Pauls Shoulder Injury Part 1

Writen by Dr. Paul Ochoa


I realize this post may not be super popular but if you love anatomy, read on…

About two weeks ago I had a sudden onset of left shoulder external rotation weakness. I immediately started to pull together some plausible differential diagnosis and came up with a possible infraspinatus tear or something neurological. I didn’t have any other neurological related signs so I just assumed that I had fully torn my infraspinatus muscle and therefore was not feeling any pain and only having severe weakness.

I called up my friend Dr. Dallas Kingsbury at NYU Langone and he saw me earlier today. This picture shows the ultrasound image of a paralabral cyst (in green) impinging the suprascapular nerve at the spinoglenoid notch (red circle).

I was just blown away at how I didn’t include this as a possible differential! Even though I had suspected some neurological deficit I doubted myself because it didn’t follow the illness script I thought it should have. This goes to show that we should expand our illness script when thinking of differential diagnoses and to really trust our clinical reasoning gut when faced with complex presentations like this.

I’ll keep you posted on things but you can definitely expect some articles on paralabral cysts. ?