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Elderly woman with sharp shoulder pain

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The patient denied recent trauma or any heavy lifting, but she’d lost 10 pounds over the previous month. What was causing her shoulder pain?


 

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A 78-year-old woman sought care at our emergency department for sudden-onset right shoulder pain that had begun 5 days earlier. She said the pain was sharp and that it radiated to the scapula, right arm, and chest. She said that nonsteroidal anti-inflammatory drugs provided pain relief.

The patient denied any recent trauma or heavy lifting, and was not experiencing extremity weakness, numbness, or tingling. She reported no fever, chills, cough, or night sweats, but said she’d lost 10 pounds over the previous month. The patient was a former smoker whose medical history included diabetes mellitus, hypertension, and hyperlipidemia. Two years ago, she was treated for recurrent right-sided pleural effusions with pleurocentesis, which was negative for cytology and acid-fast bacilli.

Auscultation revealed crackles in the right lower lung field with decreased breath sounds. The patient had full range of motion in her right shoulder and experienced minimal pain on flexion. She had no swelling, erythema, or tenderness in her right upper extremity and there was no sign of lymphadenopathy. Her laboratory data were noncontributory. A chest radiograph was obtained (FIGURE 1).

WHAT IS YOUR DIAGNOSIS?
HOW WOULD YOU TREAT THIS PATIENT?

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