When a patient complains about these kind of symptoms the osteopath should consider the possibility of a Pancoast tumor. A Pancoast tumor is an extrathoracic tumor of the lung, plaque-like, located in the upper apex of either lung usually found in smokers. It is the location of the tumor and not the pathophysiological changes in the lung tissue that result in the symptom picture, and so one rarely sees respiratory symptoms with this condition. The symptoms that do present are the result of the tumor invading adjoining tissue in the confines of the thoracic inlet compressing intercostal nerves, the lower roots of the brachial plexus, the stellate ganglion and the sympathetic chain.
Patients with a Pancoast tumor will most likely complain to the osteopath about shoulder pain and pain radiating down the medial border of the scapula, not an uncommon complaint in any osteopathic clinic! The invasion of the tumor into the lower roots of the brachial plexus (C8) and upper thoracic trunk (T1, T2), may also result in pain radiating down the ulnar border of the arm from the elbow (T1) and ultimately to the ulnar surface of the forearm to the small and ring fingers of the hand (C8).
The osteopath should examine the patient's hand muscles checking for weakness and atrophy. Reflexes may show a reduced or absent triceps reflex on the affected side (C7). Since the tumor may also involve the cervical sympathetic ganglion and stellate ganglion, sympathetic involvement leads to ispilateral Horner's syndrome (hemianhydrosis, enophthalmos, ptosis and miosis) on the affected side of the face. If the tumor invades the recurrent laryngeal nerve there may be hoarsness and a bovine cough associated with the symptoms.
The patient is often in extreme pain with postural change creating little relief. The patient may tell the osteopath that supporting the elbow of the painful arm with the unaffected hand in order to take the tension off the painful area is the only position that brings relief. The patient will most likely be taking narcotics.
The overlap of symptoms between Pancoast tumor and musculo-skeletal symptoms should now be evident to the osteopath. However, unlike an ordinary neck-shoulder condition or nerve root compression the osteopath may discover on questioning that the patient also experiences malaise, fever, weight loss and fatigue emphasising the importance of a comprehensive osteopathic case history.
A Pancoast tumor is just one example of a life-threatening pathalogical condition that mimics a musculo-skeletal one. The osteopath needs to be fully aware of these conditions in order not to make the mistake of treating the condition and potentially delaying the appropriate treatment
http://www.osteopath.co.il/
No comments:
Post a Comment