Cases reported "Shoulder Pain"

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1/23. Suprascapular nerve entrapment at the spinoglenoid notch in a professional baseball pitcher.

    Suprascapular nerve injuries at the spinoglenoid notch are uncommon. The true incidence of this lesion is unknown; however, it appears to be more common in athletes who participate in sports involving overhead activities. When a patient is being evaluated for posterior shoulder pain and infraspinatus muscle weakness, electrodiagnostic studies are an essential part of the evaluation. electromyography will identify an injury to the suprascapular nerve as well as assist in localizing the site of injury. In addition, imaging studies are also indicated to help exclude other diagnoses that can mimic a suprascapular nerve injury. The initial management should consist of cessation of the aggravating activity along with an organized shoulder rehabilitation program. If the patient fails to improve with 6 months to 1 year of nonoperative management, surgical exploration of the suprascapular nerve should be considered. Release of the spinoglenoid ligament with resultant suprascapular nerve decompression may result in relief of pain and a return of normal shoulder function.
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2/23. Adhesive capsulitis of the glenohumeral joint with an unusual neuropathic presentation: a case report.

    A 37-yr-old woman presented with a 7-mo history of unilateral shoulder girdle stiffness, pain, and weakness and had already been diagnosed with frozen shoulder. physical examination revealed scapular winging and suspicious focal paralysis of shoulder girdle muscles. Subsequently, electrodiagnostic studies reported denervation of deltoid, infraspinatus, serratus anterior, and lower cervical paraspinal muscles, in addition to a prolonged long thoracic nerve latency. The history, physical examination, and cervical magnetic resonance imaging scan seemed most consistent with neuralgic amyotrophy, although the electrodiagnostic examination could be interpreted as cervical radiculopathy. Some of the difficulties in identifying neuralgic amyotrophy and distinguishing it from cervical radiculopathy are discussed herein. Historically, frozen shoulder has seemed to develop as a complication of the neuropathic process. Both neuralgic amyotrophy and frozen shoulder have a poorly understood pathogenesis, and their combined presence is presumed to be rare. Because of difficulties inherent in the physical examination of frozen shoulder, a coexistent neuropathic process may go undetected.
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3/23. Quadrilateral space syndrome: diagnosis, pathology, and treatment.

    Quadrilateral space syndrome is an infrequent, recently established neurovascular compression syndrome affecting young active adults. With this syndrome, the neurovascular bundle, consisting of the posterior humeral circumflex artery (PHCA) and the axillary nerve, is compressed by fibrotic bands as it traverses the quadrilateral space. Symptoms result from compression of the axillary nerve, not from PHCA occlusion. Because of the vague, often nonspecific, clinical presentation of patients with quadrilateral space syndrome, diagnosis is challenging and requires a high index of suspicion from the orthopedist. Subclavian arteriography confirms the diagnosis. Treatment is usually conservative; operative management is reserved for selected patients. A posterior approach with detachment of the deltoid and teres minor muscles is recommended for surgical decompression and for lysis of fibrous tissue. We report two cases of persistent quadrilateral space syndrome in young adults, treated surgically, with 2-year follow-up. In the present report, diagnostic criteria, pathology, management, operative technique, and recent literature are also reviewed.
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4/23. Relief of non-metastatic shoulder pain with mediastinal radiotherapy in patients with lung cancer.

    Three patients with lung cancer and shoulder pain for which no local cause could be found are described. All three benefited from a course of palliative radiotherapy to ipsilateral mediastinal disease remote from the site of the pain. It is suggested that the pain is referred from intrathoracic involvement of the phrenic nerve by cancer, and that palliative irradiation of the mediastinum should be considered if investigations fail to reveal a local cause for ipsilateral shoulder pain.
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5/23. shoulder pain as an unusual presentation of pneumonia in a stroke patient: a case report.

