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MRI Shoulder Paralabral Cysts, Denervation and Parsonage Turner Syndrome

On MRI muscles around the shoulder can show features of denervation. So what are the causes and what does it  look like. Most commonly its due to nerve compression from a paralabral cyst secondary to a labral tear ( usually a SLAP tear).  It can also be due to brachial neuritis ( Parsonage Turner Syndrome) with no evidence of a compressing mass. In this post we look at paralabral cysts and in the next post at Parsonage Turner Syndrome.

ANATOMY:

The suprascapular nerve supplies the supra and infraspinatus muscles. The main branch runs in the suprascapular notch and divides into two branches one supplies supraspinatus and the second exits via the spinoglenoid notch and runs in the groove inferior to the notch and supplies infraspinatus.

 

mri shoulder denervation parsonage turner syndrome infraspinatus supraspinatus paralabral cyst anatomy radiology education asiaImage Above: Red arrow suprascapular notch. Purple arrow spinoglenoid notch. Gold arrow inferior to spinoglenoid notch  where branch to infraspanatus runs.

mri shoulder denervation parsonage turner syndrome infraspinatus supraspinatus paralabral cyst radiology education asia

mri shoulder denervation parsonage turner syndrome infraspinatus supraspinatus paralabral cyst suprascapular notch radiology education asiaImage Above: Multiloculated cyst ( red arrow) lying in the suprascapular notch where it could potentially compress the suprascapular nerve. No evidence of denervation, muscle signal normal.

mri shoulder denervation parsonage turner syndrome infraspinatus supraspinatus paralabral cyst suprascapular spinoglenoid notch radiology education asiaImage Above: Cyst in the suprascapular ( red arrow) and spinoglenoid notch extending to the groove inferior to the notch ( purple arrow). No evidence of denervation.

mri shoulder denervation parsonage turner syndrome infraspinatus supraspinatus paralabral cyst suprascapular spinoglenoid notch anatomy radiology education asiaImage Above: Suprascapular and spinoglenoid  notch cyst ( orange arrow) with denervation of infraspinatus ( orange arrow) but no denervation of supraspinatus ( yellow arrow). Acute denervation as infraspinatus is high signal on PDFS with no evidence of volume loss of the muscle. fatty replacement of the muscle would be better assessed on a non fat sat PD or T1. 

mri shoulder denervation parsonage turner syndrome supraspinatus infraspinatus paralabral cyst suprascapular spinoglenoid notch radiology education asiaImage Above: Denervation of both supraspinatus ( yellow arrow) and infraspinatus ( blue arrow).

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