Differential Diagnosis Of Shoulder Pain Research Articles

Enchondroma of acromion: case report of an unusual tumor location

Enchondroma is a benign cartilaginous tumor and is rarely located on the shoulder girdle. The lesion that affects the subacromial area can cause rotator cuff impingement’s clinical signs. Our aim is to present this patient who has shoulder pain and was finally diagnosed with an acromial enchondroma. A 62-year-old female patient had an insidious left shoulder pain in the last 2 years. At the physical examination of the left shoulder, subacromial impingement syndrome’s sign was noticed. Plain radiographs didn’t have any typical features and magnetic resonance imaging (MRI) images were used for diagnosis. Well-circumscribed hypointense content on T1-weighted images was observed, and the lesion was seen as hyperintense on T2-weighted images. At the same time, subacromial effusion was noticed. Because of enchondroma’s small size, the patient was followed up with medical treatment and radiographical features. At one year follow-up, there was no change in the size of the lesion and no increased complaint about her left shoulder. Physicians should keep in mind that enchondroma may occur rarely in acromion and this condition may cause subacromial impingement. Therewithal, this diagnosis which is a rare reason for subacromial impingement syndrome should be considered in the differential diagnosis of shoulder pain.

Morphological variations of the suprascapular notch and its clinical correlation with suprascapular nerve entrapment syndrome

The suprascapular notch present medial to the coracoid process serves as a passage for the suprascapular nerve which supplies the rotator cuff muscles and ligaments in the acromio-clavicular and shoulder joints. The suprascapular nerve is commonly compressed at the suprascapular notch, which can result in severe shoulder pain, weakness of the arm, restricted range of movement, and eventually, atrophy of the muscles supplied by the nerve. The syndrome of suprascapular nerve entrapment is a significant differential diagnosis of shoulder pain. Unfortunately, it is often neglected while diagnosing shoulder pain or discomfort. Our study's main objective is to examine how often different morphological variations occur in the suprascapular notch and their potential role in causing suprascapular nerve entrapment syndrome. We grossly examined 70 scapula to identify the presence, absence and type of suprascapular notch. We documented the observed variations of the suprascapular notch by capturing photographs and organizing the findings in a table. According to our findings, Type 3 (U-shaped notch) was the most frequently observed morphological variation of the suprascapular notch, while Type 1 (absence of suprascapular notch) was the least commonly found. Our findings provide fresh perspectives when compared to prior research. Having knowledge of the morphological variations of the suprascapular notch plays a vital role in accurately diagnosing suprascapular nerve entrapment syndrome using non-invasive diagnostic imaging and planning the most suitable surgical interventions.

Magnetic resonance imaging (mri) for parsonage turner syndrome / Ressonância magnética (ressonância magnética) para a síndrome do virador do presbitério

Parsonage Turner Syndrome (PTS) is an acute neuritis involving the brachial plexus and peripheral nerves of the shoulder, that presents with sudden onset of shoulder pain, and progresses to paresis and atrophy of the muscles innervated by the involved segments. The diagnosis relies on clinical history and physical examination combined with Magnetic Resonance Imaging (MRI) and electroneuromyography. The MRI is a very important asset in the evaluation of these patients, as it allows the confirmation of PTS diagnosis and excludes other differential diagnosis of shoulder pain. Its findings include acute and chronic denervation, and possible alteration of the brachial plexus or involved peripheral nerves signal. PTS has a good prognosis requiring only support treatment in most cases. The early and correct diagnosis is essential to the proper patient´s conduct, as it allows proper treatment, and it avoids additional tests and unnecessary surgical procedures. This article contains a PTS case report with clinical presentation, physical examination images, diagnosis, MRI images, evolution, and prognosis, as well as a literature review.

Chondroblastoma of the Acromion: A Case Report and Review of the Literature

Chondroblastomas are rare benign neoplasms and scarcely present in the acromion. We reported a case of chondroblastoma presented in the right acromion of a 36-year-old male. The patient had pain and restricted abduction. Moreover, the histological analysis of the biopsy sample was consistent with the diagnosis of chondroblastoma. The patient was treated with extended curettage and bone grafting. Besides, the 2-year follow-up of the patient was event-free. This case reveals that the chondroblastoma of acromion can be adequately treated by extended curettage. It also highlights the importance of acromion chondroblastoma in the differential diagnosis of shoulder pain to avoid the undertreatment of the patients.

Parsonage-Turner syndrome presenting with left shoulder pain and weakness: a case report

Parsonage-Turner syndrome is a clinical syndrome that begins with a sudden, neuropathic pain on the shoulder girdle, followed by pain loss over time. It is a rare syndrome that can be overlooked during differential diagnosis of shoulder pain and weakness. In this paper, we aimed to present a 39-year-old male patient with sudden onset left shoulder pain and weakness who were diagnosed with Parsonage-Turner syndrome.

