Metastatic renal cell carcinoma presenting as shoulder arthritis

Three patients with previously undiagnosed renal cell carcinoma presented with complaints of shoulder pain secondary to tumor metastases involving the clavicle or upper humerus. In two patients, bone scintigraphy and/or gallium scintigraphy demonstrated the primary renal lesion. One patient had been treated with anti-inflammatory drugs and intra-articular steroid injections for presumed arthritis before the cause of the symptoms was recognized. Review of the literature reveals that renal cell carcinoma frequently metastasizes to bones of the shoulder girdle, and that presenting complaints may relate to osseous metastases. Careful evaluation should be carried out before patients with shoulder pain are treated for presumed arthritis.