence level was 4. Retrospective case series predominated, with few strong direct comparisons.

Main results

• Combined arthroscopic decompression and labral repair: pooled recurrence 3% (95% CI 2–6%).
• Arthroscopic decompression without repair: recurrence 12%.
• Labral repair without direct decompression: recurrence approximately 6%.
• Open decompression: pooled recurrence 12%, with a very wide confidence interval reflecting sparse heterogeneous data.
• Complications were uncommon across groups, below 5%.
• The highest pooled reoperation rate was 9% after arthroscopic decompression without labral repair.

Clinical interpretation for an orthopaedic surgeon

Where a genuine labral tear accompanies the cyst, drainage alone may leave the fluid pathway intact. Repair may close that pathway. This mechanism is consistent with lower recurrence but does not replace randomized comparative evidence.

Careful assessment of the posterior and posterosuperior labrum matters. The 360° clock-face ultrasound protocol for the glenoid labrum (Polish) concerns imaging rather than cyst treatment, but addresses lesions that may coexist with a paralabral cyst.

With weakness, infraspinatus atrophy or EMG abnormalities, the clinical effect on the nerve matters alongside MRI appearance. An incidental asymptomatic cyst is not an automatic indication for surgery.

Limitations

• Most studies were retrospective and small.
• Treatment-selection criteria were inconsistent; large multiloculated cysts or advanced neuropathy may have been treated differently from smaller lesions.
• Cyst size, EMG findings, atrophy and MRI assessment were inconsistently reported.
• Follow-up duration and functional scales varied.
• Recurrence comparisons are vulnerable to patient selection, surgeon experience and associated labral pathology.

Implications for practice

A symptomatic cyst and confirmed labral tear should be considered related problems. The review argues against automatically limiting treatment to drainage when substantial labral pathology remains. It does not show that every patient needs both decompression and repair, or establish arthroscopic superiority for large, multiloculated or recurrent cysts. The proposed algorithm, including consideration of open treatment for very large or multiloculated lesions, partly rests on limited evidence and expert experience.

References

1. Poboży T, Konarski W, Janowski K, Michalak K, Poboży K, Domańska-Poboża J, Kielar M. Clock-Face Sonography of the Glenoid Labrum: A Pictorial Technical Protocol for Patients Ineligible for MRI/MR Arthrography. Diagnostics. 2025;15(23):3031. DOI: 10.3390/diagnostics15233031. PMID 41374412.
2. Chandasir AB, Lew RM, Hyeamang LJ, Khan AA, Alli NK, Hussain ZB, Nicholson GP, Garrigues GE. How to Manage the Spinoglenoid Notch Cyst: A Systematic Review and Meta-analysis. Orthop J Sports Med. 2026;14(8). DOI: 10.1177/23259671261456937. PMID 42558894.

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Content prepared by: Tomasz Poboży - orthopaedic surgeon.