Shoulder
Tumors masked as frozen shoulders: A retrospective analysis

https://doi.org/10.1016/j.jse.2009.05.010Get rights and content

Background

It was reported that some shoulder tumors were misdiagnosed with frozen shoulder syndrome. The purposes of this study were to elucidate the incidence of the initial misdiagnosis with frozen shoulder syndrome among the patients with malignant shoulder tumors, and to clarify whether such initial misdiagnosis affected the time to make a final correct diagnosis or not.

Methods

Clinical records of 34 patients (age > 40) with malignant shoulder tumors and those of 505 patients (age > 40) with shoulder pain and stiffness were reviewed in the author's institute. The duration of the prediagnostic period was compared between the patients with and without an initial misdiagnosis as frozen shoulder syndrome.

Results

Among 34 tumor patients, 9 (26%) had been initially misdiagnosed with frozen shoulder syndrome. Two patients actually manifested shoulder pain and stiffness, although they did not have a record of misdiagnosis. Among 505 patients with shoulder pain and stiffness, 4 (0.8%) were diagnosed later as having malignant tumors. One of these 4 patients had been initially misdiagnosed with frozen shoulder syndrome. Consequently, 15 malignant tumors (10 bone tumors and 5 soft tissue sarcomas) were identified. Seven of them were intraosseous humeral tumors and 4 were localized in the scapular region, where patients themselves could not find them. In 10 patients, initial misdiagnosis as frozen shoulder syndrome did cause a significant delay to reach the correct diagnosis as malignant tumors (P = .035).

Conclusion

Physicians should carefully re-examine the frozen shoulder patients with repeated plain radiographs followed by further imaging studies, if the conservative therapy fails.

Section snippets

Materials and methods

The approval of the institutional ethical committee was obtained for the research protocol of the current study. In the outpatient clinic system at the authors' institute, shoulder tumor patients are examined initially either at the tumor or the shoulder service. Those who had been diagnosed with tumors around the shoulder were referred to the tumor service for further examination and treatment. In contrast, patients without a diagnosis of a tumor were usually referred to the shoulder service

Results

Among 34 malignant shoulder tumor patients from the tumor service, 9 (26%) had been initially diagnosed with frozen shoulder syndrome instead of musculoskeletal tumors in the previous clinics. The incidence of the initial misdiagnosis with frozen shoulder syndrome among the patients with malignant shoulder tumors was 26% in the current series. The primary symptoms in all 9 patients were shoulder pain. None of the patients complained of a tumor mass at the time of onset of their symptoms. They

Discussion

In the diagnosis of musculoskeletal tumors of the shoulder, the first challenge for physicians is to think of the possibility of tumors.6 To enter into this mind-set, it is necessary for them to know the demographic data of shoulder tumors and frozen shoulder symptoms.

The results of the current study indicated that 26% of malignant shoulder tumors were initially misdiagnosed with frozen shoulder syndrome. In the literature, Robinson et al. reviewed 67 shoulder tumor cases and found that 7 cases

Acknowledgments

The authors would like to thank Mr. Francisco J.D. MacArthur and Mr. Mark S. Gurecki for editing the present paper.

Disclaimer

The authors, their immediate families, and any research foundations with which they are affiliated have not received any financial payments or other benefits from any commercial entity related to the subject of this article.

References (12)

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The approval by the Ethical Committee of Tohoku University was obtained for the current study (The Study number: 2007-128, Date of approval: July 23, 2007).

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