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Study design:
Systematic review.
Objective:
To assess the current literature regarding the relationship between the shoulder and the spine with regard to (1) overlapping pain pathways; (2) differentiating history, exam findings, and diagnostic findings; (3) concomitant pathology and optimal treatments; and (4) cervical spine-based etiology for s...
Context in source publication
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Purpose] To systematically review the literature on the use of cervical extension traction methods for increasing cervical lordosis in those with hypolordosis and cervical spine disorders. [Methods] Literature searches for controlled clinical trials were performed in Pubmed, PEDro, Cochrane, and ICL databases. Search terms included iterations relat...
Citations
... The consequence of these changes is the narrowing of the spinal canal and intervertebral foramina, causing symptoms of radiculopathy or myelopathy, as well as axial pain originating from the facet joints, which can radiate in a non-radicular pattern. These phenomena are well documented, with numerous experiments identifying pain generators in the cervical spine and mapping pain patterns often overlapping and masking shoulder pain [11]. ...
Background
Neck pain is a prevalent and burdensome health issue, with autologous conditioned serum (ACS), like Orthokine, being a recognized treatment for musculoskeletal conditions due to its anti-inflammatory effects. However, the optimal ACS administration method for neck pain remains unclear. The existing literature lacks robust evidence, especially for different injection techniques. This study aimed to compare ACS infiltration into cervical fascia with periarticular administration to determine if the former is as effective in alleviating neck pain, offering a novel approach to its management.
Material/Methods
Our study is designed to be a single-center, prospective, randomized trial involving 100 patients. Group A (n=50) will receive ACS through fascial infiltration at tender points under ultrasound guidance, with 4 doses administered every 3 days. Group B (n=50) will receive ACS injections in the articular column (facet joints) using the same dosing schedule. We will collect data at T0 (before therapy), T1 (6 weeks after therapy), and T2 (12 weeks after therapy), assessing outcomes with the Numerical Pain Scale (NRS), Neck Disability Index (NDI), and Dynamic Proprioception Test (DPT).
Results
Enrollment begins in August 2023, and the study is set to conclude in July 2024. If data analysis, manuscript preparation, and peer review proceed smoothly, we anticipate publishing the results in late 2024 or early 2025.
Conclusions
If fascial infiltration with ACS proves equally effective as the standard periarticular method, it offers promise for patients on long-term anticoagulant treatment. Paravertebral injections in such cases carry a significant risk of bleeding, making ACS infiltration a potentially safer alternative for managing neck pain in these individuals.
... Differences in symptoms between proximal cervical spondylotic muscular atrophy and shoulder disease11) ◎ are symptoms caused by the cervical spine. ☆ indicates the pain location or symptoms of shoulder disease. ...
... If the pain originates from dysfunction, inflammation, or trauma to the shoulder itself, structural alterations are visible in magnetic resonance imaging. If such imaging modalities do not reveal any obvious injury or trauma to the shoulder, the pain may be caused by dysfunctions of a different body with innervations to the shoulder such as the neck, the upper back, and the intervertebral discs [7,8]. A differential diagnosis of shoulder pain is therefore indispensable in preventing progression to a chronic dysfunction and alleviating the pain symptoms to restore or enhance quality of life. ...
Background: Shoulder pain may originate from tears, inflammation or trauma to the shoulder itself or from dysfunctions in other body regions. The temporomandibular joint is connected to the shoulder by the Nervus accessorius and its branches and hence, patients with craniomandibular dysfunction (CMD) and concomitant shoulder pain may benefit from treatment of CMD-related symptoms to alleviate the pain. We therefore aimed at assessing the impact of an osteopathic-manual intervention in the temporomandibular joint on shoulder pain in CMD patients. Methods: 49 CMD patients with chronic shoulder pain persisting for at least four months were recruited and subjected to a weekly osteopathic CMD intervention for four weeks. Self-reported pain intensity, impact on daily activities and sleep, and maximum working height were assessed by questionnaires at baseline and after the intervention. Changes in motion (attainable position with the affected arm, shoulder function, abduction, flexion, external rotation) were assessed by two chiropractors. Statistical analysis was conducted with Chi-square test (answer frequencies) and Wilcoxon test (comparison of means before and after). Results: Shoulder pain intensity on a scale from 0 (no pain) to 15 (strongest pain) was significantly reduced by the intervention from 9.7 ± 2.7 (range: 5-13.5) to 2.9 ± 2.7 (range: 0-11; p<0.001). Impairment of occupational and leisure activities due to shoulder pain was reduced from more than 50% impairment before the intervention to less than 50% impairment after the intervention (p<0.001). Working height was significantly increased by the intervention from belt height or chest height to crown height (p<0.01). A significant improvement of sleep disturbances due to the shoulder pain was noted, with most patients experiencing no such disturbances after the intervention (p<0.01). Flexion significantly increased from 97.8 degrees to 154.5 degrees (p<0.001), abduction from 86.7 degrees to 153.7 degrees (p<0.001), and external rotation from 33.6 degrees to 48.2 degrees (p<0.001). Conclusion: The results demonstrate that shoulder pain concomitant with CMD may be alleviated by osteopathic-manual treatment of the temporomandibular joint, thereby reducing pain intensity and sleep disturbances, and improving quality of life.