    Etiologies of shoulder pain in the hemiplegic population, such as glenohumeral subluxation, frozen shoulder, and reflex sympathetic dystrophy (RSD), have been described extensively. We present an 89-year-old woman with right hemiparesis secondary to ischemic lacunar infarction who developed sudden onset of right shoulder pain on the fifth day of inpatient rehabilitation. The pain was severe, limiting range of motion (ROM) and participation in therapy. Extensive investigations to rule out subluxation, fracture, connective tissue disease, RSD, and pulmonary embolism were negative. Ultimately, her shoulder pain and decreased ROM completely resolved with antibiotic treatment for right lower lobe pneumonia. We conclude that her symptoms were possibly referred pain from diaphragmatic irritation transmitted via right C4 sensory axons in the phrenic nerve, which shares the same dermatome as the right acromion area. This case was an unusual presentation of pneumonia in an elderly woman with hemiplegia. We recommend that pneumonia be considered in the differential diagnoses of shoulder pain.
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6/23. Acute brachial plexus neuritis: an uncommon cause of shoulder pain.

    patients with acute brachial plexus neuritis are often misdiagnosed as having cervical radiculopathy. Acute brachial plexus neuritis is an uncommon disorder characterized by severe shoulder and upper arm pain followed by marked upper arm weakness. The temporal profile of pain preceding weakness is important in establishing a prompt diagnosis and differentiating acute brachial plexus neuritis from cervical radiculopathy. magnetic resonance imaging of the shoulder and upper arm musculature may reveal denervation within days, allowing prompt diagnosis. electromyography, conducted three to four weeks after the onset of symptoms, can localize the lesion and help confirm the diagnosis. Treatment includes analgesics and physical therapy, with resolution of symptoms usually occurring in three to four months. patients with cervical radiculopathy present with simultaneous pain and neurologic deficits that fit a nerve root pattern. This differentiation is important to avoid unnecessary surgery for cervical spondylotic changes in a patient with a plexitis.
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7/23. Quadrilateral space syndrome: case report and review of the literature.

    The quadrilateral space syndrome is defined as tenderness over the quadrilateral space and shoulder pain radiating to the arm, secondary to compression of the axillary nerve and posterior circumflex humeral artery in the quadrilateral space. The symptoms are aggravated by forced abduction and extrenal rotation of the arm. The diagnosis is clinical and is documented by arteriography or angio-MR imaging with dynamic maneuvers. A 30-year-old woman presenting with this syndrome is described here, the differential diagnosis discussed, and the literature reviewed.
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8/23. Schwannoma of the suprascapular nerve presenting with atypical neuralgia: case report and review of the literature.

    Compressive lesions of the suprascapular nerve produce weakness and atrophy of the supra- and infraspinatus muscles and a poorly defined aching pain along the posterior aspect of the shoulder joint and the adjacent scapula. Entrapment neuropathy of the suprascapular nerve is fairly common whereas tumorous lesions are rare; among the latter ganglion cysts are frequently seen. An isolated solitary schwannoma of the suprascapular nerve presenting with atypical neuralgic pain is exceptional. The location of a schwannoma under the firm deep cervical fascia in the posterior triangle of the neck is implicated in the genesis of neuralgic pains mimicking the suprascapular entrapment syndrome. One such case is reported with discussion of the relevant clinical features.
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9/23. Physical therapy for spinal accessory nerve injury complicated by adhesive capsulitis.

    BACKGROUND AND PURPOSE: The authors found no literature describing adhesive capsulitis as a consequence of spinal accessory nerve injury and no exercise program or protocol for patients with spinal accessory nerve injury. The purpose of this case report is to describe the management of a patient with adhesive capsulitis and spinal accessory nerve injury following a carotid endarterectomy. CASE DESCRIPTION: The patient was a 67-year-old woman referred for physical therapy following manipulation of the left shoulder and a diagnosis of adhesive capsulitis by her orthopedist. Spinal accessory nerve injury was identified during the initial physical therapy examination, and a program of neuromuscular electrical stimulation was initiated. OUTCOMES: The patient had almost full restoration of the involved muscle function after 5 months of physical therapy. DISCUSSION: This case report illustrates the importance of accurate diagnosis and suggests physical therapy intervention to manage adhesive capsulitis as a consequence of spinal accessory nerve injury.
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10/23. Serratus anterior paralysis as an occupational injury in scaffolders: two case reports.

    BACKGROUND: Shoulder complaints in scaffolders are very common and may result in permanent disability. methods: We present two case reports of patients who developed acute shoulder complaints. After lifting weights up to 50 kg both patients suffered an isolated lesion of the long thoracic nerve resulting in serratus anterior paralysis. RESULTS: Physical signs are unilateral winging of the scapula and loss of strength in the arm. A combined effect of pressure and stretching of the nerve resulted in an occupational injury with a different prognosis of reversibility in both patients. CONCLUSION: Shoulder pads in the overall and limiting the weight to carry may prevent future injuries.
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