Author: David Liddle, MD
Co Author #1: Amy Powell, Universtiy of Utah Department of Orthopedics
Editor: Jeff Holloway, MD
50-year-old female recreational kayaker presents with seven days of right upper extremity swelling that developed insidiously and without associated trauma or injury.
Her primary care physician recommended rest, ice, ibuprofen and further evaluation if the symptoms did not resolve. Her symptoms continued and she was referred for further evaluation.
She describes her pain as a dull ache, localized to the underarm and has noticed axillary swelling that has not really bothered her. Her first mammogram, which was nine months ago, was unremarkable. She has no family history of clotting disorders or breast cancer.
She is very physically active including running and hiking. She recently began upper extremity strength training in preparation for a 16-day Grand Canyon rafting trip that begins in two weeks.
VS: Temperature 36.8 C, BP 129/75, HR 72, RR 16, Ht. 165 cm, Wt. 65 kg, Pain is 0.
General: Pleasant, well-appearing female in no acute distress.
Neck: Supple, no lymphadenopathy, no bruits, no JVD
Lungs: Clear to auscultation bilaterally
CV: Regular rhythm, No murmurs, rubs, or gallops
Right upper extremity: Obvious swelling, mild erythema and warmth on palpation. Humeral circumference four fingerbreadths proximal to the elbow are 28 cm on the left and 30 cm on the right. Biceps and triceps are diffusely, mildly tender to palpation. Normal shoulder range of motion; painful in the axilla only with the extremes of flexion and abduction. No palpable chord or mass, and no change in the swelling with muscle contraction.
Breast Exam: Normal on the left. On the right, she has mild fullness in the upper/outer quadrant and minimal axillary fullness.
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