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).

Fig. 11