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

Background: Shoulder pain is a common condition, often refractory to treatment. Peripheral nerve stimulation (PNS) of the suprascapular nerve (SSN) can be efficacious in providing relief of shoulder pain while improving pain-related quality of life (QOL). The objective of this case report is to demonstrate the effectiveness of a minimally invasive wireless PNS in the treatment of chronic shoulder pain. Case Report: This 94-year old man presented with severe shoulder pain. He suffered from poliomyelitis as a child affecting his left leg, forcing him to use crutches to be ambulatory. He developed progressive right shoulder pain and was subsequently diagnosed with right glenohumeral osteoarthritis. The patient was treated semiannually for 4 years with corticosteroids injections and pain medication with minimal relief (7 out of 10 on the Visual Analog Scale [VAS]). A suprascapular block with lidocaine 2% resulted in significant pain reduction (1 out of 10 on the VAS). As a result, the patient opted for wireless PNS of the SSN via a minimally invasive procedure. Two weeks post implant, the patient reported no postoperative pain, and his chronic pain was rated 0 out of 10 even during movement. Reports of reduced pain were sustained throughout the 6 months of observation with subsequent improvements in QOL and functionality. Conclusion: Wireless neurostimulation of the SSN can be a very effective therapy option for the treatment of refractory, chronic shoulder pain as a result of glenohumeral osteoarthritis. Key words: Endoscopic spine surgery, lumbar radiculopathy, minimally invasive spine, SI joint fusion

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An Intraarticular Osteoid Osteoma: A Case Report & Review of Literature

Nepalese Journal of Radiology ◽

10.3126/njr.v3i2.9615 ◽

2014 ◽

Vol 3 (2) ◽

pp. 77-80

Author(s):

AR Pant ◽

MK Gupta ◽

PK Santhalia ◽

K Ahmad ◽

RPS Kalawar ◽

...

Keyword(s):

Shoulder Pain ◽

Osteoid Osteoma ◽

Rare Case ◽

Clinical Presentation ◽

Review Of Literature ◽

Delay In Diagnosis ◽

Atypical Clinical Presentation ◽

The Common ◽

Central Calcification ◽

Chronic Shoulder Pain

Osteoid osteoma (OO) is one of the common benign bone tumors but an uncommon cause of musculoskeletal pain. Its diagnosis is usually not difficult in classic clinical setup and in typical location in diaphyseal region. However, the diagnosis of juxta or intraarticular osteoid osteoma (IAOO) is challenging because of atypical clinical presentation responsible for delay in diagnosis and treatment. We report a rare case of IAOO as a cause of chronic shoulder pain to make clinician aware to help in its early diagnosis and management. A 28-year-old woman presented with chronic debilitating right shoulder pain. The diagnosis was established on CTscan after 2 years of onset of symptoms because of atypical clinical presentation as a chronic monoarthritis of the shoulder. CTscan demonstrated radiolucent nidus with central calcification with areas of surrounding sclerosis. The tumor was excised surgically and histopathologic examination confirmed the diagnosis of osteoid osteoma. So, in the scenario of an unexplained chronic monoarthritis, the possibility of intraarticular osteoid osteoma should also be kept in mind. CT-scan remains the investigation of choice for demonstrating the nidus and surgical exicision relieves the symptoms. DOI: http://dx.doi.org/10.3126/njr.v3i2.9615 Nepalese Journal of Radiology Vol.3(2)July-Dec, 2013: 77-80

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