913 - Pancoast Tumor Presenting with Focal Scapular Pain and Thoracic Radiculopathy: A Case Report

Thursday, February 19, 2026

5:00 PM - 6:30 PM AST

Co-Author(s)

BG

Brian Gu, BA

Medical Student
University of Iowa Carver College of Medicine
West Des Moines, Iowa, United States
SG

Samuel Gay, MD

Resident Physician
Iowa Methodist Medical Center
Des Moines, Iowa, United States
DR

Danielle Rehor, MD

Resident Physician
Iowa Methodist Medical Center / Mayo Clinic PM&R
Waukee, Iowa, United States

Presenting Author(s)

PS

Patrick Shaeffer, MD

Associate Chief of Staff of Education / Adjunct Assistant Professor
Central Iowa VA / University of Iowa Carver College of Medicine
Des Moines, Iowa, United States

Submitter(s)

BG

Brian Gu, BA

Medical Student
University of Iowa Carver College of Medicine
West Des Moines, Iowa, United States

Case Diagnosis: Thoracic radiculopathy in the setting of left lung Pancoast tumor.

Case Description: A 66-year-old male with history of tobacco use disorder presented to a musculoskeletal physiatry clinic for consideration of trigger point injection. He noted eight months of left scapular pain occasionally radiating to medial elbow and ribs, as well as 10-pound weight loss over the past year but had gained back a few pounds recently. He had no relief with physical therapy, oral/topical medications, or chiropractic care. Recent cervical spine MRI and low-dose CT screening for lung cancer were unremarkable. On exam, pain was reproduced on palpation over infraspinatus. Ultrasound-guided infraspinatus trigger point injection with lidocaine provided no relief. Pain quickly evolved to radiating paresthesias to axilla and left-sided chest wall. Electromyography showed complex repetitive discharges in the upper thoracic paraspinals, suggesting thoracic radiculopathy. Thoracic MRI revealed left lung apex tumor invading left T2-3 neuroforamen. He was referred for biopsy which revealed adenocarcinoma, then referred to oncology for chemotherapy and radiation.

Discussions: Shoulder and elbow pain is a reported association of superior sulcus or Pancoast tumors. However, this generally arises with tumors at the T1 level or above and is associated with brachial plexus invasion and symptomology of Horner's syndrome. This patient lacked these symptoms, but had axilla and chest wall pain, consistent with a T2-3 dermatomal presentation. From our literature search, there has been only one previously reported case of Pancoast tumor causing thoracic radiculopathy.

Conclusions: In p</span>atients evaluated for musculoskeletal complaints, atypical presentations, alarm symptoms, and lack of improvement with conservative interventions should prompt broader workup of secondary causes. This case highlights the need for physiatrists to consider malignancy in the differential when managing complex cases of pain. It also contributes further evidence that Pancoast tumors can cause thoracic radiculopathy.