The Shoulder

Shoulder Girdle

Lesions of the lungtop

recurrens nerve
scalenus anterior muscle
lungtop
sternoclavicular joint
first rib and costoclavicular ligament

Symptoms

Bronchus cancers of the lungtop are relatively rare.
Because these apical tumours quickly involve the sub- and retroclavicular area, the brachial plexus and the sympathic ganglia at the base of the neck, musculoskeletal pain and neuromuscular symptoms arise usually quicker than pulmonary symptoms.

Clinical Findings

Symptoms and signs of an apical tumour are usually called the "Pancoast syndrome".

Pain and limitation of movements of cervical spine, shoulder girdle and arm. Passive and resisted movements of the cervical spine may be limited and / or painful. This is caused by the involvement of the scaleni and sternocleidomastoideus muscles.
Movements of shoulder girdle are painful and/ or limited.
The active and passive elevation of the arm is limited due to spasm of the pectoralis major muscle.
There is weakness of arm and hand muscles due to the involvement of the brachialis plexus.
Horner's syndrome (ipsilateral ptosis of the upper eyelid, myosis of the pupil and enophtalmos of the eye) due to involvement of sympathetic ganglia.
Hoarseness resulting from the involvement of the recurrent laryngeal nerve.

Main Menu / Preliminary Examination / Interpretation of the preliminary examination / Pathology