Description
Mr Amol Tambe, a shoulder surgeon at the Royal Derby Hospital, gives a detailed discussion on two significant cases of shoulder pain that illustrate the complexities and challenges of diagnosis in a busy practice.
The first case involves an 18-year-old female university student who presents with severe shoulder pain without any prior injury. Initial X-rays reveal no abnormalities, leading to her admission into the soft tissue shoulder clinic. Here, further examinations reveal swelling and neurological symptoms, prompting an ultrasound and eventually an MRI that uncovers a potentially sarcomatous lesion near the acromion. Following a detailed discussion with the sarcoma unit, the diagnosis shifts towards myositis as the patient's condition is assessed further, illustrating the importance of thorough investigation and collaboration in clinical decision-making.
The second case features a 20-year-old male who experiences persistent shoulder pain after lifting a heavy object. His initial X-rays were deemed normal, leading to a lengthy period of physiotherapy before returning to the clinic, where severe pain and swelling were now present. Advanced imaging eventually reveals a significant lesion affecting the proximal humerus and glenoid region, diagnosed as myxoid chondrosarcoma after an en bloc resection.
The cases highlight the difficulty of diagnosing serious conditions based solely on initial imaging and stress the need for comprehensive evaluations, including cross-sectional imaging and close collaboration with radiologists and specialists when dealing with young patients exhibiting severe or unusual symptoms. The discussion also raises awareness of the issues arising from a lack of physical examinations and the potential ramifications of misdiagnoses, emphasizing a cautious approach in busy clinical settings.