Parsonage-Turner syndrome in a patient with bilateral shoulder pain: A case report.

Objective: Parsonage-Turner syndrome is a peripheral neuropathy characterized by acute onset shoulder pain, myalgia, and sensory disturbances. The present report discusses a rare case of Parsonage-Turner syndrome and highlights the importance of accurate history recording and thorough physical examination for the diagnosis of the disease in rural areas.Patient: A 28-year-old woman presented to our clinic with acute bilateral shoulder pain and difficulty moving her right arm. A diagnosis of Parsonage-Turner syndrome was suspected based on the progression of symptoms, severity of pain, and lack of musculoskeletal inflammation. The diagnosis was confirmed by neurological specialists, and the patient was treated with methylprednisolone, after which her symptoms gradually improved.Discussion: The differential diagnosis of shoulder pain is complicated due to the wide variety of conditions sharing similar symptoms. Accurate history recording and thorough physical examination are required to differentiate among conditions involving the central nerves, peripheral nerves, and nerve plexuses.Conclusion: Although the symptoms of Parsonage-Turner syndrome vary based on disease progression and the location of impairment, proper diagnosis of acute shoulder pain without central neurological symptoms can be achieved in rural areas via thorough examination.

Osteoid osteoma (OO) of the coracoid: a case report of arthroscopic excision and review of literature.

Osteoid osteoma (OO) of the coracoid is a rare entity that may present with variable symptoms from shoulder leading to delay in diagnosis and treatment. We present the clinical and radiological findings and management of one such case along with a review of similar cases reported in the literature. There was a delay of 2 years in diagnosis, which was later confirmed by computed tomography in addition to magnetic resonance imaging (MRI). The lesion was accessed arthroscopically and excised by unroofing and curettage. “OO” should be included in the differential diagnosis of shoulder pain in young patients not responding to long-term conservative treatment. Arthroscopic excision and curettage provide a good choice for management, with low morbidity and rapid recovery.

Chronic shoulder pain referred from thymic carcinoma: a case report and review of literature

We report a case of thymic carcinoma presenting as unilateral shoulder pain for 13 months. Before an accurate diagnosis was made, the patient received conservative treatment, cervical discectomies, and myofascial trigger point injection, none of which relieved his pain. When thymic carcinoma was eventually diagnosed, he received total resection of the tumor and the shoulder pain subsided completely. Thymic carcinoma is a rare carcinoma, and our review of the literature did not show shoulder pain as its initial presentation except for one case report. The purpose of this report is to document our clinical experience so that other physiatrists can include thymic carcinoma in their differential diagnosis of shoulder pain.

Suprascapular neuropathy caused by heterotopic ossification after clavicle shaft fracture: a case report.

Suprascapular neuropathy is a rare peripheral neuropathy that can be easily overlooked in the differential diagnosis of shoulder pain and dysfunction. The suprascapular nerve may be injured as a result of repetitive overuse, constriction due to anatomic variants, compression due to space occupying lesions, retraction due to a massive rotator cuff tear and iatrogenic or traumatic lesions. Trauma-related suprascapular neuropathies are often caused by glenohumeral joint dislocations, scapular fractures, proximal humeral fractures, penetrating injuries and displaced clavicle fractures. Although many causes of suprascapular neuropathy have been described, there have been few reports of suprascapular neuropathy caused by heterotophic ossification after trauma around shoulder. Heterotophic ossification is the formation of bone in non-skeletal tissue, usually between the muscle and joint capsule. It usually occurs following trauma, surgery, burns, fractures, dislocation or soft tissue trauma. The spectrum of heterotophic ossification ranges from incidental radiographic findings to severe functional limitations. The range of motion can be decreased, resulting in soft tissue contractures. It can also cause peripheral neuropathy by impinging adjacent nerves. Management of heterotopic ossification is aimed at limiting its progression and maximizing function of the affected joint. Nonsurgical treatment is appropriate for early heterotopic ossification; however, surgical excision should be considered in cases of joint ankylosis or significant complications. We report a very unusual case of suprascapular neuropathy that resulted from heterotophic ossification after clavicle shaft fracture. This case was treated by open excision of the heterotophic ossification and external neurolysis of the suprascapular nerve. Although the incidence is very low, the heterotophic ossification should be considered as a possible cause of suprascapular neuropathy.

