How does the brain can cause "shoulder pain". The importance of history taking

This is an interesting case that was seen in the office. This patient was referred to "the shoulder surgeon" for shoulder pain. The patient reported pain to bilateral shoulders and occasional numbness and tingling to bilateral arms associated with headaches. She did not report the headaches. She was asked specifically for those as she thought that these are two problems - headache and shoulder pain-are not related. She had no neurologic deficits.

We thought at the first visit that the patient had signs of cervical radiculopathy a common cause of "shoulder pain", numbness and tingling and headaches. XRs of the cervical spine were negative.

We advised her for 4 weeks of physical therapy but she did not improve. For this reason we obtained an MRI of the c spine which at our surprise demonstrated an arachnoid cyst in the cerebellar area. After discussing the case with a neurosurgeon these cysts are benign but can explain the headaches and some neurologic symptoms.

We learn every day!