Shoulder ring complaints as a rare first symptom of malignant pleural mesothelioma

Our plain-English summary of Shoulder ring complaints as a rare first symptom of malignant pleural mesothelioma, by J. Lorkowski, O. Grzegorowska, A. Kotela, et al (Advances in Experimental Medicine and Biology, 2015).

The study

• Authors: J. Lorkowski, O. Grzegorowska, A. Kotela, W. Weryński, I. Kotela
• Journal: Advances in Experimental Medicine and Biology
• Published: 2015;852:5-10
• Cited by: 1 article, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

The prevalence of malignant pleural mesothelioma is often encountered in the areas highly exposed to asbestos. The aim of this paper was a retrospective analysis of shoulder pain as a rare, first symptom of pleural mesothelioma, which constitutes an interdisciplinary diagnostic problem concerning both orthopedics and pulmonology. The research was based on a retrospective review of the patients' medical records. The considered period of time included the years 2006-2012. The study group included a total of 49 patients. Seven patients (14.3%) presented a complain of shoulder pain, as the first symptom of mesothelioma. The remaining 42 mesothelioma patients, without this symptom, constituted a reference group. The intensity of shoulder pain was, on average, 4/10 on an analog scale. A concomitant limitation of mobility was observed in five out of the seven subjects. In one case, limitation of motion and dysfunction of the shoulder joint were at an advanced stage. Neuralgia of upper limbs was found in two cases. We conclude that shoulder pain may be a manifesting symptom of malignant pleural mesothelioma. The neoplasm appears to have a pleiotropic effect on human body, reflected in different ways of its primary manifestation which may also include the motor system.

In plain English

This was a retrospective review of the medical records of 49 patients with pleural mesothelioma diagnosed in 2006–2012. All came from the Szczucin municipality in Poland, an area the authors describe as having increased environmental asbestos exposure because of an asbestos-cement plant. Seven patients (14.3%) first saw an orthopedic doctor because of pain in the shoulder area. The other 42, who had no such pain, served as a reference group. One of the seven and six of the 42 had worked at the local asbestos-cement plant. In the seven patients the pain was diffuse, spread to the shoulder blade or neck, and was rated 3 to 6 on a 0-to-10 scale. Five had reduced shoulder mobility, and two had nerve pain in the arm. Average survival from diagnosis was 25.4 months (range 12–48) in the shoulder-pain group and 15.4 months (range 3–48) in the reference group. The article reports no statistical test of this difference. The authors concluded that shoulder pain may be a presenting symptom of malignant pleural mesothelioma.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Retrospective review of medical records (case series of patients with shoulder pain compared with a reference group of other mesothelioma patients)
• Who was studied: 49 patients with pleural mesothelioma diagnosed 2006–2012, all from the Szczucin municipality, Poland (about 14,000 inhabitants), who had lived in the area for at least 15 years. Shoulder-pain group: 7 patients (4 women, 3 men; mean age 51 plus or minus 10, range 41–66 years). Reference group: 42 patients (25 women, 17 men; mean age 64 plus or minus 12, range 38–86 years) without motor-system pain.
• Exposure: Environmental asbestos exposure in an area with an asbestos-cement plant. Some patients also had occupational exposure as workers at that plant. No fiber type is named.
• Main results:
  • Of 49 patients, 7 (14.3%) presented with shoulder pain as the first symptom of mesothelioma and went to an orthopedic doctor because of it.
  • In the 7 shoulder-pain patients, the pain was diffuse and radiated to the scapula or neck.
  • In the 7 shoulder-pain patients, pain intensity was rated 3 to 6 on a 0 to 10 scale: three patients at 3, three at 4, and one at 6.
  • Five of the 7 shoulder-pain patients had reduced shoulder mobility, confirmed on physical examination.
  • Two of the 7 shoulder-pain patients had ulnar nerve neuralgia of the upper limb. In one of them, the medial and radial nerves were also involved.
  • One of the 7 shoulder-pain patients and 6 of the 42 reference-group patients were workers at the local asbestos-cement plant.
  • Cancer spread was found within a few months in all patients with shoulder pain.
  • Average survival from diagnosis in the shoulder-pain group was 25.4 months (range 12–48 months).
  • Average survival in the reference group of 42 patients was 15.4 months (range 3–48 months). No statistical comparison between the groups is reported.
  • The authors report no differences between patients with occupational and patients with environmental asbestos exposure. No statistical test is given.
• The authors' conclusion: The authors concluded that shoulder pain may be a presenting symptom of malignant pleural mesothelioma and should raise alertness to possible malignancy in the respiratory system, particularly in areas of known asbestos exposure.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Lung cancer, Mesothelioma.

Medical terms in this study, explained in our Lexicon: Pleural Mesothelioma, Pulmonology, Mesothelioma, Neoplasm.

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