Rare Cause Of Shoulder Pain Research Articles

E027 A rare cause of shoulder pain: calcific tendonitis at the pectoralis major humeral insertion

Abstract Background/Aims Shoulder pain in the elderly is very common and often caused by calcific tendonitis of the rotator cuff muscles. We report the case of a lady presenting with unilateral shoulder pain who had an X-Ray which showed calcification over the proximal humerus. This calcification turned out to be due to calcific tendonitis of the humeral insertion of the pectoralis major, which is very rare. Unfamiliarity with this unusual condition could lead to inappropriate investigation, such as invasive biopsy, and possible mismanagement. Methods A 61-year-old lady of Pakistani origin with dual antibody positive rheumatoid arthritis, well controlled on methotrexate, reported new and severe right shoulder pain during her outpatient appointment. Her past history included coeliac disease, osteoarthritis, hypertension, iron and vitamin D deficiency, and she was not currently taking any calcium supplements. The pain had rapidly progressed over weeks to months without any trauma history and was significantly limiting all shoulder movements, particularly shoulder abduction and rotation. Her rheumatoid arthritis was in remission. Concerningly, she reported nocturnal pain, which alongside the rapidly progressive nature of the pain raises suspicions of a more sinister cause like malignancy. Results Blood tests showed a normal CRP, calcium profile and ALP. An X-Ray of the right shoulder showed no calcification or osteoarthritis affecting the glenohumeral joint, but demonstrated the unusual finding of a prominent focus of calcification close to the lateral aspect of the proximal humerus. An MSK radiologist advised further imaging to confirm nature of lesion. Subsequent USS confirms a focus of calcification (14mm x 18mm) in the pectoralis major humeral insertion, adjacent to the long head of the biceps tendon. Features that are suggestive of benign calcification rather than neoplasm include the characteristic location of the calcification and absence of an overlying soft tissue mass. The patient was reassured regarding the benign nature of the calcification and was managed conservatively with simple analgesia and physiotherapy. Conclusion Calcific tendinopathy is a common disease, but calcification of the pectoralis major at its humeral insertion point is very rare. This case highlights the importance of familiarity with this condition to enable the clinician to make an accurate diagnosis, and reduce the likelihood of unnecessary investigations and stress for the patient. Conservative management, such as simple analgesia and physiotherapy, is very effective for the majority of patients and should be used as first-line treatment. Steroid injection can be considered with orthopaedic intervention advised for those who have not responded to conservative management. Disclosure E.M. Quinlan: None. M. Kazmi: None.

A Few Considerations on “A Rare Cause of Shoulder Pain Ganglion Cyst of the Acromioclavicular Joint”: A Letter to the Editor

We are very interested in the article by Sarman et al.1 A rare cause of shoulder pain: Ganglion cyst of the acromioclavicular joint.1 Ganglion cyst often induces severe pain and impairs quality of life, even with multi-modal therapies. The ganglion cyst commonly develops along the tendons or joints. Ganglion cysts are typically round or oval shape and filled with a jellylike fluid.

Ultrasound-Guided Intralesional Methylene Blue Injection for the Arthroscopic Decompression of Spinoglenoid Notch Cyst Causing Suprascapular Neuropathy

Symptomatic spinoglenoid ganglion cyst is a rare cause of shoulder pain and disability. Surgical treatment, which may be considered after failed nonoperative treatment, includes open or arthroscopic cyst debridement. Arthroscopic treatment is less invasive and has the advantage of addressing intraarticular pathologies; however, exposure of the cyst may be deemed difficult. Furthermore, the suprascapular nerve is susceptible to iatrogenic injury owing to its close proximity to the posterior glenoid rim. The purpose of this article is to present our technique for arthroscopic spinoglenoid cyst decompression after preoperative ultrasound-guided methylene blue injection.

Osteoarthritis in a symptomatic coracoclavicular joint.

Coracoclavicular joint (CCJ) is a rare cause of shoulder pain. CCJ is not described in most orthopaedic textbooks, leading to lack of awareness in the general orthopaedic community. In that way the incidence of symptomatic cases is underestimated. We present the case of a symptomatic osteoarthtritic CCJ in a 46-year-old male patient with nearly complete relief of pain after therapeutic injection of the CCJ. The radiological signs of CCJ are briefly discussed to increase awareness of this very rare entity.

