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A rare case of pseudotumor deltoideus encountered in stroke rehabilitation

Lui SK, Koh MM

Med J Malaysia, 2019 08;74(4):333-334.
PMID: 31424044

Although post-stroke shoulder pain is a common medical complication among the stroke population, pseudotumor deltoideus which is non-malignant is rarely seen. This case report demonstrates a thorough history, physical examination followed by the relevant investigations are essential when managing a common post-stroke complication. We postulate that pseudotumor deltoideus is likely a pre-existing asymptomatic variant in our patient before the stroke and has presented symptomatically after the stroke due to the associated neurological and musculoskeletal impairments. As post-stroke shoulder pain is associated with unfavourable outcomes, it is important to recognise the underlying causes of post-stroke shoulder pain early and institute prompt appropriate treatment.

Matched MeSH terms: Shoulder Pain/etiology*
Fulltext Evaluation of surgical condition during laparoscopic gynaecological surgery in patients with moderate vs. deep neuromuscular block in low-pressure pneumoperitoneum

Esa U, Hardy Mohamad Zaini R, Mazlan MZ, Omar AA, Che Omar S, Rosedi A

Anaesthesiol Intensive Ther, 2024;56(2):121-128.
PMID: 39166503 DOI: 10.5114/ait.2024.141209

INTRODUCTION: The significant effect of deep neuromuscular block (NMB) in laparoscopic surgery is still controversial, especially in lower-pressure pneumoperitoneum. This study investigates the effect of deep neuromuscular block on intraabdominal pressure (IAP), surgical space quality, post-operative abdominal pain, and shoulder tip pain in laparoscopic gynaecological surgery.
MATERIAL AND METHODS: This is a randomised, double-blinded control trial which randomised samples to moderate NMB (train-of-four count [TOF] of 1 or 2) or deep NMB (post-tetanic count [PTC] of 1 or 2). Surgery began with IAP 8 mmHg but was allowed to increase the pressure if the surgical condition was unfavourable. The surgical condition was rated on a 4-point scale. Post-operative abdominal pain and shoulder tip pain was assessed using a numerical rating scale for pain, with 0 defined as no pain and 10 severe pain at recovery area (time 0), 30 minutes, and 24 hours post-operation.
RESULTS: Seventy patients completed the study. The rate of increasing IAP between the 2 groups ( P = 0.172) is not significant, but deep NMB requires less pressure - mean highest IAP of 10.31 (± 1.39) mmHg, moderate NMB 11.54 (± 1.69) mmHg. The mean surgical space condition score was significantly better in the deep NMB group at 2.4 (± 0.7) compared to moderate NMB at 3.2 (± 0.66), P < 0.005. There was a significantly lower post-operative abdominal pain score in deep NMB but no significant difference in shoulder tip pain score between the 2 groups.
CONCLUSIONS: Deep NMB enables the usage of lower IAP in laparoscopic surgery without interfering with surgical space condition, and it reduces the post-operative abdominal pain score in 24 hours compared to moderate NMB.

Matched MeSH terms: Shoulder Pain/etiology
Fulltext Frozen shoulder syndrome: comparison of oral route corticosteroid and intra-articular corticosteroid injection

Widiastuti-Samekto M, Sianturi GP

Med J Malaysia, 2004 Aug;59(3):312-6.
PMID: 15727375

Twenty-six patients with frozen shoulder syndrome (Stage 2 and 3) were included in this study conducted at Dr. Kariadi General Hospital, Semarang, Indonesia and randomly allocated into 2 groups: 40 mg triamcinolone intra-articular injection and triamcinolone oral tablets. The result showed that triamcinolone intra-articular injection group "cured" rate was 5.8 times higher at week one compared to the triamcinolone tablet group. Sixty-two percent of the cases with triamcinolone intra-articular injection achieved their "cured" condition after one week of therapy, compared with only 14% of the triamcinolone tablets group. We conclude that, intra-articular corticosteroid injection provide faster improvement compared to oral route.

Matched MeSH terms: Shoulder Pain/etiology
Concurrent peripheral pathologies and complex regional pain syndrome type 1 as contributors to acute post-stroke shoulder pain: a case report

Akhavan Hejazi SM, Mazlan M

Acta Med Iran, 2012;50(4):292-4.
PMID: 22592581

Post-stroke shoulder pain is associated with either a peripheral or central pathology. However, most of the time, it is challenging to establish a cause-and-effect relationship between the suggested pathology and shoulder pain reported. We report a 66 year-old man who developed a right hemiplegic shoulder pain two months post stroke with initial investigations suggestive of peripheral pathologies. Pharmacological and non-pharmacological treatment did not improve his shoulder pain. Later he developed complex regional pain syndrome (CRPS) of the right hand and the initial shoulder pain subsequently relieved following resolution of the CRPS.

Matched MeSH terms: Shoulder Pain/etiology*