Differential Diagnosis Of Shoulder Pain Followed By Progressive Weakness: A Case Report

Upper extremity weakness can be the result of a myriad of conditions ranging from contractile tissue injury, joint injury, or injury to central or peripheral nervous system components. Accurate diagnosis is important in establishing an optimal treatment regimen and sound prognosis. This report provides an overview of the diagnosis and treatment of Parsonage-Turner Syndrome, a relatively rare cause of upper extremity weakness and dysfunction.

Anomaly of the supraclavicular nerve: Case report and review of the literature

We report a male cadaver found to have his right intermediate branch of the supraclavicular nerve piercing the clavicle. No other anomalies were found in this specimen. Following a review of the literature, it appears that symptoms related to this finding are rare but do occur most commonly involving the intermediate branch of the supraclavicular nerve. Symptoms may be alleviated with surgical decompression of the entrapped nerve. Although rare, the clinician should include entrapment of the supraclavicular nerve within the clavicle in their differential diagnosis of shoulder pain.

Poster 87: Golf club grounding menace to the coracobrachialis muscle: a report of 2 cases

Setting: Office-based solo practice. Patients: 2 right-handed patients. Case Descriptions: The patients presented complaining of severe right anterior shoulder pain, particularly with internal rotation, after grounding their golf clubs. By definition, golf grounding occurs when a golf club’s forward motion is halted during the down swing; this is caused by striking the ground prior to striking the ball. This generally occurs due to any combination of poor weather, poor skill level, and/or fatigue. The patients described their pain as having an almost immediate onset after grounding their clubs, and the pain was located in the anterior shoulder and of a burning quality. Assessment/Results: Their physical examinations revealed pain-limited active range of motion pain in all planes. Both patients had slight warmth to palpation in the anterior deltoid area and appeared to have positive Hawkin’s impingement signs but negative drop arm tests. Vague tenderness was noted in the area of the bicipital tendons, but the speed tests were negative. Further examination revealed tenderness with palpation over the coracobrachialis muscle and with manual muscle testing of this muscle. In addition to nonsteriodal anti-inflammatory drugs, rest, and therapeutic modalities, the patients underwent prophylactic coracobrachialis strengthening as part of a home exercise program. Both patients became and remained pain free despite returning to golf and reportedly still grounding their clubs with a similar frequency. Discussion: Careful consideration of the mechanism of injury and assessment for the unusual finding of coracobrachialis tenderness and pain with resisted coracobrachialis muscle contraction avoided erroneously diagnosing the much more common condition, shoulder impingement syndrome. Conclusion: Golf grounding syndrome (Fosti syndrome) can present a diagnostic dilemma unless it is considered in the differential diagnosis of shoulder pain in golfers. Prophylactic coracobrachialis strengthening might help to prevent this disorder in golfers who tend to ground their clubs.

Suprascapular nerve entrapment

Isolated compression of the suprascapular nerve is a rare entity, that is seldom considered in differential diagnosis of shoulder pain. Usually atrophy of supraspinatus and infraspinatus muscles is present, resulting in weakened abduction and external rotation of the shoulder. Mostly the patients do not note the paresis, but complain about a dull and burning pain over the dorsal shoulder region. In a proximal lesion (at level of the superior transverse scapular ligament) electromyography reveals changes in both muscles, while in a distal lesion (spinoglenoidal notch) only the infraspinatus shows a pathology. From 1996 to 2001 we diagnosed an isolated suprascapular entrapment in nine patients. Seven patients were operated: The ligament was removed and the nerve was neurolysed. The average age was 36 years. All patients showed pathological findings in electrophysiological and clinical examination. Five patients had an atrophy of both scapula muscles, two showed only infraspinatus muscle atrophy (one with a ganglion in the distal course of the nerve). Six patients were followed up. All showed an improvement. Pain disappeared and all patients were able to return to work and sport activities. Electrophysiological examination one year after operation revealed normal nerve conduction velocity. The number of motor units, however, showed a reduction by half compared to the healthy side. Lesions without history of trauma are usually caused by repetitive motion or posture. Weight lifting, volley ball and tennis promote the entrapment. Rarely a lesion (either idiopathic or due to external compression) is described for patients who underwent surgery. Patients with a ganglion or a defined cause of compression should be operated, patients who present without a distinct reason for compression should firstly be treated conservatively. Physiotherapy, antiphlogistic medication and avoiding of the pain triggering motion can improve the symptoms. However, if muscle atrophy is evident, an operation is indicated from our experience.

Neurology (50)

Zoster paresis of the shoulder. (Stanford University School of Medicine, Stanford, CA) Clinical Orthopaedics and Related Research 2000;377:112–118.A case of unilateral left C5‐C6 segmental paresis attributable to herpes zoster in an otherwise healthy individual and a current review of literature are presented. A case of zoster paresis of the shoulder muscles is presented to remind the orthopedic community that this diagnosis may be confused with other diagnoses, including rotator cuff tear, and should be considered in the differential diagnosis of shoulder pain and shoulder girdle muscle weakness.

