shoulder pain breast cancer

Breast Cancer Awareness: Shoulder Pain - Jaspal Ricky Singh, M.DWhat are the warning signs of breast cancer? Breast pain or lump: Is it cancer? Acute chest pain, possibly with some tenderness, may have to wonder if it could be serious. A blowjob is often the first thing women and even men notice that makes a visit to their doctor. Although breast cancer usually does not show symptoms at the early stage, timely detection can turn a history of breast cancer into a survivors' account. We often associate pain with something bad, so when women feel tenderness or pain in their chest, they often assume it is. However, breast pain is rarely the first perceptible symptom of breast cancer. Other factors can cause pain. Clinically known as , breast pain can also be caused by the following: Although a is typically associated with breast cancer, much of the time such lumps are not cancer. According to , most are benign, or not cancerous. Common causes of benign breast lumps include: With fat necrosis, the mass cannot be distinguished from a cancerous lump without one. Although most breast lumps are caused by less severe conditions, new and painless lumps remain the most common symptom of breast cancer. At first, a woman may notice a change in her chest when she performs an abnormal or minor pain that does not seem to disappear. Early breast cancer includes: A lump that is hard with irregular edges is more likely to be cancerous. Subsequent signs of breast cancer include: Having one or more of these symptoms does not necessarily mean that you have breast cancer. The discharge of the nipple, for example, can also be caused by an infection. See your doctor for a full evaluation if you experience any of these signs and symptoms. Breast cancer is not usually associated with men. However, it may occur in rare cases at any age, although it is more common in older men. that men also have breast tissue, and those cells may suffer from cancerous changes. Because male breast cells are much less developed than female breast cells, breast cancer in men is not so common. The most common symptom of breast cancer in men is one in the breast tissue. Apart from a lump, the symptoms of breast cancer in men include: Most men do not regularly check their breast tissue to detect signs of lumps, so male breast cancer is often diagnosed much later. When you visit your doctor with concerns about breast pain, tenderness, or lump, there are common tests that may be done. Physical exam Your doctor will examine your breasts and skin in your breasts, as well as check your nipple and discharge problems. They can also feel their breasts and armpits to look for lumps. Medical History Your doctor will ask you questions about your health history, including any medication you may take, as well as the medical history of immediate family members. Because breast cancer may sometimes be related to your genes, it is important to tell your doctor about any family history of breast cancer. Your doctor will also ask you about your symptoms, even when you first noticed them. Mammogram Your doctor may request a , which is an x-ray of the breast, to help distinguish between a benign and malignant mass. Ultrasound wavesUltrasound can be used to produce breast tissue. MRI Your doctor may suggest an analysis along with other tests. This is another non-invasive imaging test used to examine the breast tissue. Biopsy This involves a small amount of breast tissue to be used for testing. There are two that reflect the nature of breast cancer: The affected tissue determines the type of cancer: Genetics begin to learn how genes affect cancer growth and have even identified one: the gene. This gene feeds the growth of breast cancer cells. Medicines can help close this gene. Like genes, hormones can also accelerate the growth of some types of breast cancers that have hormonal receptors. Depending on the type and stage of cancer, it may vary. However, there are some common practices that use doctors and specialists to combat breast cancer: Despite initial treatment and success, breast cancer can sometimes come back. This is called recurrence. Repeat occurs when a small number of cells escape initial treatment. The symptoms of a recurrence in the same place as the first breast cancer are very similar to the symptoms of the first breast cancer. They include:If breast cancer returns regionally, it means that cancer has returned to the lymph nodes or near the original cancer, but not exactly to the same place. Symptoms may be slightly different. Symptoms of a regional recurrence may include: If you have had a mastectomy or other surgery related to breast cancer, you may get lumps or strokes caused by scar tissue in the reconstructed breast. This is not cancer, but you should tell your doctor about them so they can be monitored. As with any cancer, early detection and treatment are important factors in determining the outcome. Breast cancer is treated easily and usually cured when detected in the early stages. The 5-year survival rate for breast cancer that is stage 0 to stage 2 is more than 90 percent. The 5-year survival rate for stage 3 cancer is over 70%. Breast cancer is the most common cancer in women, according to . If you are concerned about breast pain or tenderness, it is important to stay informed about risk factors and warning signs of breast cancer. The best way to fight breast cancer is early detection. Talk to your doctor about when you should start programming regular mammography. If you're worried that your breast or tenderness may be serious, make an appointment with your doctor today. If you find a lump in your chest (even if your most recent mammography was normal), see your doctor. Last medical review on October 3, 2018 Read this next series of words

