Shoulder Pain: Fat Or Fiction?

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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. Return To The Case Studies List.		Back
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