Suprascapular Nerve Compression Secondary to a Spinoglenoid Ganglion Cyst: A Case Report

Suprascapular nerve entrapment is an uncommon entity; it is usually missed as a differential diagnosis of shoulder pain, especially since the main presentation of this condition in patients is usually non-specific shoulder pain. It is often only considered when the patient presents with weakness and denervation of the supraspinatus and infraspinatus muscles. Diagnosis of spinoglenoid ganglion cysts is usually considered after other causes have been ruled out. They are usually detected on magnetic resonance imaging (MRI); however, this could be delayed and happens only after suprascapular nerve compression has already occurred and the patient's muscles have atrophied leading to limitations in their function. Treatment of spinoglenoid ganglion cysts should be tailored to each individual patient. Numerous treatment options are available and can range from conservative management to open decompression. The aim of our study was to highlight the clinical presentation of this condition by describing a case that we have diagnosed and managed at our center. We report a 29-year-old male who presented with dysfunctional left shoulder pain. The patient was diagnosed with a spinoglenoid ganglion cyst, which was treated successfully with open excision. The patient's condition improved following the procedure with a successful return to his daily activities.

Acute Large Bowel Obstruction Caused by Endometriosis Requiring Sigmoidectomy

Large bowel obstruction (LBO) accounts for nearly 25% of all bowel occlusions. LBO is managed as a surgical emergency due to its increased risk of bowel perforation. Nearly, 2% to 4% of all surgical admissions are a result of LBO. The most common pathological development of LBO remains colonic malignancy, representing approximately 60% of cases. Other etiology includes abdominal adhesions, diverticulosis, hernia, inflammatory bowel disease (IBD), and in rare cases endometriosis. In this report, the patient is a 36-year-old female with an LBO, originally thought to be a complication of diverticulitis. However, it was confirmed that the obstruction was a result of endometriosis tissue adherence to the colonic wall narrowing the intestinal lumen. The patient presented to the emergency department (ED) with nausea, vomiting, and abdominal pain that started six weeks prior. In this case report, we will discuss the rare complication of endometriosis causing LBO, clinical presentation, diagnosis, and management.

Trends in Open and Endoscopic Cubital Tunnel Release in the Medicare Patient Population

BACKGROUND

Cubital tunnel syndrome (CUT) is the second most common peripheral neuropathy with an annual incidence of 24.7 per 100 000, affecting nearly twice as many men as women. With increasing focus on cost-effectiveness and cost-containment in medicine, a critical understanding of utilization of health care resources for open and endoscopic approaches for cubital tunnel release is of value. The purpose of this study was to evaluate the costs and utilization trends of open and endoscopic cubital tunnel release.

METHODS

We performed a retrospective review of a Medicare database within the PearlDiver Supercomputer (Warsaw, Indiana) for procedures performed from 2005 to 2012. Annual utilization, charges, reimbursement, demographic data, and compound annual growth rate were evaluated.

RESULTS

Our query returned 262 104 patients with CUT, of which 69 378 (26.5%) and 4636 (1.8%) were surgically managed with open and endoscopic release respectively. Average charges were higher in endoscopic release ($3798) than open release ($3197) while reimbursements were higher in open releases ($1041) than endoscopic release, ($866). Both were performed most commonly in the <65 years age range.

CONCLUSIONS

Despite the unexpectedly lower reimbursement rate with endoscopic release, endoscopy utilization is growing faster than open releases in the Medicare population. Lower reimbursement is likely related to lack of a dedicated current procedural terminology code for endoscopic cubital tunnel release.