Houston Methodist. Leading Medicine

Shoulder FAQ

Question:

Our son came back from Iraq pretty banged up and in the hospital for months. Now that he is home and continuing rehabilitation, he's been complaining of arm pain but says i'ts also numb and he can't move it. The doctor is calling it a "conversion syndrome" (a physical manifestation of emotions). We don't agree. How do we get a proper diagnosis?

Answer:

It's possible there are some additional undiagnosed or undetected problems here. The first thing that comes to mind is the possibility of a scapular (shoulder blade) fracture. Scapular fractures are rare but we are seeing more and more unusual and rare injuries among our veterans who have had traumatic injuries. A traumatic force strong enough to break the scapula usually also causes other serious injuries. There can be head, neck, arm, chest, rib and even pelvic injuries along with the scapular fracture. These other injuries tend to be more life-threatening and receive immediate medical attention (as they should). This can leave some of the other more "minor" injuries undetected until much later. Many times the scapular fractures are missed because the bone is well-covered by surrounding soft-tissues. It isn't until the patient is out of the intensive care unit (ICU) that symptoms of neck, back or arm pain, along with numbness and tingling in the arm alert the physician to yet another problem. Loss of control over the shoulder and what feels like paralysis (called pseudoparalysis can be mistaken for conversion symptoms. X-rays and three-dimensional CT (3D-CT) scans are needed to make a clear and accurate diagnosis. The imaging studies mentioned (especially 3-D CT scans) show if there is a fracture and the extent of any bony damage. Scapular fractures can extend into the shoulder joint affecting motion and function. CT scans also show if the bony displacement has changed the angles, shortened the bone or caused other deformities. These are key features that can alter shoulder function and point to the need for surgical intervention. Peter A. Cole, MD, et al. Management of Scapular Fractures. In Journal of the American Academy of Orthopaedic Surgeons. March 2012. Vol. 20. No. 3. Pp. 130-141.

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