Medicine & Science in Sports & Exercise:
May 2006 - Volume 38 - Issue 5 - p S135
Presidential Closing Remarks 12:05 PM - 12:15 PM: Immediately Following President's Lectures ROOM: Ballroom 2/3 and Ballroom 1: B-20 Clinical Case Slide - Shoulder: WEDNESDAY, MAY 31, 2006 1:00 PM - 3:00 PM: ROOM: 710
HISTORY: A 65-year-old right hand dominant female presents with a several year history of intermittent right shoulder pain. Pain is a dull ache which started insidiously without any history of trauma or injury. Pain is mainly in the lateral and posterior aspects of her shoulder and has progressively become worse in the last few months. Pain used to respond to Tylenol and Voltaren. Reaching overhead, reaching for her back pocket, and carrying grocery bags aggravate the pain. Her sleep has been disturbed by pain. There is no popping sensation, numbness, or tingling. She has been smoking 1 1/2 PPD for 50 years. Her past medical history is unremarkable.
REVIEW OF SYSTEMS: Unchanged chronic productive cough. No weight change.
PHYSICAL EXAM: Poor dental hygiene. Cardiopulmonary was unremarkable. Right shoulder abduction and forward flexion to 180° with pain from 90°-120°. External rotation to 60°, internal rotation with Appley scratch test was to T12 on right side and to T8 on left side. Resisted external rotation caused mild pain on posterior shoulder. Empty can and lift-off tests were positive for mild pain. Neer and Hawkins tests were positive for mild pain. Other shoulder tests were unremarkable.
DIFFERENTIAL DIAGNOSIS:
1. Rotator cuff tendinopathy/impingement
2. Degenerative joint disease
3. Bone pathology including tumors
4. Lung pathology including tumors
TESTS AND RESULTS:
Standard shoulder plain radiograph
* Early degenerative changes within the AC joint with a bone spur formation at the inferior aspect as well as a curved acromion
* Incidentally noted a dense opacification of part of the right upper lung Chest x-ray
* 9 × 7 cm right upper lobe opacity CT scan
* Right upper lobe mass measuring 6 × 8 × 9 cm consistent with bronchogenic carcinoma
* Mediastinal and left adrenal metastasis Bronchoscopy with biopsy
* Squamous cell carcinoma
DIAGNOSIS:
* Stage IIIB non-small cell lung cancer
* Rotator cuff tendinopathy/impingement
TREATMENT AND OUTCOME: Radiation and chemotherapy