Disclosures: Naveen Singh Khokhar, DO: Nothing to disclose

Case Description: The patient presented with hemoptysis, headaches, and ataxia to the emergency room. CT head demonstrated a right parafalcine mass consistent with bronchogenic carcinoma. Neurosurgery were consulted and the patient underwent a hemicraniotomy. Pathology was consistent with metastatic squamous cell carcinoma with primary lung tumor. On admission to Rehab, patient was noted to have left lower extremity weakness secondary to tumor resection. Much of his therapies were limited due to chronic left shoulder pain. The patient believed this was a chronic injury that he suffered with no prior investigation. X-ray of the shoulder demonstrated mild degenerative joint disease. The patient was provided with an Omotrain brace, underwent therapeutic ultrasound, and was prescribed a TENs unit. Plan was for lidocaine injection.

Setting: Inpatient Rehabilitation Center

Patient: A 73-year-old male with metastatic squamous cell carcinoma.

Assessment/Results: Ultrasound of the shoulder demonstrated a full-thickness tear of the left supraspinatus muscle, AC joint arthrosis, and a large hypoechoic region inferior to the glenohumeral joint. Differential included muscular tear, large labral cyst, or other cystic lesion. Lidocaine injection was deferred until further evaluation of cystic lesion. Subsequent PET scan to delineate cancer progression demonstrated a large lesion at the left scapular glenoid with prominent soft tissue and destructive component.

Discussion: Diagnostic ultrasound can be performed for dynamic visualization of anatomy for both diagnostic accuracy and planning for therapeutic intervention. This is beneficial in cases with possible variant anatomy to optimize safety and appropriate localization of injections. Musculoskeletal anatomical variants are commonly featured in patients with metastatic disease.

Conclusion: Metastatic disease is an unpredictable process in terms of tumor spread and seeding. Diagnostic ultrasound should be considered in patients presenting with chronic musculoskeletal complaints with history of metastatic cancer. Incorporating this can ensure safety with injection administration in such cases to avoid risk of promoting pathological fractures.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/change-in-musculoskeletal-treatment-based-on-ultrasound-findings-of-a-metastatic-tumor-a-case-report/