... In addition, the treatment of TFESI combined with PRF can result in greater clinical efficacy when compared to TFESI alone or PRF alone in patients with chronic LSRP (Koh et al., 2015;Ding et al., 2018;Karaköse Çalışkan et al., 2021). In addition, the degenerative spinal disease often occurs in multilevel disks, and the distribution of radicular pain is usually related to multilevel spinal nerve dermatome, especially in adults with longer pain duration (Voermans et al., 2006;Albert et al., 2019;Katsuura et al., 2020). In our study, the pain duration of all patients was ≥ 2 years (the mean duration of 4 years), which was notably longer than that in previous studies, in which the means of pain duration were about one year (Chang et al., 2017;Lee et al., 2018). ...
Background
Transforaminal epidural steroid injection (TFESI) or dorsal root ganglion pulsed radiofrequency (PRF) are alternative treatments for lumbosacral radicular pain (LSRP). This study aimed to investigate the clinical efficacy of TFESI combined with dorsal root ganglion PRF using bipolar technology to treat LSRP in patients with pain duration ≥ 2 years.
Methods
This prospective single-armed cohort study included 20 patients with LSRP duration ≥ 2 years, who underwent treatment of TFESI combined with bipolar PRF. The primary outcomes included numerical rating scale (NRS) and successful treatment rate (pain relief ≥50%). The secondary outcomes included Oswestry Disability Index (ODI), patient satisfaction using the modified MacNab criteria, severe complications, hospital stay and total costs. The final follow-up was 6 months postoperatively.
Results
The successful treatment rate and average pain relief at 6 months postoperatively were 80% and 73.0% ± 17.5%, respectively. The successful treatment rates in patients with and without prior intervention history at 6 months postoperatively were 77.8% and 81.8%, respectively. The mean NRS score significantly decreased from 6.5 ± 0.8 to 1.1 ± 0.7 at 2 weeks postoperatively, to 1.3 ± 0.7 at 3 months postoperatively, and to 1.7 ± 1.0 at 6 months postoperatively (all P < 0.001), while the mean ODI score significantly decreased from 43.5 ± 2.5 to 22.5 ± 4.3 at 2 weeks postoperatively, to 20.0 ± 3.5 at 3 months postoperatively, and to 19.5 ± 3.6 at 6 months postoperatively (all P < 0.001). The excellent and good patient satisfaction at 6 months postoperatively was 85%. No severe complications were observed in this cohort. The average hospital stay and total costs were 3.0 ± 0.5 days and 3.36 ± 0.77 thousand dollars, respectively.
Conclusion
The treatment of TFESI combined with PRF using bipolar technology might be an alternative option to treat chronic LSRP in patients with pain duration ≥ 2 years after a failure of conservative treatments, with a favorable 6-month efficacy and inexpensive total costs. However, long-term outcomes and superiority of bipolar procedure over monopolar procedure in patients with longer pain duration should be further investigated in future studies.
... Furthermore, the patient was concerned because the pain, from being low in intensity and dull, had become worse, was cramping and deep ( Figure 2-body chart), and had a negative influence on his working and sporting life. A deeper clinical investigation regarding associated symptoms, as suggested by the evidence [8,23], led the PT to question the patient about any other significant disturbance or discomfort, but no other neuro-musculoskeletal disorders were reported by the patient. A checklist for significant or potential "red flags" as a widely and accepted system to rule The patient reported suffering from chronic neck pain; however, in the last month, the neck pain was reported to have changed, becoming persistent and associated with intermittent paresthesia on the upper trapezius and, on the back, on the scapular area, warned as a pinprick sensation both during everyday activities (e.g., lifting c. 5 kg objects) and while resting in bed. ...
