ABSTRACT
STUDY DESIGN: Patients are often referred for the evaluation of neck or radiating shoulder or arm pain who are suspected of having a possible cervical spine origin of their symptoms. Careful evaluation may show ganglion cysts of the glenohumeral joint mimicking symptoms of cervical radiculopathy. OBJECTIVES: To present a series of patients in whom cysts originating from the glenohumeral joint caused symptoms mimicking cervical radiculopathy. SUMMARY OF BACKGROUND DATA: Suprascapular nerve entrapment in the suprascapular notch by ganglion cysts from the glenohumeral joint has been described as the source of vague radicular symptoms. This paper presents a series of patients referred to a spine practice for the evaluation of cervical radiculopathy who actually had glenoid cysts mimicking cervical radiculopathy. METHODS: Three hundred forty-two patients were evaluated for cervical radiculopathy; of these, eight had glenoid cysts that were the source of the patients' symptoms. RESULTS: All eight patients had a positive shoulder impingement sign, or, in all, symptoms were temporarily relieved with intra-articular lidocaine injection. Four of the eight patients had abnormal electromyelography and nerve conduction velocity for suprascapular nerve compression. Magnetic resonance imaging of the shoulder was diagnostic in all eight patients. CONCLUSION: Proper evaluation of the shoulder must be done because it may mimic symptoms of cervical radiculopathy.
Subject(s)
Cysts/diagnosis , Shoulder Joint , Spinal Nerve Roots , Adult , Diagnosis, Differential , Female , Humans , Magnetic Resonance Imaging , Male , Middle Aged , Peripheral Nervous System Diseases/diagnosisABSTRACT
Reversible complication of intrathecal morphine delivered by an implanted pump is described in one patient. The patient was evaluated initially using a contrast CT of the thoracic spine as well as urodynamics studies. After decreasing the intrathecally administered morphine from 2 mg/24 hr to .5 mg/24 hr, the patient's neurogenic bladder reversed within 4 days. Implanted pumps to deliver intrathecal narcotic medications are being used currently to treat intractable pain. This is a case report of reversible urinary retention secondary to the intrathecal narcotic.
Subject(s)
Morphine/adverse effects , Urinary Retention/chemically induced , Aged , Dose-Response Relationship, Drug , Equipment Failure , Humans , Infusion Pumps, Implantable , Injections, Spinal , Male , Morphine/administration & dosage , Spine/diagnostic imaging , Thorax , Tomography, X-Ray Computed , Urinary Bladder, Neurogenic/chemically induced , UrodynamicsABSTRACT
BACKGROUND AND PURPOSE: Acute paraplegia must be investigated promptly to exclude reversible causes. In this report we illustrate the usefulness of transesophageal echocardiography in identifying the vascular etiologies of acute paraplegia. CASE DESCRIPTIONS: Two patients presented with acute paraplegia, one spontaneously and the other after removal of an intra-aortic balloon pump catheter. Through the use of transesophageal echocardiography, we excluded aortic dissection and identified protruding atherosclerotic plaques in the descending thoracic aorta of each patient. Embolization of atheromatous material from the thoracic aorta was considered the most likely etiology of paraplegia in both cases. CONCLUSIONS: Embolization from atherosclerotic plaques in the thoracic aorta may be an underestimated cause of acute paraplegia. Transesophageal echocardiography provides a safe, rapid, and reliable tool for investigating a vascular etiology of acute paraplegia.