Idiopathic snapping scapula in a Moroccan patient: A rare cause of shoulder pain

IntroductionThe jumped shoulder blade or “snapping scapula” is a rare cause of shoulder pain that entails cracking of the scapula in connection with multiple causes. In 30% of cases no etiology is found. Case presentationWe report a case of a 54year old Moroccan male patient with left shoulder pain lasting for 14years associated with pain at the anterior-upper corner of the scapula. Clinical examination did not reveal any deformation of neither cervical nor thoracic spine on inspection; testing of the tendons of the shoulder rotators and active and passive shoulder mobility were normal and an audible crack was noted during the arm movement or apprehension test with left arm pain on mobilization of the scapula “vital sign” without limitation of the range of motion. The anterior drawer sign of laxity and refocusing sign were negative. Imaging performed including plain radiographs, musculoskeletal ultrasound and CT scan of the scapula with 3D image reconstruction found no bone or soft tissue abnormalities that could explain this syndrome. The diagnosis of jumped scapula of unknown origin was made and symptomatic treatment with non-steroidal anti-inflammatory drugs and a rehabilitation protocol based on isometric and isotonic strengthening periscapular muscles, posture and endurance exercises were instituted. ConclusionOur case illustrates a new case of a jumped shoulder blade of unknown origin after completion of all etiological imaging. Further analysis of clinical events is needed to better understand this type of jumped shoulder blade.

Two-Year Outcomes following Arthroscopic Treatment for Snapping Scapula Syndrome

Objectives:Snapping scapula syndrome is a rare cause of shoulder pain that can result in significant dysfunction. The purpose of this study was to report clinical outcomes following arthroscopic treatment for snapping scapula syndrome, as well as identify associated risk factors that affect outcomes.Methods:One-hundred patients underwent arthroscopic treatment for snapping scapula syndrome from October 2005 to October 2013. This was an IRB-approved retrospective outcomes study with prospectively collected data. Patients were excluded if they had prior scapula or rib surgeries, or concomitant sternoclavicular or glenohumeral reconstructive procedures. Patients included in this study failed non-operative modalities for mechanical symptoms of snapping scapula and reported symptomatic relief from a local anesthetic injection prior to surgery. Preoperative and postoperative pain and functioning levels were assessed with the American Shoulder and Elbow Surgeons (ASES), QuickDASH (Disabilities of the Arm, Shoulder and Hand), and general health SF-12 including both physical (PCS) and mental (MCS) components. Patient satisfaction was recorded on a 10-point visual analog scale (VAS).Results:There were 86 scapulae in 79 patients that met inclusion criteria. Mean age at time of surgery was 33 years old (range 12-65). A partial scapulectomy and bursectomy was performed in 79 scapulae, with 7 having bursectomy alone. Mean duration from onset of symptoms to surgery was 3.8 years (range 90 days-16.6 years). One patient died in the follow-up period from unrelated causes, and 6 patients refused to participate. Of the remaining 72 scapula, 8/72 (11%) failed and underwent a revision procedure at a mean of 309 days (SD+283 days). Of those that met inclusion criteria and did not require revision surgery, 86% (55/64) returned surveys with a mean follow-up of 3.4 years (range 2-7 years). There was a significant improvement following surgery in SF-12 PCS (p<0.001), SF-12 MCS (p=0.043), ASES (p<0.001), and QuickDASH (p=0.001) scores. Overall, median patient satisfaction was 7 out of 10 (range 1 to 10). Increasing age correlated with decreased postoperative SF-12 PCS (r= -.372;p=0.007), ASES (r= .279;p=0.043), and QuickDASH (r=.350;p=0.011) scores, while gender was not found to be associated with outcomes. A lower preoperative SF-12 MCS score was found to correlate with lower postoperative ASES scores (r=.395;p=0.011), while longer duration of symptoms prior to surgery also correlated with lower postoperative ASES (rho=-.296; p=0.027) and QuickDASH (rho=.315;p=0.019) scores.Conclusion:Arthroscopic surgery is an effective treatment for individuals that have failed conservative management for snapping scapula syndrome, demonstrating significant improvements in all postoperative outcome scores at a mean of 3.4 years. Lower preoperative mental status score, greater age, and longer duration of symptoms prior to surgery were associated with poorer outcomes.

Joint hypermobility syndrome must be investigated in case of snapping scapula syndrome