... A deeper clinical investigation regarding associated symptoms, as suggested by the evidence [8,23], led the PT to question the patient about any other significant disturbance or discomfort, but no other neuro-musculoskeletal disorders were reported by the patient. A checklist for significant or potential "red flags" as a widely and accepted system to rule out serious pathologies or systemic symptoms (fever, weight loss, balance problems) was performed [3,[24][25][26]. ...
Shoulder pain is often attributable to a musculoskeletal disorder, but in some instances, it may be linked to pathologies outside the physiotherapist’s area of expertise. Specifically, some intracranial problems can cause pain and disability to the shoulder complex. This case report aims to describe the clinical presentation, history taking, physical examination, and clinical decision-making procedures in a patient with an intracranial epidermoid cyst mimicking a musculoskeletal disorder of the shoulder girdle. A 42-year-old man complained of pain and disability in his left shoulder. Sudden, sharp pain was reported during overhead movements, associated with intermittent tingling of the left upper trapezius and left scapular area. Moreover, the patient reported reduced hearing in his left ear and left facial dysesthesia. The physical examination led the physiotherapist to hypothesize a pathology outside the physiotherapist’s scope of practice and to refer the patient to another health professional to further investigate the patient through imaging. It is essential for the physiotherapist to recognize when the patient’s clinical condition requires a referral to another healthcare professional. Therefore, the physiotherapist must be able to, in a timely manner, identify signs and symptoms suggesting the presence of medical pathology beyond his expertise, through appropriate medical history collection and physical evaluation.
... While there is a well-known relationship regarding the dermatomal overlap of pain pathways in the shoulder joint as originating from either the joint itself or the cervical spine, few studies have evaluated patient-reported outcomes (PROs) after shoulder arthroscopy in patients with concomitant cervical spine pathology. [6][7][8][9][10] Dunn et al. 7 demonstrated in an 86,501 patient analysis of prevalence across time that the number of patients with both rotator cuff pathology and cervical spine stenosis has increased significantly in the past decade. Moorthy et al. 11 compared outcomes in patients undergoing arthroscopic rotator cuff repair with or without concomitant cervical radiculopathy but found no significant difference in postoperative functional outcomes between the 2 groups. ...
Purpose
To determine whether an association exists between the presence of cervical spine pathology and postoperative patient-reported outcomes (PROs) in patients undergoing open subpectoral biceps tenodesis (BT).
Methods
A retrospective review of patients undergoing isolated BT from August 2011 to May 2019 was conducted. Cases were defined as patients with concomitant cervical spine disease (disc disease, disc herniations, neuroforaminal/central stenosis). Controls were patients without cervical spine disease. Postoperative PROs were collected from all patients with a minimum of 12-month follow-up. Cases and controls were matched 1:1 using age and body mass index. PROs were compared using the χ² text, Fisher exact test, or analysis of variance.
Results
A total of 23 cases and 23 controls were identified. Cases and controls had similar distributions of age (42.4 ± 4.4 years, 40.4 ± 4.5, P = .15), sex (83% male, 87% male, P = .68), body mass index (28.0 ± 4.0, 27.6 ± 4.3, P = .78), and percentage of athletes (65% athlete, 61% athlete. P = .76). All cases had evidence of neuroforaminal stenosis and multilevel degenerative disc disease, whereas 19 of 23 (83%) had evidence of central canal stenosis. Cases had a greater visual analog scale (VAS) score during Sport score (3.6 ± 0.7 vs 1.2 ± 0.6, P = .013) and lower Subjective Shoulder Value (69.5 ± 5.8 vs 84.1 ± 5.4, P = .070) and Shoulder Instability-Return to Sport after Injury score (60.4 ± 5.8 vs 77.4 ± 6.0, P = .046). There were no significant differences between groups’ ASES, baseline VAS, overall satisfaction scores, and willingness to undergo the same operation again. No significant differences were found in postoperative rate of return to sport, time to return, and return to preoperative competitiveness.
