Department of Anesthesiology and Pain Medicine, The Catholic University of Korea, St. Vincent's Hospital, Suwon, Republic of Korea.
Medicine (Baltimore). 2024 Oct 25;103(43):e40177. doi: 10.1097/MD.0000000000040177.
Shoulder pain is a common type of musculoskeletal pain. While musculoskeletal issues are primary causes of shoulder pain, it is important to note that referred pain in the shoulder area can also originate from non-musculoskeletal problems.
A 60-year-old male presented with a month-long stabbing pain in the right shoulder that was worsened by deep breathing. He had no trauma history or neurological symptoms. He also experienced a 5 kg weight loss over 3 months. Physical examination was normal. Shoulder X-ray suggested degenerative arthritis. Despite medication including opioids, his pain persisted and worsened to a 10/10 severity, spreading to the right flank and anterior chest.
An abdominal CT scan revealed multiple hepatic nodules, ascites, and right pleural effusion, suggesting a systemic condition.
This prompted immediate referral to oncology, where subsequent investigations confirmed the diagnosis of intrahepatic cholangiocarcinoma.
The patient deteriorated and passed away during the buildup phase for cancer treatment.
This case underscores the importance of considering systemic conditions in patients presenting with seemingly localized symptoms such as shoulder pain. It highlights the significance of thorough evaluation and prompt referral for further investigations when necessary.
肩部疼痛是一种常见的肌肉骨骼疼痛类型。虽然肌肉骨骼问题是肩部疼痛的主要原因，但需要注意的是，肩部区域的牵涉痛也可能源自非肌肉骨骼问题。
一名 60 岁男性出现右肩部持续一个月的刺痛，深呼吸时加重。他没有外伤史或神经系统症状。他还在 3 个月内体重减轻了 5 公斤。体格检查正常。肩部 X 光片提示退行性关节炎。尽管包括阿片类药物在内的药物治疗，但他的疼痛持续存在并加重至 10/10 严重程度，疼痛扩散到右肋部和前胸。
腹部 CT 扫描显示多个肝结节、腹水和右侧胸腔积液，提示全身性疾病。
这促使立即转介肿瘤科，随后的检查证实了肝内胆管癌的诊断。
患者在癌症治疗的建立阶段病情恶化并死亡。
本例强调了在出现看似局部症状（如肩部疼痛）的患者中考虑全身性疾病的重要性。它强调了彻底评估和必要时及时转介以进行进一步检查的重要性。
