Metastatic gastric cancer presenting with shoulder-hand syndrome: a case report

Abstract

Introduction: Shoulder-hand syndrome is a relatively rare clinical entity classified as a complex regional pain syndrome type 1 and consisting essentially of a painful 'frozen shoulder' with disability, swelling, vasomotor or dystrophic changes in the homolateral hand. The pathophysiology is not completely clear but a predominant 'sympathetic' factor affecting the neural and vascular supply to the affected parts seems to be involved. Shoulder-hand syndrome has been related to many surgical, orthopedic, neurological and medical conditions; it is more often seen after myocardial infarction, hemiplegia and painful conditions of neck and shoulder, such as trauma, tumors, cervical discogenic or intraforaminal diseases and shoulder calcific tendinopathy, but has also been associated with herpetic infections, brain and lung tumors, thoracoplasty and drugs including phenobarbitone and isoniazid. The diagnosis of shoulder-hand syndrome is primarily clinical, but imaging studies, particularly bone scintigraphy, may be useful to exclude other disorders.

Case presentation: We report the case of a 67-year-old woman who presented with shoulder-hand syndrome as the initial manifestation of gastric cancer which had metastasized to bone.

Conclusion: Wider investigations are advisable in patients with atypical shoulder-hand syndrome. To the best of the authors' knowledge this is the first case of shoulder-hand syndrome associated with metastatic gastric cancer.

Figure 1

Late phase bone scintigraphy of the hand and wrist. 3 hours after injection planar ventral view demonstrated light uptake at the carpo-metacarpal joint of the right hand.

Figure 2

Scintigraphy of the chest. 3 hours after inlìjection planar antero-posterior view demonstrated diffuse spots of hyperfixation in the right humeral head and acromion, medial right clavicle, sternum and ribs. Other views confirmed bone localization of metastases on more sites.