title: Thoracic disc herniation: a diagnostic challenge.
abstract: An unusual case of lower thoracic disc herniation combined with shoulder pain is presented in this case report, A literature search showed that shoulder pain associated with a lower thoracic disc herniation has not yet been reported. An acromioplasty for chronic impingement syndrome was performed to relieve the patient's shoulder symptoms. An unsatisfactory outcome plus a progressive but incomplete paraplegia, prompted further investigation and this revealed a low thoracic herniation. The nucleotomy which followed afterwards lead to a rapid improvement of both the shoulder symptoms and the incomplete paraplegia. This case report shows that chronic shoulder pain may be caused or exacerbated by a thoracic disc herniation in the low thoracic spine. Therefore, prior to performing surgery for peripheral joint symptomatology, the possibility of a central sensitising trigger should be excluded by physical examination of neural tissue dynamics as well as any other necessary confirmatory investigations.
authors.affiliation: Orthopädische Universitätsklinik Marburg, Germany.
authors.forename: A
authors.initials: A
authors.lastname: Wilke
authors.forename: U
authors.initials: U
authors.lastname: Wolf
authors.forename: P
authors.initials: P
authors.lastname: Lageard
authors.forename: P
authors.initials: P
authors.lastname: Griss
mesh_terms: D000328:Adult; D003937:Diagnosis, Differential; D003951:Diagnostic Errors; D005260:Female; D006801:Humans; D007405:Intervertebral Disc Displacement / Q000150:complications / Q000175:diagnosis*; D019534:Shoulder Impingement Syndrome / Q000175:diagnosis / Q000601:surgery; D020069:Shoulder Pain / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery; D013904:Thoracic Vertebrae