Warning: The NCBI website requires JavaScript to operate. The shoulder pain due to metastatic breast cancer -A young report-salir case KimDepartment of Anesthesiology and Pain Medicine, Faculty of Medicine, Keimyung University, Daegu, Korea. Min Woo JungDepartment of Anesthesiology and Pain Medicine, Faculty of Medicine, Keimyung University, Daegu, Korea. Jin Mo KimDepartment of Anesthesiology and Pain Medicine, Faculty of Medicine, Keimyung University, Daegu, Korea. Abstract A broken rotating cuff causes shoulder pain and limits the movement of the shoulder joint. A chronic degenerative change or impingement is the reason for a broken rotating cuff. The diagnosis is made based on medical history and physical and radiological examinations. Other causes of shoulder pain include calcific tendonitis, degenerative arthropathy, joint dislocation, primary or metastatic fracture and neoplasm. However, metastatic cancer in the shoulder joint is difficult to diagnose. We experienced a case in which a 46-year-old patient complained of left shoulder pain and limited joint mobility, and these symptoms were due to metastatic breast cancer on the shoulder. The shoulder pain occurs in 6.6 to 25 people of every 1000, and is the third most common musculoskeletal disease after low back pain and knee pain [-]. The shoulder joint is the joint with the highest range of movement in the body, and the cause of shoulder pain is not only limited to the shoulder joint, but can also be caused by injuries in the surrounding area. Common causes of shoulder pain are rotating fist pathology, adhesive capsulitis, calcific tendinitis, degenerative joint disease, dislocation, fracture, acute trauma and tumors []. The authors have recently experienced a case in which a 46-year-old patient complained of left shoulder pain and movement limitation (LOM). After taking a medical history and giving a physical exam, it was suspected that the pathology of the rotating cuff with tear of the rotator cuff, but no anomalies were observed in ultrasound. Through magnetic resonance imaging (MRI) and bone scan, metastatic breast cancer that was believed to have been completely removed by prior surgery was observed in the wet head. In this case, we report a case of metastatic breast cancer in the shoulder joint's humeral head in a 46-year-old woman along with a literature review. CASE REPORT The 46-year-old patient visited our department that complained of left shoulder pain that began after the frequent use of arm 1 month before his visit. The pain was dull in nature with a visual analogue scale (VAS) of 35/100 mm and when the left arm was moved, the pain was increased with a 100/100 mm VAS. He also complained of the LOM in the left shoulder joint and pain sleep interruption. The patient had been diagnosed with right breast cancer 6 years before his visit and had made a modified radical mastectomy. He had been regularly visiting a surgical clinic until recently, was taking tamoxifen every day, had a bone scan and body ultrasound done in the breast area once a year, and PET-CT (Positron Emission Tomography-Computed Tomography) took once every two years to observe progress, but there was no trace of recurrence or metastasis. In the physical examination, there were no irregularities in the inspection, but there was tenderness in the left palpado greater tuberosity. The LOM in its left shoulder joint during the active movement was the following: 150° bending and 50° extension of the sagittal plane; 110° abduction, 50° aggregation of the coronal plane; 40° external rotation. As for internal rotation on the back, your left hand could reach your first lumbar vertebrae. Meanwhile, in terms of passive movement, the patient complained of pain between 90 to 120° in kidnapping, but there was no LOM in any direction. The patient was positive for the Neer test, positive for the empty tin test, and positive for the test of the gout arm; therefore, the pathology of the rotating cuff was suspected with a rupture of the accompanied supraspinatus tendon. Therefore, a laboratory and simple x-ray examination was performed, but there were no anomalies, and the left shoulder area was examined using ultrasound by our department, but the pathology of the anticipated rotating fists could not be confirmed. An ultrasound-guided left-handed suprascapular block was performed to treat pain in the shoulder area, but pain relief was insignificant. Therefore, the Department of Radiology was asked to do an echosonography, but no abnormalities were found in the rotary cuff. The patient complained of continual pain and LOM to make a magnetic resonance and bone scan. The MRI examination saw a cancerous lesion in the humeral head (), and the bone scan found suspicious abnormalities of a metastatic tumor in the humeral head and the 10th chest vertebrae. The patient was transferred to the Department of Internal Medicine and was diagnosed with metastatic breast cancer in the wet head and 10 chest vertebrae and received chemotherapy and radiation therapy. Currently, six months later, there are no observations of metastases in other areas and the cancer lesion in the head of the wetland has not changed. Magnetic resonance imaging. The axial image weighted by T2 (A) and the coronal image (B) shows osteolytic lesion in the left head and humeral metaphysics. DISCUSSION The rotary cuff is composed of the supraspinatus, infraspinatus, subscapularis and minor teres. These ensure the shoulder joint so that it can move and allows the normal functioning of the shoulder. However, the rotary cuff is worn easily and susceptible to degeneration, so it is the weakest part of the shoulder joint. Therefore, tears of the rotating cuff occur frequently, and this