Shoulder ache or not…

A classmate of mine has recently passed away from a year’s battle with lung cancer.

We had been classmates for our first two years in class before he had to stop school due to his condition. He was one of those who sat right under the teacher’s nose and nothing seemed to faze him. He provided myself and a couple of “girls” at the back row some classroom entertainment as we gossip about his love interest. Life was all seemingly innocent.

But he had one nagging problem – a persistent shoulder ache. I recalled seeing him seek treatment from our instructor during one of our clinical practical sessions together. He had the usual management for shoulder ache – acupuncture, cupping or moxibustion. Apparently he had been going to different teachers with the same complaints. No one suspected anything, including me.

He had none of the classical presenting symptoms for lung cancer. He did not have shortness of breath, chest pain, hemoptysis, or anything to that matter. As far as I was concerned, I did not notice an appreciable weight loss in him. Hence, it really came as a huge shock when I heard of his diagnosis. By the time he was diagnosed, he was deemed inoperable and chemotherapy was his best and only option.

My work recently involves more lung treatment planning. One patient’s medical history stood out. His presenting symptom was also persistent shoulder pain without other accompanied signs and symptoms. He was diagnosed with Pancoast’s tumour. He had 20 pack years and had quitted smoking in 2002. My classmate was a smoker as well. Closer to home, my dad was one too. He himself had been smoke free since 2009.

I was alerted to the fact that a shoulder ache maybe more than it seems. However, before we run paranoid and go get a chest X-ray for a longer than usual shoulder pain, there are in fact many more causes of shoulder pain which we cannot ignore.

What is vital for me is that the next time I see another case of shoulder pain in the clinic, I hope to be reminded that besides the usual muscle pain or frozen shoulder, there are other underlying etiology that I have to rule out. It is far too common to conclude a shoulder ache as anything more than a muscle strain. As a TCM practitioner in future, it is my duty and my responsibility to advise patients of the need for other investigations when necessary. We can help raise the red flag too.

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