Granulocytic sarcoma – An unusual cause of shoulder pain

Abstract

This case highlights the difficulty that clinicians face in trying to identify the relevant clinical facts when patients present with complex conditions. A 53 year old woman was referred to an orthopaedic management service in November 2003 with left-sided shoulder and thumb pain. On initial presentation, she displayed many clinical features consistent with a mechanical shoulder problem. However, her previous medical history of acute myeloid leukaemia could not be ignored. Investigations revealed a granulocytic sarcoma arising in the cervical spinal canal and extending to the paraspinal tissues adjacent to the C5 and C6 vertebrae.

This case highlights the importance for physiotherapists of relying on their own clinical reasoning skills and illustrates the challenge they face when working in extended roles of practice, when presented with ‘Red Flags’.

Key Words:

• red flags
• spinal pathology
• granulocytic sarcoma
• brachial plexus