Cervical Syrinx as a Cause of Shoulder Pain in 2 Athletes

Abstract

The orthopaedic surgeon can be the first specialist to diagnose a neurologic, Many neurologic conditions are first seen with musculoskeletal symptoms. 6,29 The syringomyelic cavity, or syrinx, is formed by a disturbance in the normal cerebral spinal fluid (CSF) flow. The purpose of this communication is to describe the presentation of a syrinx in an athlete and review the presentation, diagnosis, and treatment of syringomyelia for the practicing orthopaedic clinician. A discussion of the pathophysiology behind syrinx development is complex and well debated and, therefore, beyond the scope of this article. The interested reader is referred to a recent review by Greitz. 11 CASE REPORTS Case 1 An 18-year-old, left-hand-dominant, male high school baseball pitcher was seen with arm fatigue and loss of pitch accuracy and velocity. Four months before presentation, he experienced an acute onset of a sharp pain in his left rib cage, which then radiated to his left shoulder and upper extremity while pitching. The patient tolerated the pain for 1 month until he developed changes in pain and temperature sensation in the left upper extremity, highlighted by the patient's description of noting a difference in water temperature from arm to arm while showering. He denied swelling in the extremity, tingling sensations, and nocturnal pain. His medical history included hyperthyroidism. On physical examination, his shoulders were well developed and symmetric, demonstrating full range of motion (ROM) bilaterally with no evidence of scapulothoracic dyskinesis, instability, or labral, acromioclavicular, or rotator cuff abnormalities. There was full ROM of his neck with no tenderness to palpation and a negative Spurling test finding. Manual muscle testing results were normal. Reflexes were brisk, yet symmetric bilaterally, and Hoffman sign results were negative. The examination was notable for only decreased sensation to light touch throughout the entire left upper extremity. Radiograph findings of the neck and shoulder were normal. A cervical spine magnetic resonance imaging (MRI) scan was recommended because of his vague complaints and minor neurologic findings. The MRI demonstrated a Chiari I malformation with a large cystic fluid collection within the spinal cord consistent with a syrin