Paralabral Cyst Debridement

What is Paralabral Cyst Debridement?

Paralabral cyst debridement is a surgical procedure that is usually performed by arthroscopy (keyhole surgery) for the treatment of paralabral cysts. Arthroscopy is a minimally invasive surgical procedure in which an arthroscope, a small flexible tube with a light and video camera at the end, is inserted through small incisions into a joint to evaluate and treat the condition.

A paralabral cyst is a type of ganglion cyst that may occur anywhere around the socket of the shoulder joint (glenoid) and is usually caused by a labral tear. It can occur as one large cyst or a cluster of smaller cysts. Paralabral cysts are defined as fluid-filled masses or pockets of joint fluid that develop outside of the joint underneath the labral tear. Based on the location of the cyst in the joint area, they may be defined as anterior paralabral cyst, posterior paralabral cyst, superior paralabral cyst, or inferior paralabral cyst. If left untreated, the cyst can become enlarged and press on crucial nerves in the shoulder joint, causing significant pain and weakness of the muscles supplied by the nerves. The most common nerve affected by a paralabral cyst is the suprascapular nerve.

Treatment for paralabral cysts causing nerve compression will involve arthroscopic repair of the labral tear and drainage of the cyst to decompress the nerve. Labral repair has been shown to greatly minimize the recurrence of paralabral cysts coupled with improvement in pain and shoulder function.

Indications

Your physician may recommend paralabral cyst debridement if non-surgical treatment options are not successful and when a nerve is acutely compressed by the cyst, resulting in significant shoulder pain, followed by shoulder weakness, muscle atrophy, reduced range of motion, numbness or tingling, and activity limitation.

Preparation for Paralabral Cyst Debridement

Preparation for paralabral cyst debridement may involve the following steps:

• A review of your medical history and a physical examination to check for any medical issues that need to be addressed prior to surgery.
• Depending on your medical history, social history, and age, you may need to undergo tests such as blood work and imaging to help detect any abnormalities that could compromise the safety of the procedure.
• You will be asked if you have allergies to medications, anesthesia, or latex.
• You should inform your doctor of any medications or supplements you are taking or any conditions you have such as heart or lung disease.
• You may be asked to stop taking blood-thinners, anti-inflammatories, aspirin, or other supplements for a week or two.
• You should refrain from alcohol and tobacco at least a few days prior to surgery and several weeks after, as it can hinder the healing process.
• You should not consume any solids or liquids at least 8 hours prior to surgery.
• You should arrange for someone to drive you home after surgery.
• A signed informed consent form will be obtained from you after the pros and cons of the surgery have been explained.

Procedure for Paralabral Cyst Debridement

Paralabral cyst debridement surgery is commonly performed with an arthroscopic technique under local or general anesthesia. The approach for surgery will depend upon the location of the paralabral cyst in your shoulder joint. In general, the surgery will involve the following steps:

• You will lie in a semi-reclined or beach-chair position, and anesthesia is administered.
• Your surgeon makes a few small incisions (arthroscopic portals), about half-inch in length, over your shoulder joint.
• An arthroscope, a slender tubular device attached with a light and a small video camera at the end is inserted through one of the incisions into your shoulder joint.
• The video camera transmits the image of the inside of your shoulder joint onto a television monitor for your surgeon to view.
• Once the paralabral cysts are located, your surgeon then uses small surgical instruments passed through the other tiny incisions to perform arthroscopic debridement of the cysts. This involves removal of the fluid-filled cysts and damaged tissue, repair of the ruptured labrum by reattaching the torn labrum to the bone of the socket (glenoid) using suture anchors, and decompression of the nerve.
• Once adequate repair is achieved, the scope and the instruments are withdrawn, and the incisions are closed and covered with a sterile bandage.

Postoperative Care and Recovery

In general, postoperative care and recovery after paralabral cyst debridement will involve the following steps:

• You will be transferred to the recovery area where your nurse will closely observe you for any allergic/anesthetic reactions and monitor your vital signs.
• Following the surgery, your arm will be placed in a shoulder sling for 2 to 4 weeks to rest the shoulder and promote healing.
• You may experience pain, swelling, and discomfort in the shoulder area. Pain and anti-inflammatory medications are provided as needed to address these.
• Antibiotics are also prescribed to address the risk of surgery-related infection.
• You may also apply ice packs on the shoulder to help reduce swelling and pain.
• Instructions on incision site care and bathing will be provided to keep the wound clean and dry.
• Refrain from strenuous activities and lifting heavy weights for at least a couple of months. A gradual increase in activities is recommended.
• An individualized physical therapy protocol is designed to help strengthen your shoulder muscles and optimize shoulder function.
• You will be able to resume your normal daily activities in 3 to 4 weeks, but with certain activity restrictions. Return to sports may take 6 months or longer.
• Refrain from driving until you are fully fit and receive your doctor’s consent.
• A periodic follow-up appointment will be scheduled to monitor your progress.

Benefits of Arthroscopic Paralabral Cyst Debridement

Some of the benefits of arthroscopic technique over open surgery include:

• Smaller incisions
• Minimal muscle trauma
• Smaller scars
• Minimal blood loss
• Lower risk of infection
• Less post-operative pain
• Shorter hospital stay
• Quicker recovery

Risks and Complications

Paralabral cyst debridement surgery is a relatively safe procedure; however, as with any surgery, some risks and complications may occur, such as the following:  

• Infection
• Bleeding
• Postoperative pain
• Stiffness or restricted motion
• Thromboembolism or blood clots
• Anesthetic/allergic reactions
• Damage to surrounding joint structures, such as nerves or blood vessels
• Recurrence of paralabral cysts
• Re-rupture of the labrum