weakens the shoulder joint and causes pain []. A rotating cuff tear occurs from the mixed effects of various mechanisms such as mechanical impact, degenerative changes, circulatory disorders and joint abrasion. Miller and Dlabach [] contend that the supraspinatus is more susceptible to tear in the rotating cuff. The tear of the supraspinatus tendon occurs from the abrasion by being trapped between the humeral head and the acromion or acromioclavicular joint instead of mechanical impact [,]. For the diagnosis of tear of the rotating cuff, history taking and physical examination are important. The patient finds it difficult to lift the arm and is characteristic that the active movement is limited but the passive movement is free in the physical examination. Also, when the arm is lowered, the sign of the drop arm appears where the patient does not have the strength or the arm drops due to the pain. The findings of a physical examination are different for the tears of each tendon. In a supraspinatus tear, a painful arch sign is detected between 60 and 120° in the abduction. When the arm rises to a certain level, the final lift can be performed easily. Also, when both arms extend around 40° and the elbow joints extend to where the thumbs point down as if pouring water out of a cup, the pain is generated when the resistance applies to the upper area (force can prove). In an infraspinatus tendon tear, when the arm rotates passively to the maximum range of external rotation, the patient is not able to maintain this active position and the arm is removed from the body or rotated internally (load sign). In a subscapular tendon tear, when the patient's arm is behind the back, there is a lack of muscle strength that makes it difficult to stretch from the back as it overcomes the resistance (extract the test) []. The radiological diagnostic method for tears of rotary cuff uses ultrasonography or magnetic resonance examination. Rafii et al. [] reported that the sensitivity of tears of rotating cuff in the MR was 95% in the case of tears of full thickness and 84% in the case of partial tears, while Quinn et al. [] reported that the sensitivity of magnetic resonance examinations in relation to tears of rotating cuffs was 84% and the specificity was 97%. Burk et al. [] compared the MRI observations and arthrography with direct observations during surgery in 16 cases and reported that MRI and arthrography had sensitivity of 92% and 100% specificity. There are also reports on the usefulness of ultrasound in tears of rotating cuff, in which Brandt et al. [] reported that, compared to observations during arthroscopic surgery in 38 cases, ultrasound had 57% sensitivity and 76% specificity. As you can see, ultrasound is known to be less accurate compared to magnetic resonance in the diagnosis of tears of rotating cuff. Ultrasound has many merits in which it is possible to perform tests and treatment in real time; there is no risk of radiation exposure so that it can be safely used in pregnant women and children, and it is cheap and non-invasive. However, there are limitations to ultrasound such as seeing deep structures such as intestines because it cannot penetrate the air and cannot pass through the bone or metal, so there are limits to evaluating the bone marrow or the safety of the orthopedic hardware. The most common malignant neoplasm in women is breast cancer, taking 32% of malignant neoplasms. With the development of modern diagnostic techniques and treatment modalities, the mortality rate is decreasing, but it remains the most common cause of death for women in their forty years. Coleman and Rubens [] claim that the complete recovery of breast cancer is possible if surgically removed at the initial stage, and that bone metastasis occurs in 69% of all cases of breast cancer. According to Martin and Moseley [], breast cancer is easily spread to the spine, rib, pelvis and proximal long bone, and the metastasis rate is 70%. Thomas et al. [] reported that cancer cells that spread to the bone marrow accelerate osteolysis and osteoclast reactions and may cause pathological fractures or pain. In the shoulder pain caused by metastatic cancer, cases of lung cancer are reported that has spread to humerus [], and kidney cancer that has spread to humerus and escapula []. Computed tomography, magnetic resonance and bone scan are used to diagnose cancer that has spread to the bone, and the irregular osteolytic lesions that appear in these images are the most common observations for skeletal metastases []. The patient in our study had received surgery in the past for breast cancer, but had not shown trace of recurrence or metastasis in observations of progress through regular visits. Since he complained of pain on the left shoulder, he had limited active joint motion, but free passive joint movement, and was positive for the sign of the gout arm and the vacuum can prove, pathology of the rotating cuff with a tear of the supraspinatus tendon was suspected; however, there were no images indicating the tear in ultrasonography images. Thus, magnetic resonance and bone scan were performed and, as a result, breast cancer was found that spread to the bone. Recently, the use of ultrasound in pain clinics increases. However, it is necessary for health professionals to realize that ultrasound cannot penetrate the bone and that additional tests such as magnetic resonance may be needed when there is discordium with clinical symptoms. In addition, cancerous lesions or skeletal metastases should be considered when musculoskeletal pain occurs in patients who think they have recovered completely from the cancer. ReferencesFormats: Share , 8600 Rockville Pike, Bethesda MD, 20894 USA

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