Shoulder pain in a patient with renal cell carcinoma? Suprascapular neuropathy caused by bone metastasis of renal cell carcinoma: A case report

Background: Pain management is crucial in palliative care for patients with advanced cancer. Here, we report a case of shoulder pain in a patient with renal cell carcinoma. Case presentation: A 36-year-old male diagnosed metastatic renal cell carcinoma presented with pain and weakness on left shoulder for more than 6 months. Physical examination showed limited range of motion and atrophic changes on supraspinatus and infraspinatus muscles. Weakness in shoulder abduction and external rotation was also noted. Possible courses of action: In this case, suprascapular neuropathy, adhesive capsulitis of shoulder and metastatic lesions involving shoulder joint were suspected. Formulation of a plan: We planned imaging studies including X-ray, bone scan, magnetic resonance imaging, and electrodiagnostic studies. Outcome: Imaging and electrodiagnostic studies showed suprascapular neuropathy by bone metastasis. Conservative treatment including injection and rehabilitation therapy reduced the patient's pain and improved the range of motion limitation. Lessons from the case: Clinicians should be aware that bone metastasis in patients with advanced cancer can cause suprascapular neuropathy, shoulder pain and shoulder dysfunction. View on research problems, objectives, or questions generated by the case: More research is expected on development of an early surveillance model, barriers to cancer pain management, communication from patients' perspectives.