title: Metastatic gastric cancer presenting with shoulder-hand syndrome: a case report.
abstract: BACKGROUND
  Shoulder-hand syndrome is a relatively rare clinical entity classified as a complex regional pain syndrome type 1 and consisting essentially of a painful 'frozen shoulder' with disability, swelling, vasomotor or dystrophic changes in the homolateral hand. The pathophysiology is not completely clear but a predominant 'sympathetic' factor affecting the neural and vascular supply to the affected parts seems to be involved. Shoulder-hand syndrome has been related to many surgical, orthopedic, neurological and medical conditions; it is more often seen after myocardial infarction, hemiplegia and painful conditions of neck and shoulder, such as trauma, tumors, cervical discogenic or intraforaminal diseases and shoulder calcific tendinopathy, but has also been associated with herpetic infections, brain and lung tumors, thoracoplasty and drugs including phenobarbitone and isoniazid. The diagnosis of shoulder-hand syndrome is primarily clinical, but imaging studies, particularly bone scintigraphy, may be useful to exclude other disorders.
  
  
  METHODS
  We report the case of a 67-year-old woman who presented with shoulder-hand syndrome as the initial manifestation of gastric cancer which had metastasized to bone.
  
  
  CONCLUSIONS
  Wider investigations are advisable in patients with atypical shoulder-hand syndrome. To the best of the authors' knowledge this is the first case of shoulder-hand syndrome associated with metastatic gastric cancer.
authors.affiliation: Rheumatology Unit, IRCCS Humanitas Clinical Institute, University of Milan, Via Manzoni, 20089 Rozzano, Milan, Italy. marco.massarotti@humanitas.it
authors.forename: Marco
authors.initials: M
authors.lastname: Massarotti
authors.forename: Gianluigi
authors.initials: G
authors.lastname: Ciocia
authors.forename: Roberto
authors.initials: R
authors.lastname: Ceriani
authors.forename: Arturo
authors.initials: A
authors.lastname: Chiti
authors.forename: Bianca
authors.initials: B
authors.lastname: Marasini