title: Lung cancer metastasis to the scapula and spine: a case report.
abstract: BACKGROUND
  The objective of this case report is to describe the clinical presentation of a patient who complained of shoulder pain and was diagnosed with carcinoma of the scapula and spine that metastasized from the lung.
  
  
  METHODS
  A 76-year-old man without a history of cancer sought chiropractic care for right shoulder pain. Careful evaluation, radiographs, and subsequent imaging revealed primary and metastatic lung cancer. The patient was referred to his primary care physician for immediate medical care. Diagnostic images are included in this case to provide a comprehensive depiction of the scope of the patient's disease.
  
  
  CONCLUSIONS
  Musculoskeletal symptoms are commonly encountered in chiropractic practice. It is important to recognize that primary lung cancer may be unidentified, and musculoskeletal symptoms may reflect the first sign of primary or metastatic pulmonary disease. Thoughtful evaluative procedure and clinical decision making, combined with the use of appropriate diagnostic tests may allow timely identification of primary or metastatic disease.
authors.affiliation: New York Chiropractic College, Seneca Falls, NY, USA. jdemetrdc@aol.com
authors.forename: James
authors.initials: J
authors.lastname: Demetrious
authors.forename: Gregory J
authors.initials: GJ
authors.lastname: Demetrious