Conclusions
Patients with SLAP tears undergoing isolated BT in the presence of cervical spinal stenosis may have inferior Subjective Shoulder Value, Shoulder Instability-Return to Sport after Injury, and VAS during sport scores as compared with controls, although many PROs were similar at follow-up. Athletes undergoing BT, particularly with concomitant cervical spine pathology, should be counseled appropriately before surgery.
Level of Evidence
Level III, case–control study.
... In addition, common radicular symptoms are often similar to symptoms that arise from shoulder pathology. A 2020 review of shoulder and cervical spine pathology reported that 15% of cervical spondylosis patients are ultimately diagnosed with a shoulder disorder [6]. Hence, shoulder and cervical spine pathologies can often overlap and be easily confused. ...
... The importance of distinguishing shoulder and cervical spine pathologies is amplified when considering that they can result in similar symptoms. Such similarities often cause the pathologies to be confused with one another [6]. For instance, one study previously reported that 15% of cervical spondylosis patients were misdiagnosed and later received treatment for a shoulder condition [6]. ...
... Such similarities often cause the pathologies to be confused with one another [6]. For instance, one study previously reported that 15% of cervical spondylosis patients were misdiagnosed and later received treatment for a shoulder condition [6]. It is, therefore, important that all relevant testing is conducted before a decision is made concerning the need for surgery. ...
Background:
Diagnostic dilemma exists in differentiating between neck and shoulder pathology, as both can give a rise to shoulder and arm symptoms. In addition, the hypersensitivity of magnetic resonance imaging (MRI) scans may wrongly highlight non-clinically significant changes as potential targets for surgical intervention. The arm- squeeze test is a recognised recognized method used to help differentiate pathology arising from the shoulder or the neck. Performing this test preoperatively may prevent needless surgical intervention when diagnostic difficulties exist, even when MRI scans are not helpful.
Case presentation:
We report the case of a 41-year-old male who initially presented with numbness and pins and needles in both arms. Following clinical review and an MRI scan of the cervical spine, the patient underwent an Anterior Cervical Discectomy and Fusion. Unfortunately, there was no relief of symptoms following surgery. A post- operative clinical review identified the shoulder as a potential cause of the symptoms.
Conclusion:
The arm- squeeze test is not popular and is not routinely used in shoulder and cervical spine examinations. However, it is recommended by National Institute for health and care excellence to help differentiate between neck and shoulder pathology, and, hence, dissemination of this information is vital.
... It may be difficult for the clinician to isolate the etiology of pain occurring either in the neck or shoulder because neck pain can refer to the shoulder and vice versa [1]. Furthermore, neck and shoulder pathology also coexist, creating a care issue to be tackled first [2]. One of the most prominent causes of posterior neck and shoulder pain is cervical spondylosis [3]. ...
Purpose
It is often difficult for the clinician to isolate the etiology of pain occurring either in the neck or shoulder because of the reason that neck pain can refer to the shoulder and vice versa. Concordance research has found that around one in 10 patients who were referred for cervical radiculopathy had comorbid shoulder pathology. The goal of this research is to analyze and correlate risk factors for persistent shoulder pain (non-dermatomal) following cervical spine surgery.
Methods
This was a single-center, retrospective study. The medical records of patients admitted for anterior cervical discectomy and fusion (ACDF) were reviewed from August 2018 to Feb 2021. Patients of both sexes and age more than 18 years who underwent ACDF (single/multiple levels) were included and the medical record was checked for whether they had persistent shoulder pain following ACDF. The proportion of patients undergoing shoulder surgery for associated rotator cuff tears and subacromial impingement were recorded.
Results
Seventy patients presenting with cervical prolapsed intervertebral disc (PID) were studied. A majority of our patients were females (n=48, 68.6%) and males (n=22, 31.4%) with an M:F ratio of 1:2 and the majority of patients were between the ages of 40 to 60 years (n=34, 48.6%). After surgical intervention (ACDF), 48 patients (68.6%) noted the cessation of shoulder symptoms (pain, weakness, and numbness) during their last visit. Rotator cuff tear (supraspinatus mainly) was the predominant finding in MRI in those who didn’t improve after ACDF (n=18, 25.7%, p-value: 0.001). Twenty patients (28.6%) underwent acromioplasty and rotator cuff tendon repair and four patients responded well to subacromial injection. The C6-7 level was most commonly affected (n=48, 68.6%) followed by C5-6 level (n=19, 27.1%). No significant association was found between cervical levels with shoulder pathologies (p-0.171), though a significant association between a visual analog scale (VAS) score >7 after surgery with shoulder pathologies (p-0.001) was found. The C6-7 level was commonly affected in females (p=0.038) but no significant association between gender and shoulder pathologies was found (p=0.332).