The snapping scapula syndrome (SSS) is an uncommon clinical picture responsible for significant discomfort. Various diagnoses are known but this problem is often non-specific. The joint hypermobility syndrome (JHS) has never been described in association with SSS. We report three cases of idiopathic SSS associated with JHS. Case 1: Female 18 yo, SSS right, JHS with a Beighton score of 9/9. Maximal passive external rotation of the shoulder > 85°. CT, MRI, Ultrasound and EMG: normal. Treatment with extended rehabilitation. Evolution unchanged. Case 2: Male 32 yo, SSS left, JHS with a Beighton score of 8/9. Maximal passive external rotation of the shoulder > 85°. CT, MRI and EMG: normal. Treatment with rehabilitation. Partially favorable evolution. Case 3: Male 45 yo, SSS right. Previous history of shoulder dislocation with spontaneous reduction. HJS with a Beighton score of 9/9. Maximal passive external rotation of the shoulder > 90°. MRI normal. No further follow-up data. SSS first described by Boinet in 1867 is a rare cause of shoulder pain. A “mechanical conflict” between the rib cage and the scapula is proposed. The conflict may be favoured by the presence of congenital or acquired bone abnormalities (exostosis, scapula fractures), muscle abnormalities (atrophy, tumors) or others like bursitis. In about 30% of the cases SSS no specific cause is found. CT, MRI and EMG are often required in the diagnostic process. Our 3 cases with SSS were only associated with positive criterion of JHS and shoulder passive external rotation more than 85°. Shoulder passive external rotation > 85° is a criteria of shoulder hyperlaxity but not of JHS. Only one patient was known for glenohumeral dislocation. We believe that JHS could be a factor favouring development of non-specific SSS, although the exact mechanism of SSS remains unclear. Treatment is based on rehabilitation often with poor results. We recommend searching a JHS as well as shoulder hyperlaxity in case of SSS.

Occipital condyle fracture as a rare cause of shoulder pain

Abstract Occipital condyle fractures (OCFs) usually occur due to high energy trauma and are often associated with serious injuries, particularly in the brain. Because it is difficult to determine this fracture on plain radiographs, it can easily be misdiagnosed. In this report, we present a patient admitted to our emergency department with one and only complaint of shoulder pain following a motor vehicle accident. We aimed to underline the importance of physician’s elaboration and attention in the diagnosis of this rare entity.

Arterial Thoracic Outlet Syndrome

Arterial thoracic outlet syndrome is a rare cause of shoulder pain due to compression of the subclavian or axillary artery within the thoracic outlet. It is the least common form of thoracic outlet syndrome but is potentially dangerous as it can result in significant morbidity. An athlete initially may present with exertional pain, early fatigability, a dull ache, or discomfort in the affected arm. History and physical examination are paramount in diagnosis, and imaging confirms the anatomy. Surgical repair or resection alleviates the compression of the affected structure and allows for a safe return to participation. Familiarity with this condition aids in the prompt diagnosis and treatment of this disorder.

Nadir görülen bir omuz ağrısı nedeni: Spinoglenoid çentikte ganglion kisti

A rare cause of shoulder pain: Ganglion cycts in the spinoglenoid notch Although ganglion cysts are most common soft tissue tumors of foot, hand and wrist, they are rarely seen in shoulder girdle. In this manuscript it is aimed to present a patient who was admitted with shoulder pain due to atypically located ganglion cyct. The symptoms were relieved after excision of lesion.

Bilateral Suprascapular Nerve Entrapment by Ganglion Cyst Associated with Superior Labral Lesion

Suprascapular nerve compression is a rare cause of shoulder pain. We report the clinical features, radiological findings, arthroscopic management and outcome of three patients with suprascapular nerve compression caused by labral ganglion cyst associated with SLAP lesion. We performed simultaneous suture anchor SLAP repair and cyst decompression with a blunt probe. Upon a two-year follow-up, patients recovered full shoulder function without pain or limitations in activities of daily living.

Inferior paralabral ganglion cyst of the shoulder with labral tear - A rare cause of shoulder pain

Paralabral ganglion cysts of the shoulder are rare, and their pathogenesis is similar to that of meniscal cysts. The paralabral cysts are most frequently reported along the posterior, superior, and anterior aspects of the glenohumeral joint and are uncommon inferiorly to the joint. These cysts rarely become evident clinically, unless they cause compression of surrounding structures, i.e. nerve. We report a retrospective series of five patients with inferior paralabral ganglion cysts of the shoulder without compression of the surrounding nerve which were treated during the period from March 2007 to December 2009. All these patients presented with only chronic shoulder pain as their chief complaint, and preoperative MRI showed the cyst over the inferior aspect of a torn glenoid labrum. All patients were treated by arthroscopic cystic decompression with labrum repair. All patients were re-evaluated with MRI performed at an average of 15 months postoperatively. The clinical outcome, including the Constant score, was assessed for all patients at a median of 16 months postoperatively. All the five patients had remission of pain and were satisfied with the shoulder function. The postoperative MRI in all patients showed no labral cyst recurrence. The median Constant score improved from a preoperative level of 81.5 points to 98.0 points at last follow-up. This study demonstrates that, in the absence of any nerve compression symptoms around the shoulder joint, inferior paralabral cysts with labral tear also be considered in the differential diagnosis of chronic shoulder pain. Arthroscopic repair of the cyst with repair of the labrum can lead to the disappearance of symptoms. Knowledge of this clinical condition and its imaging features is critical for a correct diagnosis of this uncommon cause of chronic shoulder pain. Level IV. Retrospective therapeutic study.

