An Elderly Woman With Persistent Arm Pain

Introduction. A 79-year-old, right-handed woman presented to her primary care physician’s office with no prior hospitalizations for persistent right arm pain associated with a right antecubital mass.

History. The patient’s past medical history includes hypertension, chronic obstructive pulmonary disease (COPD), generalized osteoarthritis, and total left hip arthroplasty. The patient attributed her pain to crocheting, which she planned on continuing. She denied any trauma, muscle weakness, numbness, or tingling. She endorsed generalized myalgias and arthralgias secondary to her generalized arthritis. Her right upper extremity examination had a 2 cm soft mass in the medial aspect of the antecubital fossa. Her upper extremity strength was 5/5. She had full range of motion actively and passively. Her upper extremity reflexes were 2+ (normal response) and sensation was intact to light touch.

Diagnostic testing. Radiograph and magnetic resonance imaging (MRI) images of the right upper extremity were obtained (Figures 1-4).


Fig. 1. Anterior posterior radiograph of the right shoulder indicates radiopaque lesion of proximal humerus.

Fig. 2. An axial T1 MRI indicating rings and arcs type lesion in proximal humerus is shown.

Fig. 3. A coronal T2 MRI showing lesion right proximal humerus in rings and arcs pattern.

Fig. 4. A coronal T1 MRI showing lesion of the right proximal humerus.