title: Referred shoulder pain from ventriculoperitoneal shunts. Report of three cases.
abstract: The authors report on three pediatric patients with ventriculoperitoneal (VP) shunts who presented with chronic right shoulder pain. Imaging revealed that the distal peritoneal catheter was positioned between the right hemidiaphragm and liver. Following surgical repositioning of the distal tubing, all patients experienced resolution of their shoulder pain, which has not recurred. Although seemingly rare, referred shoulder pain from a VP shunt should be added to the list of complications seen with this method of cerebrospinal fluid diversion. The clinician who cares for patients with VP shunts may wish to evaluate cases of shoulder pain without obvious neural or musculoskeletal cause by performing imaging of the distal shunt tubing.
authors.affiliation: Department of Cell Biology, Section of Pediatric Neurosurgery, University of Alabama at Birmingham, USA. richard.tubbs@uab.edu
authors.forename: R Shane
authors.initials: RS
authors.lastname: Tubbs
authors.forename: John C
authors.initials: JC
authors.lastname: Wellons
authors.forename: Jeffrey P
authors.initials: JP
authors.lastname: Blount
authors.forename: Paul A
authors.initials: PA
authors.lastname: Grabb
authors.forename: W Jerry
authors.initials: WJ
authors.lastname: Oakes
mesh_terms: D034841:Abdominal Cavity / Q000000981:diagnostic imaging; D000293:Adolescent; D002543:Cerebral Hemorrhage / Q000150:complications; D002648:Child; D004868:Equipment Failure; D005260:Female; D006801:Humans; D006849:Hydrocephalus / Q000601:surgery*; D008297:Male; D010147:Pain Measurement; D010388:Pelvis / Q000000981:diagnostic imaging; D011859:Radiography; D012008:Recurrence; D012086:Reoperation; D012720:Severity of Illness Index; D020069:Shoulder Pain / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology; D017287:Ventriculoperitoneal Shunt / Q000009:adverse effects*