Subcoracoid impingement syndrome: a painful shoulder condition related to different pathologic factors

Subcoracoid impingement syndrome represents a rare cause of shoulder pain. To date, there are a few papers in literature that have addressed specifically the subcoracoid impingement. We reviewed 13 consecutive patients suffering from this syndrome who underwent an arthroscopic treatment. There were 4 men and 9 women with a mean age of 45 years (range, 23-58 years). The diagnosis of subcoracoid impingement was carried out on the basis of clinical examination and magnetic resonance imaging finding. Arthroscopic surgery consisted of a coracoplasty alone in 2 patients, coracoplasty and acromioplasty in 2 patients, coracoplasty and subscapularis tendon repair in 4 patients, and in the last 5 patients no coracoplasty was done and surgery consisted in treating a minor shoulder instability. Patients were reviewed at a mean follow-up of 2.4 ± 0.7 years. We evaluated the difference between preoperative and final postoperative range of motion, VAS, UCLA, SST and Constant score using a Student's t test. At follow-up, we observed a significant improvement in range of motion and shoulder scores; moreover, clinical findings of subcoracoid impingement were negative in all patients. Different pathological shoulder conditions can be responsible for a subcoracoid impingement that can be primary or secondary to factors different from mechanic attrition against the coracoid because of its morphology. In case of primary impingement, coracoplasty is a good treatment to relieve clinical symptoms. In patients suffering from an associated minor shoulder instability with MGHL capsulolabral lesion, surgical treatment of this lesion without coracoplasty led to the improvement in symptoms.

Diagnosis and management of vascular injuries in the shoulder girdle of the overhead athlete

Vascular injuries represent a rare cause of shoulder pain and functional limitation among overhead athletes. Complaints of heaviness, fatigue, paresthesias, and effort-related pain should prompt the sports medicine clinician to consider vascular pathology as a possible cause of such symptoms. Position-dependent compression of the subclavian and axillary vessels within the thoracic outlet may result in functional limitation and a decline in overhead athletic performance, particularly when symptoms occur in the dominant upper limb. Treatment options include physical therapy and (in the case of thrombus) thrombolysis, but surgical decompression of the neurovascular bundle is generally advocated. This article reviews the diagnosis and management of effort thrombosis (also known as Paget-Schroetter syndrome), arterial thoracic outlet syndrome, and entrapment of the posterior circumflex humeral artery within the quadrilateral space. Familiarity with these conditions may help to minimize the risk of delayed diagnosis and associated morbidity.

Diagnosis and Management of Vascular Injuries in the Shoulder Girdle of the Overhead Athlete

Vascular injuries represent a rare cause of shoulder pain and functional limitation among overhead athletes. Complaints of heaviness, fatigue, paresthesias, and effort-related pain should prompt the sports medicine clinician to consider vascular pathology as a possible cause of such symptoms. Position-dependent compression of the subclavian and axillary vessels within the thoracic outlet may result in functional limitation and a decline in overhead athletic performance, particularly when symptoms occur in the dominant upper limb. Treatment options include physical therapy and (in the case of thrombus) thrombolysis, but surgical decompression of the neurovascular bundle is generally advocated. This article reviews the diagnosis and management of effort thrombosis (also known as Paget-Schroetter syndrome), arterial thoracic outlet syndrome, and entrapment of the posterior circumflex humeral artery within the quadrilateral space. Familiarity with these conditions may help to minimize the risk of delayed diagnosis and associated morbidity.

Clinical Diagnosis of a Superior Glenoid Labrum Cyst with Suprascapular Nerve Entrapment (GLEN Lesion)

n ABSTRACT A ganglion cyst arising from the superior labrum with entrapment of the inferior branch of the suprascapular nerve (GLEN lesion) is a rare cause of shoulder pain and weakness. The aim of this study was to determine which clinical findings might predict a GLEN lesion. Twenty-seven clinical signs were assessed on five patients with an MRI-confirmed GLEN lesion and 29 agematched patients who presented with shoulder pain and no GLEN lesion. The clinical assessment included power for internal rotation, external rotation, supraspinatus and lift-off using a hand-held dynamometer. The most predictive tests for the diagnosis of a GLEN lesion were a reduction of 33% or more of external rotation power compared with internal rotation power, or a reduction of 33% or more of external rotation power compared with supraspinatus power as assessed by handheld dynamometry. These tests had a likelihood ratio of 100 and 25 respectively for diagnosing a GLEN lesion.

Osteochondritis Dissecans of the Humeral Head

Idiopathic osteochondritis dissecans of the humeral head is a rare cause of shoulder pain and immobility. If conservative management fails, surgical debridement and revascularization by drilling subchondral bone can lead to the restoration of a painless, functional joint.