Assessment and management of the painful shoulder

The shoulder joint is a complex structure composed of intricate bony architecture and an ornate system of muscles, tendons, and ligaments. What many refer to as the “shoulder joint” is actually a combination of 4 articulations—the glenohumeral joint, acromioclavicular joint, sternoclavicular joint, and the scapulothoracic articulation. These structures work together to provide the shoulder complex with multiple degrees of freedom, which allow the upper extremity to be abducted, adducted, rotated, flexed, and extended. Although this flexibility is vital for positioning the arm in space, it can make the evaluation of pathology difficult. Furthermore, neck pathology can refer pain to the shoulder, which may require a screening evaluation of the neck. This article reviews the relevant anatomy and discusses an approach to the differential diagnosis of shoulder pain.

Zoster Paresis of the Shoulder

More than 95% of people in the United States are infected with the varicella zoster virus at some time in life, and this infection usually is manifested as chicken pox during childhood. The virus then establishes a latent infection of sensory ganglia, from which it may reactivate many years later to cause herpes zoster (shingles), a cutaneous painful rash along a dermatomal distribution. Less commonly, the varicella zoster virus may result in myotomal motor weakness or paralysis in addition to a painful dermatomal rash. A case of unilateral left C5-C6 segmental paresis attributable to herpes zoster in an otherwise healthy individual and a current review of the literature are presented. A case of zoster paresis of the shoulder muscles is presented to remind the orthopaedic community that this diagnosis may be confused with other diagnoses, including rotator cuff tear, and should be considered in the differential diagnosis of shoulder pain and shoulder girdle muscle weakness.

BILATERAL SUPRASCAPULAR ENTRAPMENT NEUROPATHY: A CASE REPORT

Suprascapular nerve entrapment is an uncommon condition. It is not often included in the differential diagnosis of shoulder pain and is therefore probably underdiagnosed. The nerve may be compressed at either the suprascapular notch or spinalglenoid notch.The clinical presentation is often unremarkable with poorly localised pain over the posterolateral shoulder, which tends to become persistent. There is often a history of minor trauma or repeated exertion. Weakness of external rotation and abduction may be present and in advanced cases there is wasting of the supraspinatous and infraspinatous muscles. There may be tenderness over the suprascapular notch. Diagnosis is established with EMG findings of delayed nerve root conduction and/or denervation potentials in the involved muscles.

The injured shoulder. Primary care assessment.

Shoulder problems are the second most common orthopedic complaint in primary care medicine. The range of motion, ligamentous and muscular support, and central location of the shoulder are key factors for the successful performance of persons at work or on the playing field. These special attributes also contribute to injury and to difficulty in assessing the painful shoulder. An understanding of the pertinent anatomic structures, the differential diagnosis of shoulder pain (intrinsic and referred pains), and a systematic approach to the evaluation including a complete history and physical examination are necessary in this assessment. Adequate examination consists of inspection, muscle strength and range-of-motion testing, palpation, and neurologic testing of the shoulder, neck, and elbow followed by special tests to detect impingement, instability, or tendinosis. This basic assessment is augmented by the proper use of radiographs, arthrography, computed tomography, ultrasonography, and magnetic resonance imaging. An adequate database and proper assessment of the injured shoulder allow the primary care physician to make a pathoanatomic diagnosis and formulate an appropriate treatment plan and make appropriate use of orthopedic consultants.

Suprascapular nerve entrapment: evaluation with MR imaging.

Entrapment of the suprascapular nerve is frequently overlooked in the differential diagnosis of shoulder pain. The diagnosis is typically not considered until patients develop severe weakness secondary to atrophy of the spinatus (spinous) musculature that the nerve supplies. Twenty-seven masses were identified adjacent to the suprascapular nerve on magnetic resonance (MR) images of the shoulder; there were 21 ganglion cysts, two synovial sarcomas, one Ewing sarcoma, one chondrosarcoma, one metastatic renal cell carcinoma, and one hematoma associated with a fracture. Atrophy of both the supraspinatus and infraspinatus muscles was seen in association with anteriorly located masses and proximal entrapment of the nerve in 11 cases (40%); isolated atrophy of the infraspinatus muscle was seen in association with posteriorly located masses and distal entrapment of the nerve in nine cases (33%). MR imaging may facilitate the diagnosis of suprascapular nerve entrapment in patients with shoulder pain of unclear origin when perineural masses and atrophy of the spinatus musculature are present.

Differential Diagnosis of Shoulder Pain

Differential Diagnosis of Shoulder Pain