Dog Gone Painful: An Unusual Case Of Acute Shoulder And Chest Pain

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Dog Gone Painful: An Unusual Case Of Acute Shoulder And Chest Pain - Page #4

Working Diagnosis: Primary diagnosis: Plasma cell dyscrasia Additional diagnoses: Full-thickness anterior labral tear, partial-thickness supraspinatus tendon tear Treatment: The patient has since been referred to both an Orthopaedic and Medical Oncologist with subsequent extensive laboratory and imaging workup evaluating for multiple myeloma. Notably, this revealed a slightly elevated kappa light chain level of unclear significance. Subsequent skeletal survey, whole body PET CT, and DEXA scans were negative. Results were most consistent with a diagnosis of a plasma cell dyscrasia requiring ongoing serial monitoring for the development of multiple myeloma. Outcome: The patient has since been referred to both an Orthopaedic and Medical Oncologist with a subsequent extensive oncologic laboratory and imaging workup evaluating for multiple myeloma. With indeterminate results, she has been diagnosed with a plasma cell dyscrasia with ongoing serial monitoring for the development of multiple myeloma. Editor's Comments: This case highlights the importance of the full evaluation of a patient with multiple sources of pain. While the rotator cuff tear was the direct result of the trauma related to the presenting complaint, it was the patient's associated chest/clavicle pain which ultimately led to the more important finding. This pain could have easily been overlooked or attributed to her shoulder findings, potentially delaying the diagnosis and treatment of her underlying malignancy. Return To The Case Studies List.		Back
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