A Janitor With Elbow Pain?

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A Janitor With Elbow Pain? - Page #4

Working Diagnosis: Metastatic spinal cord compression (MSCC) of the cervical spine secondary to B-cell lymphoma Treatment: She underwent initial decompression, followed by a second surgery to address laxity with re-fixation. Outcome: After surgery, she had 5/5 strength. PET scan revealed potential primary site in the uterus. Gynecologic Oncology was consulted for further treatment. Author's Comments: Both primary and metastatic tumors can invade the epidural space and compress the thecal sac. The degree of compression will influence the degree of symptoms. Severe compression can be an oncologic emergency. Signs and symptoms of concerning presentations include sensory loss, difficulty walking, weakness, bowel or bladder dysfunction, thoracic or cervical pain, pain that is increased with straining, nocturnal pain. Editor's Comments: It is important to keep central nervous system pathologies in the differential diagnosis when there are symptoms equal bilaterally. While bilateral tendinopathies can occur, if the expected outcome does not occur after initial treatment, further exploration should be done. A thorough history and physical exam looking for signs of myelopathy, including balance issues and bowel and/or bladder incontinence, is key to assisting in the diagnosis. References: Lawton AJ, Lee KA, Cheville AL, et al. Assessment and Management of Patients With Metastatic Spinal Cord Compression: A Multidisciplinary Review. J Clin Oncol. 2019;37(1):61-71. doi:10.1200/JCO.2018.78.1211 Robson P. Metastatic spinal cord compression: a rare but important complication of cancer. Clin Med (Lond). 2014;14(5):542-545. doi:10.7861/clinmedicine.14-5-542 Return To The Case Studies List.		Back
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