Shoulder Pain: Fat Or Fiction? - Page #4
 

Working Diagnosis:
Intramuscular Brachialis Lipoma

Treatment:
Patient was seen in surgery and opted for conservative therapy. He did not want a biopsy.
If size increases or pain worsens, he will undergo biopsy.
Physical therapy for his shoulder helped improve strength and decrease pain.

Outcome:
Strength is near normal.
Pain is now resolved.

Author's Comments:
He is currently able to do all activities, including fly fishing.

Editor's Comments:
Lipomas occur in about 1% of the population and are usually benign, depending on the location. If a fatty tumor is located in the retroperitoneum or is intramuscular, it should be considered to be a potential liposarcoma until proven otherwise. Liposarcomas are malignant tumors that arise from adipocytes. They may recur locally and have potential to metastasize.

There is suggestion that trauma-related fat herniation through tissue planes creates so-called pseudolipomas. There is also a theory that trauma-induced cytokine release triggers pre-adipocyte differentiation and maturation. So far there is no definitive link between trauma and lipoma formation.

On clinical exam, intramuscular lipomas cause a diffuse, palpable swelling, which is more prominent when the related muscle is contracted. MRI does not allow an absolute, reliable distinction between a lipoma and a liposarcoma. This is why biopsy is suggested for a definitive diagnosis.

References:
Nickloes, T. Lipomas. Medscape. 3 Jun 2013. Editor: Geibel, J. Accessed on 9 Aug 2014.

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