In this web we talk a lot about the herniated discs and the injuries that can produce in the nerves that go towards the arms. In some cases, the hernia is not to blame for the symptoms. One of these situations is what causes the Pancoast tumor.
Mr. Henry Pancoast studied and named the tumors that appeared in the apical area of the lungs (red area of the photo). The lungs have a triangle shape, so to speak, and there is a type of lung tumors that occur at the top apex of the triangle. Just above this zone pass the blood vessels and the nerves that go to the arms.
When we have a tumor of this type the initial symptoms are usually the shoulder pain that radiates through the arm, to the scapula and armpit or towards the neck. Irradiation by the arm is due to compression of the lower brachial plexus (corresponding to roots C8 and T1). Pain and sensitivity changes can occur on the 4th and 5th fingers (pinky and ring) and on the part of the forearm that continues with these fingers, even from the inside of the arm to the armpit. When affecting the motor nerves we can see a loss of muscle mass in the hand (the bones of the hand are very noticeable due to the atrophy of these muscles).
When speaking of a tumor in the lung one would think that the main symptoms would be the respiratory ones like the cough (with possible exit of blood) or the lack of air; but it does not. Being in the upper part of the lung, in a peripheral zone, it is unlikely to see these symptoms at the beginning of the disease.
There is a symptom that makes us suspect of this disease and is what we call Horner’s sign. It occurs in many of these patients because they compress the nerves of the sympathetic system. The top eyelid falls off and the pupil becomes small. In addition we no longer have sweat in this area of the face. It can also give pain in this region. These symptoms sometimes occur in the Pancoast tumor but are not exclusive to it. In fact, they are more common in spinal problems.
In general, shoulder pains that radiate to the neck or arm are very common and fortunately it is almost never a tumor of this type. That is why it can be difficult to suspect these tumors. When an atrophy of the muscles of the hand and Horner syndrome is added, it is easier to reach the diagnosis.
Once the tumor is suspected and detected, it is analyzed by a needle biopsy to make the diagnosis. The usual treatment of these tumors (if there is no metastasis) is chemotherapy and radiation therapy followed by resection with surgery.
From time to time I include on the web diseases of this type that are rare but share symptoms with habitual back and neck injuries. It is not with the intention to frighten but to emphasize the importance of a medical evaluation when we have a disease. It is up to the doctor to rule out these serious cases in his evaluation.