Decompression of Paralabral Cyst near Axillary Nerve: A Case Report.

Introduction: Paralabral cyst is benign fluid-filled lesion that occurs adjacent to glenoid labrum. Origin of the cyst can be traumatic or atraumatic. This cystic lesion can compress nearby axillary nerve or suprascapular nerve, resulting in shoulder pain and numbness. In this case report, we will discuss about anteroinferior paralabral cyst with axillary neuropathy in atraumatic condition. Case Report: A 35-year-old male was admitted in our institute with complaining of numbness in the mid-part of the lateral arm and pain in the posterior aspect in the left shoulder for 2 weeks. The patient has on-and-off pain in the left shoulder on lifting weight. He had no history of trauma. X-ray was normal. On examination, tenderness presents over the dorsal aspect of shoulder and reduced sensations over deltoid muscle (regimen badge sign). Deltoid atrophy was noted. Range of motion was normal. On examination, cervical spine was normal, and reduced sensation over the lateral aspect of arm and deltoid atrophy was present. Magnetic resonance imaging (MRI) shows large multiloculated paralabral cyst caudal to inferior glenoid rim. The diagnosis was compressive axillary neuropathy which was confirmed by nerve condition study. Conclusion: According to this case report, accurate early clinical examination and MRI evaluation are crucial in patients with atraumatic shoulder pain associated with neurological symptoms. On identification, cyst can be successfully decompressed by shoulder arthroscopy which can prevent axillary nerve damage, muscle denervation, and also recurrence of cyst can be avoided.

Management of Acquired Compressive Myelopathy due to Spinal Fluorosis.

BACKGROUND: Fluorosis is an endemic disease of India which causes compressive cervical and/or dorsal myelopathy. This study aims to evaluate the role of surgical management in the crippling fluorosis along with evaluation of radiological imaging as screening/diagnosing tool for the disease. MATERIALS AND METHODS: This is a prospective cohort study of 33 patients operated at tertiary care center having nontraumatic involvement of spinal cord affecting neurology with history, clinical and radiological features (Ossified Posterior Longitudinal Ligament-, Ossified Ligamentum flavum) suggesting fluorosis as the cause of compression. Outcomes were measured in terms of improvement in Nurick grading, Rankins scale, spasticity, Oswestry Disability Index, modified Japanese Orthopaedic Association scores. RESULTS: Spinal fluorosis is a male predominant disease affecting the elderly after years of fluorine intake. Cervical and/or dorsal spine are predominantly involved at multiple levels (>=2). Diagnosis of the disease poses difficulty due to lack of established laboratory parameters with high sensitivity, availability, and lack of awareness among surgeons. Skeletal survey alone has >90% sensitivity for diagnosing the disease. Once evaluated properly, decompression at correctly identified levels invariably improves the spasticity and quality of life immediately post-surgery. At final followup, there was on average improvement of 2 scales in nurick grade, rankins scale and ashworth grading whereas average improvement in ODI, mJOA and dorsal specific mJOA were 52%, 3.17 points and 2.7 points respectively. However, preoperative counselling for "apparent neurological deterioration" in immediate postoperative period is very important. Complications like infection and dural tear have to be prevented with special surgical tactics. CONCLUSION: Skeletal survey along with computed tomography and magnetic resonance imaging is cost-effective modality for the screening/diagnosis for fluorosis. Once developed, surgery, either curative or palliative, is the best treatment at crippling stage of the disease.