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A Rare Source Of Scapular Pain - Page #1
 

Author: Andres Harris Caceres, DO
Co Author #1: Lindsay Lafferty, MD
Senior Editor: Christian Fulmer, DO, FAMSSM
Editor: James OBrien, MD

Patient Presentation:
A 58-year-old man presented with a one-year history of insidious onset of intermittent, severe pain localized to the superomedial aspect of the right scapula. . The pain radiated across the trapezius but did not extend into the shoulder joint or down either arm. Symptoms were exacerbated by overhead reaching and neck movement. He also reported intermittent mild paresthesia in the thumb and index finger, neck stiffness, and mild right arm weakness. The pain was refractory to treatment with topical and oral nonsteroidal anti-inflammatories, lidocaine patches, home exercise, and a right glenohumeral steroid injection administered one month earlier.

History:
His past medical history was significant for a full-thickness re-tear of the right supraspinatus and infraspinatus muscles one year prior.

Physical Exam:
A 3×4 cm erythematous area was noted along the superomedial scapula which was tender to palpation. Shoulder range of motion was symmetric except for mild limitation of right internal rotation with scapular dyskinesis observed.. Neck range of motion was markedly restricted in all planes but without pain. Muscle strength was 5/5 with shoulder abduction, external/internal rotation, and wrist and elbow flexion/extension. Sensation was intact and equal to distal upper extremities bilaterally except for paresthesia to the right index finger. Deep tendon reflexes were 1+ at biceps, triceps, and brachioradialis, and Hoffmann’s sign was negative bilaterally. Special tests for rotator cuff, labral, and biceps pathology were negative except for mild discomfort with Speed’s test on the right.

Click here to continue. Challenge yourself by writing down a broad differential diagnosis before moving to the next slide.

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