Sharp pain in shoulder HIV

by Nathan Wei, MD, FACP, FACR

Nathan Wei is a nationally known board-certified rheumatologist and author of the Second Opinion Arthritis Treatment Kit. It's available exclusively at this website... not available in stores.

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The shoulder has many parts including the joint, the joint capsule, tendons, muscle, blood vessels, nerves, lymph nodes, etc.

Shoulder pain as a specific complication of either HIV infection itself or due to a side effect of treatment would be unusual but shoulder pain is common in the general population.

Possible relationships are:

• Avascular necrosis due to drug therapy (particularly steroids). This condition refers to a condition where the bone dies. The most likely areas for this to occur in are the hips, shoulder, and knee. While the pain is usually a deep constant aching pain, it sometimes can cause sharp pain as well.

• Neuropathy due to drugs. Neuropathy is a condition where the nerves are damaged. Localized pain in the shoulder due to neuropathy is unusual. A condition called brachial plexopathy (Parsonage-Turner Syndrome) is a rare neuropathy that affects the large bundle of nerves that lead into the arm and causes severe sharp pain in the shoulder area. Viruses are the most common cause.

• Frozen shoulder due to protease inhibitor therapy. The following references discuss this phenomenon.

Frozen shoulder: a new delayed complication of protease inhibitor therapy? . AU - Zabraniecki L; Doub A; Mularczyk M; Andrieu V; Marc V; Ginesty E; Dromer C; Massip P; Fournie B
SO - Rev Rheum Engl Ed 1998 Jan;65(1):72-4.

We report three cases of frozen shoulder (including one with bilateral involvement) in human immunodeficiency virus (HIV)-positive patients under triple antiretroviral therapy. In each case, the diagnosis was confirmed by arthrography, and the classic causes of frozen shoulder were ruled out. We suggest that protease inhibitor therapy may have contributed to the development of frozen shoulder in these patients. Long-term follow-up of the increasing numbers of patients under triple antiretroviral therapy will confirm or refute this hypothesis.

AD - Rheumatology Department, Purpan Teaching Hospital, Toulouse, France. PMID- 9523391

- Adhesive capsulitis of shoulder and treatment with protease inhibitors in patients with human immunodeficiency virus infection: report of 8 cases.
AU - Grasland A; Ziza JM; Raguin G; Pouchot J; Vinceneux P
SO - J Rheumatol 2000 Nov;27(11):2642-6.

OBJECTIVE: To describe our experience with human immunodeficiency virus (HIV) infected patients receiving protease inhibitor therapy who presented with adhesive capsulitis of the shoulder. METHODS: Between July 1996 and December 1999, 8 HIV-infected patients (7 male) treated with protease inhibitors who presented with adhesive capsulitis of the shoulder were retrospectively identified. Diagnosis of adhesive capsulitis relied on clinical features including shoulder pain and both active and passive restricted range of motion (ROM). All available clinical and radiographic data were reviewed. RESULTS: Onset of symptoms was insidious, and at presentation, patients complained of shoulder pain, which was bilateral in 4 of the 8 cases. Physical examination showed global restriction of active and passive ROM of the glenohumeral joint. The mean delay between initiation of HIV protease inhibitors and onset of shoulder pain was 14 months (range 2 to 36). The protease inhibitor therapy always included indinavir. No underlying condition associated with secondary adhesive capsulitis of the shoulder, including shoulder trauma, diabetes mellitus, thyroid disease, pulmonary or cardiac diseases could be identified. In all 8 patients, despite continuation of therapy with indinavir, both shoulder pain and restricted ROM completely resolved, after a mean disease course of 7.4 months. CONCLUSION: Adhesive capsulitis of shoulder seems to be a new adverse event of HIV protease inhibitor therapy. In all reported cases, patients were treated with indinavir. Further observations will be necessary to confirm adhesive capsulitis as a side effect.

AD - Service de Medecine Interne, Hopital Louis Mourier, Universite Paris VII, Colombes, France. PMID- 11093447

Finally, other types of problems that occur in people without HIV can also occur. These include bursitis and tendonitis.

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