Schwannoma: A Rare Etiology of Pancoast Syndrome

Musculoskeletal disorders represent a major public health problem and they are frequently managed in primary care centers. Shoulder pain is a frequent musculoskeletal complaint and it can result from intrinsic disorders of the shoulder or referred pain. We present the case of a 24-year-old woman who presented to the family medicine clinic complaining of left shoulder pain for three months duration. The pain was not associated with numbness or weakness. There was no history of preceding trauma. The initial diagnosis was supraspinatus tendinosis. The patient was prescribed oral analgesics and was advised to undergo multiple physiotherapy sessions. Later, the patient presented to the clinic again and reported she did not have any improvement in her symptoms. The patient was referred to the orthopedic clinic for further evaluation and management. The patient underwent a frontal radiograph of the chest which demonstrated a well-defined opacity located in the apex of the left lung. A computed tomography scan of the chest demonstrated the presence of erosion to the vertebral body raising the suspicion for a neurogenic tumor as was later supported by magnetic resonance imaging. The patient underwent video-assisted thoracotomy with brachial plexus exploration. Complete resection of the tumor was achieved with no complications. The present case highlights those common musculoskeletal complaints, such as shoulder pain, which could indicate underlying non-orthopedic pathology.