{
  "abstract": "A 37-year-old woman with progressive difficulty in using her left arm and with discomfort in the left shoulder was evaluated. Her complaints were of insidious onset and progressed over a period of 3 months. She had a soft shoulder and passive movements in the left shoulder were increased in all ranges, with internal and external rotation of 180° each ( figure 1A,B). Active abduction was up to  90°. Radiographs of the shoulder demonstrated the absence of humeral head and a small sliver of bone, reminiscent of the greater tubercle (figure 1C). She was evaluated for neuropathic arthropathy, infection, neoplastic, metabolic and endocrine causes of osteolysis using appropriate blood tests and imaging techniques. Her blood parameters were normal. MRI confirmed absence of the proximal humerus and resorption and expansion of the glenoid cavity (figure 2A,C). A syrinx extending from the C2–D9 spinal region (figure 2C,D) was incidentally found corroborating with the suspicion of neuropathy, but the patient had no neurological manifestations and the nerve conduction tests were normal. Presence of pain, extensive osteolysis and absence of neuropathy led to the suspicion of Gorham-Stout syndrome (GSS). Since the patient had minimal disability, she was not willing for a biopsy or any form of surgical intervention. Due to lack of convincing evidence in the literature, pharmacotherapy was not tried and the patient was put on a regimen of shoulder strengthening and range of motion exercises. On telephonic enquiry, she revealed that the disability did not worsen at 2 years and hence refused further hospital visits. GSS is a rare disease, and to the best of our knowledge its presentation alongside an extensive syrinx is not reported in the literature.",
  "authors": [
    {
      "affiliations": [
        "Department of Orthopaedics, Pondicherry Institute of Medical Sciences, Pondicherry, India"
      ],
      "name": "Shishir Murugharaj Suranigi"
    },
    {
      "affiliations": [
        "Department of Orthopaedics, Pondicherry Institute of Medical Sciences, Pondicherry, India"
      ],
      "name": "Abhay Harsh Kerketta"
    },
    {
      "affiliations": [
        "Department of Orthopaedics, Pondicherry Institute of Medical Sciences, Pondicherry, India",
        "Department of Orthopaedics, Jawaharlal Institute of Postgraduate Medical Education, Pondicherry, India"
      ],
      "name": "Pasupathy Palaniappan"
    },
    {
      "affiliations": [
        "Department of Orthopaedics, Pondicherry Institute of Medical Sciences, Pondicherry, India"
      ],
      "name": "Syed P Najimudeen"
    }
  ],
  "title": "An interesting case of vanishing shoulder",
  "uid": "ffbe5505-427a-591d-abfe-7c0ffdd90911"
}