Shoulder pain and Pancoast tumor: a diagnostic dilemma

Shoulder pain with radiation into the arm and hand in an ulnar nerve dermatomal pattern should be an indicator to the possible existence of a Pancoast tumor. The chiropractic physician should be aware of this malignant tumor and the characteristic clinical syndrome it produces. The physician should furthermore make every possible effort to include the apical region of the lung on any shoulder or cervical spine radiographs performed. By this careful technique and detailed interpretation of the films, the early and accurate diagnosis of a Pancoast tumor with appropriate referral can be made.