Scapulothoracic Bursitis as a Significant Cause of Breast and Chest Wall Pain: Underrecognized and Undertreated
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Pain is one of the most commonly reported breast complaints. Referred pain from inflammation of the shoulder bursa is often overlooked as a cause of breast pain. The objective of this study is to evaluate the role of shoulder bursitis as a cause of breast/chest pain.
An IRB-approved retrospective review from July 2005 to September 2009 identified 461 patients presenting with breast/chest pain. Cases identified with a trigger point in the medial aspect of the ipsilateral scapula were treated with a bursitis injection at the point of maximum tenderness. The bursitis injection contains a mixture of local anesthetic and corticosteroid. Presenting complaint, clinical response and associated factors were recorded and treated with descriptive statistics.
Average age of the study group was 53.4 ± 12.7 years, and average BMI was 30.4 ± 7.4. One hundred and three patients were diagnosed with shoulder bursitis as the cause of breast pain and received the bursitis injection. Most cases (81/103 or 78.6%) presented with the breast/chest as the site of most significant discomfort, where 8.7% (9/103) had the most severe pain at the shoulder, 3.9% (4/103) at the axilla and 3.9% (4/103) at the medial scapular border. Of the treated patients, 83.5% (86/103) had complete relief of the pain, 12.6% (13/103) had improvement of symptoms with some degree of residual pain, and only 3.9%(4/103) did not respond at all to the treatment. The most commonly associated factor to the diagnosis of bursitis was the history of a previous mastectomy, present in 27.2% (28/103) of the cases.
Shoulder bursitis represents a significant cause of breast/chest pain (22.3% or 103/461) and can be successfully treated with a local injection at site of maximum tenderness in the medial scapular border.
KeywordsBursitis Complete Relief Intercostal Nerve Breast Pain Serratus Anterior Muscle
- 8.Hockenberry MJ, Wilson D, Winkelstein ML. Wong’s essentials of pediatric nursing, 7th ed. St. Louis, MO: Mosby; 2005. p. 1259.Google Scholar
- 10.Della Valle CJ, Rokito AS, Birdzell MG, Zuckerman JD. Biomechanics of the shoulder. In: Norkin M, Frankel, VH, editors. Basic biomechanics of the musculoskeletal system. Philadelphia: Lippincott Williams & Wilkins; 2001. p. 318–39.Google Scholar
- 13.Chen B, Stitik TP, Foye PM. Spinal injection procedures. In: DeLisa JA, Gans BM, Walsh ME, Bockeneck WL, Frontera WR, editors. Physical medicine and rehabilitation: principles and practice, 4th ed. Philadelphia: Lippincott, Williams, & Wilkins; 2005. p. 369–87.Google Scholar
- 14.Lehtinen JT, Macy JC, Cassinelli E, Warner JJ. The painful scapulothoracic articulation: surgical management. Clin Orthop Relat Res. 2004; (Jun):99–105.Google Scholar