Schwannoma of the Suprascapular Nerve Presenting With Atypical Neuralgia
Journal Title: Journal of Medical Science And clinical Research - Year 2015, Vol 3, Issue 3
Abstract
The suprascapular nerve, being a mixed peripheral, supplies the supraspinatus and the infraspinatus muscles and posterior aspect of the capsule of the shoulder joint. Impairment of this nerve, therefore presents as weakness and atrophy of these muscles and a poorly defined aching pain along the posterior aspect of the shoulder joint and the adjacent scapula.Amongst the various non-traumatic suprascapular nerve lesions, entrapment neuropathy at the suprascapular notch is far more common than tumorous lesions. When considering the latter, ganglion cysts occurring in relation to the suprascapular nerve are more frequently seen. Whereas lipoma, other soft tissue and peripheral nerve sheath tumours [PNST] are rare. This is a case report of 24 year male presented with complaint of a poorly defined aching pain along the posterior aspect of the right shoulder joint and adjacent scapula, and difficulty in carrying out over head activities since 4 months. On examination weakness and atrophy of supraspinatus and infraspinatus noted. Tenderness elicited in the posterior aspect of the shoulder joint. Rest of the neurological examination including sensation over the shoulder and scapular regions was normal. Antero-posterior radiograph and Scapular V-Y view of the right shoulder no obvious abnormality noted. MR imaging on T1weighted image showed an isointense mass in the substance of infraspinatus, normal labrum and articular cartilage. MRI on STIR image showed hyper intense signal due to cystic degeneration in the mass at the spinoglenoid notch with no communication of the lesion to the gleno-humeral joint. MR Coronal image showed a more peripheral location of the mass than usual at the spinoglenoid notch. ENMG showed delayed conduction velocities distal to suprascapular notch secondary to suprascapular nerve compression with denervation potentials in the supra- and infra-spinatus muscles. Managed with diagnostic shoulder arthroscopy and open surgical excision of the benign tumour. Histopathological examination revealed Spindle cells with elongated nuclei arranged in alternating hyper cellular palisading regions and hypo cellular loosely meshed regions. Immunohistochemical staining Positive for S 100 classical of Schwannoma. Postoperatively the pain subsided over a period of 5 months and the weakness recovered considerably. Three years following surgery the patient was symptom free and there is no recurrence of swelling
Authors and Affiliations
Dr. Buchupalli Bharath Reddy
Keywords
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