Conclusion
Dual pathologies in patients with cervical PID are very common. It needs careful attention by doing thorough clinical examination and correlating patient symptoms with radiological investigations. A patient who presents with persistent shoulder pain after cervical spine surgery had a higher chance of having concurrent shoulder pathology, and they should be properly investigated and managed to alleviate the suffering of the patient.
... The order of treatment of concomitant shoulder and cervical spine pathology can be difficult to determine, since which pathology should take precedence is not well understood [10]. Previous recommendations suggest that shoulder surgery should be attempted first in such patients as it is typically associated with a lower risk profile [8,13]. ...
... In the present cohort of patients undergoing arthroscopic rotator cuff repair for full-thickness rotator cuff tears, 9.2% had concomitant cervical radiculopathy. This is in line with previous studies which have reported rates ranging from 4 to 29% of patients presenting to the shoulder or spine clinical having dual pathology [2,10,20,22]. ...
PurposeThe aim of this study was to compare postoperative functional outcomes after arthroscopic rotator cuff repair in patients with only rotator cuff tears versus those with concomitant cervical radiculopathy.MethodsA retrospective study of patients who underwent unilateral rotator cuff repair at a tertiary hospital between 2012 and 2016 was conducted. Patients included in the study were divided into two groups: (1) those with rotator cuff tears only (RC only) and (2) those with concomitant cervical radiculopathy (RC + radiculopathy). Cervical radiculopathy was treated non-surgically in these patients. Oxford Shoulder Score (OSS), Constant Shoulder Score (CSS), University of California at Los Angeles Shoulder Score (UCLASS) and Visual Analog Scale (VAS) pain score were measured for each patient preoperatively and at 3, 6, 12, and 24 months postoperatively.ResultsAs compared to the RC-only group (n = 324), the RC + radiculopathy group (n = 33) had significantly poorer OSS (p = 0.001), CSS (p = 0.017) and UCLASS (p = 0.009) functional scores preoperatively. On follow-up, there were no significant differences in functional outcomes between the groups at 3, 6, 12 and 24 months postoperatively for OSS, CSS, UCLASS and VAS pain scores, with the exception of CSS which was higher in the RC-only group at 6 months (p = 0.007). The absolute change and number of patients that attained minimum clinically important difference (MCID) for OSS, CSS and UCLASS at 12- and 24-month follow-ups were also comparable between the groups.Conclusion
Patients with rotator cuff tears and concomitant cervical radiculopathy achieve similar postoperative functional outcomes to those with only rotator cuff tears, after arthroscopic rotator cuff repair.Level of evidenceIII
... La tendencia muestra que las zonas articulares con mayor número de lesiones son la columna lumbar, hombro y rodilla 6, 7 , siendo en su conjunto una de las causas por las cuales se generan trastornos musculoesqueleticos crónicos. A su vez la rodilla es uno de los complejos articulares que recibe la mayor carga del peso corporal de un sujeto 8 , al igual que la columna lumbar; sin embargo, la columna lumbar depende de la estabilización muscular para mantener su indemnidad similar a la zona articular de hombro 9,10 . ...
En la actualidad no se ha podido realizar una caracterización para saber cuáles son los trastornos de mayor prevalencia que aquejan a la población chilena según edad, género, trastorno musculo esquelético y zona articular lesionada. Por tanto se realizo un estudio no experimental con un enfoque cuantitativo descriptivo y un diseño transversal, con un muestreo no probabilístico de tipo convencional en las tres regiones con mayor cantidad de habitantes en Chile. Donde la región del Bio Bio cuenta con el mayor número de atenciones para el género femenino (1292), siendo los 70 años o más el rango etario con mayor número de consultas, la articulación de columna lumbar una de las zonas articulares con mayor número de consulta (983) y las tendinopatías con 1067 atenciones, como la patología con mayor incidencia entre los usuarios.
