Turkish Journal of Physical Medicine and Rehabilitation 2007 , Vol 53 , Num 3
A Rare Cause of Shoulder Pain: Radiation Induced Plexopathy: A Case Report
Derya Demirbağ Kabayel 1 ,Ferda Özdemir 2 ,Ercüment Ünlü 3 ,Kemal Balcı 2 ,Nilgün Bilgili 2
1 Derya Demirbağ Kabayel; Trakya Üniversitesi Tıp Fakültesi, Fiziksel Tıp ve Rehabilitasyon Anabilim Dalı, Edirne
2 Trakya Üniversitesi Tıp Fakültesi, Fiziksel Tıp ve Rehabilitasyon Anabilim Dalı, Edirne
3 Trakya Üniversitesi Tıp Fakültesi Fiziksel Tıp ve Rehabilitasyon Radyoloji Anabilim Dalı, Edirne

Brachial plexopathy (BP) is a rare cause of the shoulder pain. The radiation-induced brachial plexopathy that it is a type of BP may be occured after supraclavicular and upper thoracal region irradiation. We describe a unique case with right shoulder pain of the RP that occurred after treated for carcinoma of the breast. A 48-year-old woman has right shoulder pain and weakness. The breast canser patient who diagnosed four years ago was treated with postoperative radiation therapy for five weeks after radical mastectomy by a standardized. At physical examination manual assessment of shoulder muscle strength was found 2/5. Pain measured by the Visual Analog Scale (VAS) value was 9. Electromyographic study and magnetic resonance imaging (MRI) revealed BP. In this case, MRI could not distinguish between a delayed radiation injury and tumor infiltration. The diagnosis was clarified with an PET and tumor infiltration was not detected. The VAS value improved from 9 before the medical treatment to 3 after gabapentin and amitriptilin treatment. The risk of BP after supraclavicular lymph node irradiation in breast cancer patients with shoulder pain remains constant for a considerable portion of the patient's life. Gabapentin and amitriptilin were a really useful treatment of pain due to BP. 

Keywords : Shoulder pain, brachial plexopathy, radiation therapy, gabapentin, amitriptili