Cancer
It is common for breast cancer and other cancer patients to come into physical therapy due to shoulder pain and restrictions following a cancer-related treatment but if a patient comes in with shoulder pain and no diagnosis of cancer it is up to the therapist to confirm or not confirm a musculoskeletal component of the pain that is in the therapist’s scope of practice. Referred visceral pain is discussed in another section, but it should be mentioned here that if a patient has a history of cancer, no matter what type or location, and they are currently not responding to treatment interventions targeted at their shoulder pain and impairments as expected, a referral should be made to their physician for appropriate medical assessment. The pain in the shoulder may be referred from visceral cancers that are irritating the diaphragm.
If the patient does not have a history of cancer, but is not responding to the physical therapy interventions as anticipated, cancer should be considered. They may also present with unexpected weight loss, nausea, excessive fatigue, fever, and difficulty and pain with sleeping. While the skeleton is a common site for cancers to spread, the scapula is not a common location; instead the spine, ribs and long bones are more common due to the areas of bone marrow that continue to provide high levels of red blood cell production. However, osteochondroma, a benign bone tumor, may be found in the scapula following chemotherapy, and radiotherapy especially if the radiation is targeted close to the shoulder region. These tumors may or may not be painful but are not likely to respond to physical therapy interventions.
Through direct access, patients may bypass their physician when seeking outpatient physical therapy; therefore, the therapists should be cognizant that they may be treating a patient with systemic disease, including cancer, that is presenting as musculoskeletal dysfunction.
If the patient does not have a history of cancer, but is not responding to the physical therapy interventions as anticipated, cancer should be considered. They may also present with unexpected weight loss, nausea, excessive fatigue, fever, and difficulty and pain with sleeping. While the skeleton is a common site for cancers to spread, the scapula is not a common location; instead the spine, ribs and long bones are more common due to the areas of bone marrow that continue to provide high levels of red blood cell production. However, osteochondroma, a benign bone tumor, may be found in the scapula following chemotherapy, and radiotherapy especially if the radiation is targeted close to the shoulder region. These tumors may or may not be painful but are not likely to respond to physical therapy interventions.
Through direct access, patients may bypass their physician when seeking outpatient physical therapy; therefore, the therapists should be cognizant that they may be treating a patient with systemic disease, including cancer, that is presenting as musculoskeletal dysfunction.
References
Fruth, S. J. (2006). Differential diagnosis and treatment in a patient with posterior upper thoracic pain. Phys Ther, 86(2), 254-268.
Jemal, A., Siegel, R., Xu, J., & Ward, E. (2010). Cancer statistics, 2010. CA Cancer J Clin, 60(5), 277-300.
Poustchi-Amin, M., Leonidas, J. C., & Elkowitz, S. S. (1996). Simultaneous occurrence of osteosarcoma and osteochondroma following treatment of neuroblastoma with chemotherapy, radiotherapy, and bone marrow transplantation. Pediatr Radiol, 26(2), 155-157.
Walsh, R. M., & Sadowski, G. E. (2001). Systemic disease mimicking musculoskeletal dysfunction: a case report involving referred shoulder pain. J Orthop Sports Phys Ther, 31(12), 696-701.
Jemal, A., Siegel, R., Xu, J., & Ward, E. (2010). Cancer statistics, 2010. CA Cancer J Clin, 60(5), 277-300.
Poustchi-Amin, M., Leonidas, J. C., & Elkowitz, S. S. (1996). Simultaneous occurrence of osteosarcoma and osteochondroma following treatment of neuroblastoma with chemotherapy, radiotherapy, and bone marrow transplantation. Pediatr Radiol, 26(2), 155-157.
Walsh, R. M., & Sadowski, G. E. (2001). Systemic disease mimicking musculoskeletal dysfunction: a case report involving referred shoulder pain. J Orthop Sports Phys Ther, 31(12), 696-701.
A.T. Still University
Class of 2015
Published 07/03/2014
Class of 2015
Published 07/03/2014