lipoma and ganglion cyst...

Pain began gradually, pin point area up the arm to the shoulder, rotator cuff area. It became acute and ended up in ortho office. Xray found a large mass on greater tuberosity of humerus. I was sent for MRI w/wo contrast. Lipoma in the greater tuberosity of the humerous and the 2nd was in the humeral neck. High abnormal signal in subdeltoid/subcoracoid bursa of unknown etiology and a ganglion cyst was in the spinoglenoid notch, documented as incidental.
Acute pain resolved but after researching online it appears the ulner nerve effected. My small/ring fingers tingle and cannot open/close properly. Ortho had no explanation and ortho oncology says pain is unrelated to benign tumors. Mornings are the worst. I cannot hold a writing utensil and unfortunately this problem is in my dominent hand. Looking for more info or a treatment center or how to research a surgeon to treat such a problem in Los Angeles. Thank you for any help.

[Abhijeet Deshmukh, MD]

Hello.

it is indeed difficult when your dominant hand is not working fine.

Did your orthopedic surgeon order for an MRI of the spine also ? This ulnar nerve problem (root C7/C8) could be a separate pathology.  

Alternatively, have you considered posterior interosseous nerve compression ? It causes weakness of the little finger opening. And it is associated with lipomas, though, rarely.

regards

[Globalgal61]

First thank you for your response. I am quite certain it is related to all the findings in the shoulder. No Cspine films were ordered. I am familiar with nerve pain in the neck, which I've had none. The pain began as muscle pain above my wrist, my elbow and then when it settled into my shoulder it became so extreme they first thought it was a frozen shoulder until they found the mass on Xray. I could put my finger on isolated spots (not shooting pain) that felt like someone was stabbing me. MRI, CT and whole body bone scan were ordered STAT because of the size of the lesion in the humerus. Within 2-3 weeks the shoulder pain became manageable, ROM returned slowly but pain and occasional swelling in the two fingers began. Afterwards, pressure and tingling in my arm/hand would wake me up at night when I fell asleep on that shoulder. I have been propping myself in bed to avoid sleeping on that side and it does seem to help...more reason to believe it is shoulder related. Does this nerve come in the path of any of the areas mentioned? I am no stranger to spine issues. C 4-5 fused/2002, T 7-8 thoracoscopic microdiscetomy/2000. I am an active athlete and have had no complications post op. Occasional pain days but managed through massage and swimming. No pain meds.
I am not familiar with "posterior interosseous nerve compression". Can you tell me more?
Thank you

[Globalgal61]

Mystery diagnosis...part 2

After the diagnostic team declared my shoulder problem as : "etiology unknown, possible inflammatory process" my health began the downhill slide...

I began experiencing stomach bloating and pain in the upper R quadrant after eating. Labs/upper GI/ab ultrasound were normal but a little spike on the ALK PHOS. I continued to complain but it fell on deaf ears in Hawaii until I demanded my PC do something. He wrote a script for reflux meds and a referral to GI doc #1 out of 2 on the island (Hawaii resident). I called and got the first appt date avail: 5 months out...
Out of desperation, I jumped a flight, came to the mainland and was admitted, same day to the hospital. They found an ampullary stricture. ERCP created ugly pancreatitis and follow up labs found a 640 ANA titer. Two weeks passed and I seemed to improve. Week 3 and it all fell apart again after I had returned to Hawaii. Pain/high liver function results put me back on a plane and back in the hospital. MRCP with Doc #2 "no cut seen" from ERCP w/sphincterotomy. Doc #2 now wants to repeat the ERCP. Rheumatology ruled out SLE. I do not want to volunteer for another go-around with pancreatitis not knowing the 2nd ERCP will succeed in resolving the problem. I'm not even sure there is a clear DX. No one has even thought about linking the two problems (benign shoulder lesions/abnormal liver functions) even though one came right after the other with no diagnosis. Any opinions on this would be appreciated. Thanks.

[Globalgal61]

is the policy here, one time response?

[Abhijeet Deshmukh, MD]

Hello.

A very Happy New Year to you. And one time response is definitely not the policy. I apologize for the late response.

I will try to help as best as I can. Your symptoms are indeed difficult to put together into one singular diagnosis.

The posterior interosseous nerve is responsible for movements of the wrist. And it supplies pretty much all the small muscle that extend the wrist. And it has been found to be associated with lipomas on the humerous head. But on a second thought, this nerve does not explain all your hand and fingers problem.

On the other hand, ulnar nerve does not go close to the humeral head.

You have mentioned about C4-C5 fusion. Can you describe the events that led to this ? Was there an accident ? Has the MRI shown any C5-C6 problem ?

Regards

[Globalgal61]

Happy New Year to you as well. I'm pleased to know that a discussion is possible. I will have more patience in the future waiting for a response. No apology needed, just clarification.

Unfortunately, I have never offered the medical world a text book case. As a matter of fact, my Tspine case is written up in a journal somewhere.

MR Shoulder Impression: *Rotator Cuff, unremarkable.
*Abnormal crescentic high signal in subdeltoid bursa, extending into subcoracoid recess. Uncertain etiology. Following gadolinium, pathologic enhancement of high signal surrounding the anterolateral aspect of the humeral head. 2.2 cm lesion in greater tuberosity of humerus, and 6.0mm lipoma in the humeral neck. 2.0cm ganglion cyst iin the spinoglenoid notch.

Ortho Oncology: benign lesions

When I awake from sleeping on my shoulder, my arm/finger are numb/tingling, I cannot close my hand and my shoulder feels like it is going to explode (pressure). It takes up to an hour of getting up and moving around to get sensation back. My two fingers (ring/pinky) have constant tingling/stiffness X 2 months now. (Rheumatology saw no arthritis, physical exam r/o SLE) Doesn't common sense indicate the findings in the shoulder are the cause of this and further investigation should be directed? In the past, imaging has failed to clearly present what the problem was and it nearly cost me my life. I do not trust the studies because of the sequence of events.

As to the continued failed health (liver issues), I am very suspicious of the two of them being linked and not in a comforting way...especially when the MR report states: etiology unknown and now having extremely ANA titers of 640 without any DX yet. Additional labs, breaking down the ANA profile are pending.

C 4-5 Fusion was in 2002 with next day d/c, motrin for pain X one week. Nothing since, no complications and a return to work/sports.

I am still retrieving reports from the two admissions and aggressive evaluations that were done.

Thank you for your continued offerings.