A 50-year-old woman, without known allergies, with a history of 20 cigarettes per day, 2 uncomplicated pregnancies and left ear stapedectomy for smoking cessation surgery.
He came to the Traumatology consultation derived from his Health Center in May 2002 for atraumatic left earache of 2 years of evolution.
He had previously been evaluated and treated by the Neurology, Rheumatology and Rehabilitation services without improvement.
On physical examination, the patient presented nonspecific pain in the middle third of the left arm, which was sometimes exacerbated without any relationship with exertion or postural changes.
There were no signs of subacromial attachment or clinically evident muscle damage.
Mobility was complete.
The reflexes were normal and symmetrical.
Cervical MRI (April 2002) showed no evident pathological findings.
Shoulder MRI (May 2002) showed a partial rupture of the supraspinatus tendon and subacromial bursitis, which was treated with local corticoids and rehabilitation without improvement.
The patient continued to present the same symptoms so a neurophysiological study (June 2003) of the left C5-C6 dependent muscles was performed, which was normal.
A new MR scan of the shoulder (Agosto 2003) showed a new partial rupture of the supraspinatus tendon.
Established this situation and according to the patient was decided arthroscopic exploration (December 2003) that showed signs of subacromial bursitis with intact cuff, performing an arthroscopic acromioplasty.
After this intervention and new rehabilitation, the patient showed no clinical improvement.
We decided to perform a series of imaging studies of the brachial plexus in a thoracic TAC (December 2004), an ultrasound of the left shoulder and an MRI of the brachial plexus (January 2005) that showed the existence of a lesion compatible with bladder cancer.
A new MRI of the brachial plexus was performed (June 2005) showing the same lesion and a new neurophysiological study (July 2005) in which there were no signs of brachial plexus involvement.
At this moment the patient is considered the possibility of a surgical intervention for its resection.
The patient's treatment at that time included pregabalin (300 mg/12 hours), transdermic fentanyl (50 μg/72 hours) and ketorolac (10 mg/8 hours).
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Surgical intervention is performed in August 2005 and removal of the tumor by clavicle osteotomy with subsequent reconstruction with plate.
Anesthesia and surgery are uneventful.
Pathological anatomy is described as an old malformation.
In subsequent consultations the pain of the left upper limb had resolved.
There was only slight hypoesthesia at the level of the territory of the circumflex nerve, without evidence of changes in strength or reflexes, which in the last review of the patient had normalized.
