title: Scapulothoracic bursitis as a significant cause of breast and chest wall pain: underrecognized and undertreated.
abstract: OBJECTIVE
  Pain is one of the most commonly reported breast complaints. Referred pain from inflammation of the shoulder bursa is often overlooked as a cause of breast pain. The objective of this study is to evaluate the role of shoulder bursitis as a cause of breast/chest pain.
  
  
  METHODS
  An IRB-approved retrospective review from July 2005 to September 2009 identified 461 patients presenting with breast/chest pain. Cases identified with a trigger point in the medial aspect of the ipsilateral scapula were treated with a bursitis injection at the point of maximum tenderness. The bursitis injection contains a mixture of local anesthetic and corticosteroid. Presenting complaint, clinical response and associated factors were recorded and treated with descriptive statistics.
  
  
  RESULTS
  Average age of the study group was 53.4 ± 12.7 years, and average BMI was 30.4 ± 7.4. One hundred and three patients were diagnosed with shoulder bursitis as the cause of breast pain and received the bursitis injection. Most cases (81/103 or 78.6%) presented with the breast/chest as the site of most significant discomfort, where 8.7% (9/103) had the most severe pain at the shoulder, 3.9% (4/103) at the axilla and 3.9% (4/103) at the medial scapular border. Of the treated patients, 83.5% (86/103) had complete relief of the pain, 12.6% (13/103) had improvement of symptoms with some degree of residual pain, and only 3.9%(4/103) did not respond at all to the treatment. The most commonly associated factor to the diagnosis of bursitis was the history of a previous mastectomy, present in 27.2% (28/103) of the cases.
  
  
  CONCLUSIONS
  Shoulder bursitis represents a significant cause of breast/chest pain (22.3% or 103/461) and can be successfully treated with a local injection at site of maximum tenderness in the medial scapular border.
authors.affiliation: Division of Breast Surgical Oncology, Department of Surgery, University of Arkansas for Medical Sciences and the Winthrop P. Rockefeller Cancer Institute, Little Rock, AR, USA. cboneti@uams.edu
authors.forename: Cristiano
authors.initials: C
authors.lastname: Boneti
authors.forename: Candy
authors.initials: C
authors.lastname: Arentz
authors.forename: V Suzanne
authors.initials: VS
authors.lastname: Klimberg
mesh_terms: D000700:Analgesics / Q000008:administration & dosage; D001941:Breast Diseases / Q000188:drug therapy / Q000209:etiology*; D002062:Bursitis / Q000150:complications* / Q000188:drug therapy; D002637:Chest Pain / Q000188:drug therapy / Q000209:etiology*; D005260:Female; D006801:Humans; D007273:Injections, Intramuscular; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D012540:Scapula; D020069:Shoulder Pain / Q000188:drug therapy / Q000209:etiology*
chemical_list: D000700:Analgesics