Author: Emily Rowe, Pamela Farnsworth, Stephen Ojo / Editor: Sarah Edwards / Codes: NeuC10, OncC1, OncP1, SLO1 / Published: 15/03/2022
A 50-year-old female presents to the Emergency Department (ED) with non- traumatic right arm pain. She tells you that the pain has stopped her from sleeping over the last week. She has taken simple analgesia which hasn’t helped. No changes in movement or function of shoulder since.
- S-Global right shoulder pain
- O-Gradual over the last week
- C-Sharp
- R- Down the arm
- A-Nil
- T-Intermittent, worse at night
- E-Lying on arm
- S-Severe
She tells you that she has never had pain like this before. There have been no changes in movement or function of the shoulder and arm and no trauma has occurred.
No previous neck or spinal injuries, and no new trauma to neck or back either.
She attends ED for pain management predominantly.
The patient has a 5 pack year smoking history. She has been off food due to pain for last week, but no noticeable weight loss. No night sweats/ fevers/ coughs/ chest or abdominal pain.
No significant past medial history.
On examination, the patient looks comfortable at rest.
There are no deformities/ swellings/ bruising or erythema to shoulder and arm.
No bony tenderness is elicited to upper arm, chest or neck and the patient has full active range of movement to shoulder/ elbow/ wrist and neck against resistance without eliciting pain.
She has normal radial pulses and CRT was <2secs.
The patient is discharged with analgesia, and safety netted to return to the department if any worsening symptoms or acute concerns.
The patient does indeed return 6/7 later having run out of analgesia. On this occasion she has a single episode of haemoptysis and therefore a chest x-ray is performed (please see the image below).
Module Content
Acute Limb Ischaemia
This session covers the diagnosis and initial management of a patient with acute limb ischaemia.
Shoulder and Brachial Plexus Injury
In UK ED practice a large group of patients present with musculo-skeletal disorders
Shoulder and Brachial Plexus
This session covers the anatomy, common pathology and the clinical and radiological assessment of the shoulder and brachial plexus. This should lead to the formulation of appropriate management plans
13 Comments
Thanks
Good case
good learning
nice case
Great case! It is always important to think of more sinister conditions causing limb pain
Excellent revision
Very good
Well done
Cause of atypical neuropathic pain
Common things are common, rare things are common in ED (and exams) – great case, thanks
Very interesting
good revision
Very good case. And very subtle initial presentation. Always good to safety net patients. And take a good look on a subsequent presentation for the same complaint.