Extra-abdominal desmoid around the shoulder joint: one of the differential diagnoses of frozen shoulder

Diagnosis and treatment of extraabdominal desmoid fibromatosis

INTRODUCTION

The desmoid fibromatosis is a very rare connective tissue disease which is recognized as semimalignant. The aim of this work is to review the relevant literature and to analyze the management of our patient collective.

MATERIAL AND METHOD

Surgery was performed on 7 patients with extraabdominal desmoid fibromatosis between August 1998 and May 2007. MRI examination as well as biopsy was carried out in all cases. All patients were operated on; the mean follow up was 4 years (1-7). Upon follow up, every patient has undergone clinical and MRI examination.

RESULTS

The results show that we have achieved R0 resection in 4 cases and R1 in two cases and Rx in one case. In 4 patients, no recurrence was observed after the single surgery performed in our hospital. In 2 patients a single revision surgery was performed in each case and yielded no further recurrence. In only one case, multiple surgeries (one primary and two revision surgeries) were necessary, after which no recurrence was reported.

CONCLUSION

The early diagnosis of the disease is of utmost importance to the success of the outcome. MRI examination and biopsy are mandatory. Surgery is the therapy of choice. The recurrence rate is high and is linked to the difficulty of recognition of the exact infiltrative extent of the tumour. This necessitates a close follow-up.

Tumors masked as frozen shoulders: a retrospective analysis

BACKGROUND

It was reported that some shoulder tumors were misdiagnosed with frozen shoulder syndrome. The purposes of this study were to elucidate the incidence of the initial misdiagnosis with frozen shoulder syndrome among the patients with malignant shoulder tumors, and to clarify whether such initial misdiagnosis affected the time to make a final correct diagnosis or not.

METHODS

Clinical records of 34 patients (age>40) with malignant shoulder tumors and those of 505 patients (age>40) with shoulder pain and stiffness were reviewed in the author's institute. The duration of the prediagnostic period was compared between the patients with and without an initial misdiagnosis as frozen shoulder syndrome.

RESULTS

Among 34 tumor patients, 9 (26%) had been initially misdiagnosed with frozen shoulder syndrome. Two patients actually manifested shoulder pain and stiffness, although they did not have a record of misdiagnosis. Among 505 patients with shoulder pain and stiffness, 4 (0.8%) were diagnosed later as having malignant tumors. One of these 4 patients had been initially misdiagnosed with frozen shoulder syndrome. Consequently, 15 malignant tumors (10 bone tumors and 5 soft tissue sarcomas) were identified. Seven of them were intraosseous humeral tumors and 4 were localized in the scapular region, where patients themselves could not find them. In 10 patients, initial misdiagnosis as frozen shoulder syndrome did cause a significant delay to reach the correct diagnosis as malignant tumors (P=.035).

CONCLUSION

Physicians should carefully re-examine the frozen shoulder patients with repeated plain radiographs followed by further imaging studies, if the conservative therapy fails.