Shoulder Pain - Heavy Lifting

HISTORY: 29-year-old female who presented to the clinic for evaluation of left shoulder pain. Patient reports the pain began while performing yardwork 1 month ago and during increased physical activity assisting her husband after he had surgery 3 months prior. She reports stabbing and sharp pain that is worse with activity, specifically twisting and lifting motions. She also endorses decreased range of motion, grinding, and morning stiffness in the left shoulder. Patient has not had any formal treatment. PHYSICAL EXAMINATION: Positive tenderness to palpation of: left proximal biceps tendon, biceps muscle belly, AC joint, and SC joint. Decreased range of motion in forward flexion, abduction, and posterior internal rotation of the left shoulder with 3+/5 strength in all planes of range of motion. Notable positives: Neer, Hawkins, Cross body, Lift off, Empty can, Speeds, and Obrien tests. DIFFERENTIAL DIAGNOSIS: Giant cell tumor, Ewings sarcoma, Osteolytic osteosarcoma, Nonossifying fibroma Enchondroma TEST AND RESULTS:X-ray 4 views of left shoulder: Lucent lesion in left humeral head. Old cortical fracture inferiorly of the humeral head. Lucent lesion does not appear expansile in nature. MRI Shoulder Joint wo Contrast Left: Relatively long segment lytic lesion of the proximal humerus from physis through the proximal diametaphysis. Some cortical breakthrough and likely small soft tissue component posteriorly at the distal aspect of the lesion in the region of the overlying long head of the triceps. Slightly enlarged single right axillary lymph node measuring up to 1.3 cm short axis. This is suspicious given the bone lesion. Likely subacute nondisplaced pathologic fracture through the humeral lesion mentioned in 1 above. CT Chest w/contrast: Indeterminate and nonspecific pulmonary nodules measuring up to 5 mm. Unchanged asymmetrically prominent left axillary/retropectoral lymph nodes of doubtful clinical significance. Path report: Giant cell tumor of bone FINAL WORKING DIAGNOSIS: Giant cell tumor of left proximal humerus TREATMENT AND OUTCOMES: Tertiary care center orthopedic oncology referral. Surgery: Left proximal humerus curettage and bone and bone grafting. Surveillance of the lung nodules. Aspirin and acetaminophen for pain PRN. Sling for comfort. HEP, deferred formal PT. Post-op x-rays.