METASTASIS INTO THE BONE

Casuistry of metastasis into the cotyle of the glenohumeral articulation

A patient comes due to terrible pains of the shoulder, and a restriction of its motility. She cannot sleep on it at night. She has the problems for 2 months. But at an ultrasound examination only a minimal effusion of the long head of the biceps is found, it rather corresponds to tenovaginitis. On the basis of the conclusion we made a steroid  peritendinous injection. But the problems at the entrance examination do not correspond to so small finding, so if her state is not getting better, she will be sent to MRI. The peritendinous injection really did not help, but the patient does not come back. She begins to see the orthopaedic outpatient department. There CT of the shoulder with a normal finding is made. MRI is refused as a needless examining method. From these reasons the steroid peritendinous injection was made several times (again without any success). In the meantime other 3 months pass under a diagnosis of a frozen shoulder, and the patient (rather as a manifestation of desperation of a treating doctor) is sent to the rehabilitation where we accidentally catch her again.

 

CT Picture

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picture the entrance CT picture indicated at orthopaedics closed at the radiodiagnostic department as a normal finding in spite of that a change is already indicated where, in our opinion, it deals with an early phase of osseous metastasis. (an arrow is made after the determination of the final diagnosis). Compare with a following (after two months) CT picture.

Ultrasound Examination

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Picture and scheme of the expansion of posterior labrum of the glenohumeral articulation

Video of the expansion of posterior labrum of the glenohumeral articulation in the ultrasound picture

Conclusion from the Ultrasound Examination (before MRI Examination):

A deformation of labrum glenoidale posterior, articular hydrops.

 

MRI

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MRI picture the expansion in the area of labrum glenoidale recommended a checking CT

arrows show : 1 metastasis in labrum glenoidale . 2 a breaking of posterior labrum, and there is a liquid between it and the head of the humerus . 3 the liquid along the long head of the biceps

 

Checking CT

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Checking CT for the determination of the diagnosis, MRI metastasis in the area of labrum glenoidale posterior, an arrow again shows metastasis

Conclusion

Metastasis into the cotyle.

 

Commentary

The ultrasound examination does not often bring a definitive diagnosis, but if we find hydrops of the glenohumeral articulation during the examination, we assure at least that the affection is a serious one. The patient with the finding of hydrops is examined by means of all the accessible methods (MRI or arthroscopy) in the dependence on probable etiology. A useful feature of the ultrasound is also a possibility of the repeated examination in short intervals, and a watching a dynamics of the changes. The repeating of the examination was successful at this patient. Today we are not able to judge if the minimal finding at the first examination on the ultrasound corresponded to the initial stage of the disease or to our mistake. But the following examination uncovered the serious changes, and it helped to determine the diagnosis.