Case Diagnosis: Patient was referred by orthopedics for EMG/NCS after he came in presenting with shoulder pain and dysesthesias down the right upper limb.
Case Description or Program Description: A 62 year-old male with right shoulder pain chronically. Currently, shoulder pain became worse and he decided to see orthopedics, who ordered an MRI, showing moderate glenohumeral joint effusion into the subscapularis recess and labral cyst measuring roughly 2-3 x 2-3 x 2-3cm. He was referred for EMG studies because of visible right deltoid atrophy when compared to the left UE. He is a smoker of 40 years and has a history of alcoholism. He was admitted in 2019 for balance issues, deemed to be secondary to neuropathy from alcohol use. He states his brain MRI in 2019 showed indeterminate white matter changes. Has tingling sensation down the RUE in the radial distribution stopping at the wrist. Has chronic neck pain on the right.
Setting: Outpatient
Assessment/Results: NCV/EMG studies were unremarkable, thus we sent the patient for chest, x-ray, MRI of his brain, right upper quadrant ultrasound, and labs CBC and CMP. Results were within normal limits other than increased echotexture of the liver consistent with fibrosis vs. steatosis, for which patient made an appointment with gastroenterology.
US showed a significant subscapularis recess effusion, which was compressing the brachial plexus. We aspirated the bursa. Thereafter he experienced 80% relief of both his pain and neuropathic symptoms with resolution of subscapularis effusion on ultrasound evaluation.
Discussion (relevance): This is the only case to our knowledge of brachial plexopathy as a result of glenohumeral joint osteoarthritis causing effusion into the subscapularis recess and compressing, in this case, the posterior cord of the brachial plexus, causing deltoid atrophy and radial nerve distribution dysesthesias.
Conclusions: Due to the close proximity of the brachial plexus to the anterior shoulder joint, any space occupying mass including a joint effusion can cause nerve pain and should not be mistaken for a cervical radiculopathy.
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