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Noticed Painful Lump On Left Acromion. Hurts To Move Arm. Linear Ultrasound Transducer Done. Prognosis?
Question: I am a 22 year old female with a painful, palpable lump on the posterolateral aspect of my left acromion. I first noticed pain in the area at least 3-4 weeks ago when leaning against the corner of a wall (the significant ache made me jerk away in surprise). Even though I could recall no injury, I supposed it might be a non-visible, residual bruise. It is still causing me consistent aching pain on palpation, and occasionally when I move my arm. I can now associate it with a lump/contour change in the surface if the bone that is approximately the size of my thumb print (that may have been there all along, but I only paid attention recently when I decided it had been an adequate amount of time for a bruise to resolve).
I took a quick look with a 15MhZ linear ultrasound transducer (I'm a sonographer), and see that there is a hypoechoic area below and distorting the bone surface that corresponds to the palpable lump. My question is, in the absence of a definable injury, what is the differential?
I took a quick look with a 15MhZ linear ultrasound transducer (I'm a sonographer), and see that there is a hypoechoic area below and distorting the bone surface that corresponds to the palpable lump. My question is, in the absence of a definable injury, what is the differential?
Dear friend, welcome and thanks for entrusting your query here at Healthcaremagic!
I am Dr. Prasad Akole (Critical Care Expert- http://bit.ly/Dr-Prasad-Akole) and am glad to address to your query here.
You have a good description here! Do you mean you see something within the bone with your USG probe? Or is it the soft tissue lesion below the acromion?
Is it smooth contoured or has irregular contour?
IS it below the articular/ cortical bone surface or in the soft tissue or in the acroio-clavicular joint space?
Such slow growing lesions, if in the bone, which are now paining and causing any bruising (and no history of trauma) could be bone cysts (if smooth cystic) or tumours (benign or malignant).
If you feel it is not within the bone, it may be a joint cyst, bursa or connective tissue tumour/ collection.
Did you have any fever, reduced range of arm movement?
Any discoloration, bruising of the overlying skin?
Are there any dilated veins around the area affected?
IS the lump warmer and swollen?
Rarely bone infections may present like this, but there will be fever.
Osteolytic lesions may be secondary to many systemic diseases affecting bone/ mineral metabolism.
Please answer these and describe any other problem that you may now feel you have in detail.
I would be more specific in my answer then.
I would advise you to take an orthopedic opinion and get fully evaluated with a Xray. An MRI may be advised. Further evaluation will be guided by these findings.
You can take a simple pain killer like acetaminophen till then.
I would be glad to answer any further queries.
Take care and please keep me informed of your progress at http://bit.ly/Dr-Prasad-Akole
Good Luck! Thank you!!
I am Dr. Prasad Akole (Critical Care Expert- http://bit.ly/Dr-Prasad-Akole) and am glad to address to your query here.
You have a good description here! Do you mean you see something within the bone with your USG probe? Or is it the soft tissue lesion below the acromion?
Is it smooth contoured or has irregular contour?
IS it below the articular/ cortical bone surface or in the soft tissue or in the acroio-clavicular joint space?
Such slow growing lesions, if in the bone, which are now paining and causing any bruising (and no history of trauma) could be bone cysts (if smooth cystic) or tumours (benign or malignant).
If you feel it is not within the bone, it may be a joint cyst, bursa or connective tissue tumour/ collection.
Did you have any fever, reduced range of arm movement?
Any discoloration, bruising of the overlying skin?
Are there any dilated veins around the area affected?
IS the lump warmer and swollen?
Rarely bone infections may present like this, but there will be fever.
Osteolytic lesions may be secondary to many systemic diseases affecting bone/ mineral metabolism.
Please answer these and describe any other problem that you may now feel you have in detail.
I would be more specific in my answer then.
I would advise you to take an orthopedic opinion and get fully evaluated with a Xray. An MRI may be advised. Further evaluation will be guided by these findings.
You can take a simple pain killer like acetaminophen till then.
I would be glad to answer any further queries.
Take care and please keep me informed of your progress at http://bit.ly/Dr-Prasad-Akole
Good Luck! Thank you!!
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
The lesion appears to be within the bone; it is not in the soft tissue around the bone. Due to location and technical scanning characteristics of the region, I can't determine whether the lesion is cystic or just hypoechoic. It has a smooth contour, and is not within a joint or deep to any of the acromion's articular surfaces. It has not caused a decreased range of motion. I have had not fever and never noticed a bruise in the area, nor has there been redness, swelling, venous dilatation, or warmth.
Thanks for the details.
So, it is clearly a bony lesion. Less likely to be an infection or a bursa.
My previous advice remains the same.
You should get evaluated by an orthopaedic expert, do an Xray of the affected area and if also felt appropriate by the ortho expert, a MRI of the shoulder may be advised.
That will characterize the lesion and then we can work up the differentials among cystic bone lesion, tumour or systemic bone affecting diseases /osteoclastic lesions etc.
Sometime a biopsy is needed.
Let us see first what xrays show.
If there is a definite lesion, I would advise routine basic labs.
I hope to have answered your query satisfactorily. I would be glad to answer any further queries. Please ask for any clarifications before closing and rating this query.
Please keep me informed of your progress at http://bit.ly/Dr-Prasad-Akole
All the best !!
So, it is clearly a bony lesion. Less likely to be an infection or a bursa.
My previous advice remains the same.
You should get evaluated by an orthopaedic expert, do an Xray of the affected area and if also felt appropriate by the ortho expert, a MRI of the shoulder may be advised.
That will characterize the lesion and then we can work up the differentials among cystic bone lesion, tumour or systemic bone affecting diseases /osteoclastic lesions etc.
Sometime a biopsy is needed.
Let us see first what xrays show.
If there is a definite lesion, I would advise routine basic labs.
I hope to have answered your query satisfactorily. I would be glad to answer any further queries. Please ask for any clarifications before closing and rating this query.
Please keep me informed of your progress at http://bit.ly/Dr-Prasad-Akole
All the best !!
Note: For further queries, consult a joint and bone specialist, an Orthopaedic surgeon. Book a Call now.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Answered by
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