Changes in spinal alignment also change the mechanics of the shoulder and this can cause shoulder problems. Additionally shoulder pathology may refer pain to the neck. ~ Dr. Broussard
The Study: Overlapping, Masquerading, and Causative Cervical Spine and Shoulder Pathology: A Systematic Review .
The Facts:
a. The authors reviewed the literature regarding the link of shoulder pain to the spine.
b. Their review included 76 articles.
c. They noted a number of relevant facts including: “The phenomenon of referred pain occurs when nerve fibers from different locations in the body synapse on the same second order neurons. Pain from the shoulder is relayed through the brachial plexus and into the cervical nerve roots, particularly at the C5-6 level.”
d. “Head forward posture results in overuse injury to the shoulder.”
e. “The spine and shoulder have an integral biomechanical relationship.”
f. “Spinal malalignment specifically in the thoracic region seems to negatively impact the shoulder. Culham and Peat showed that altered cervical and thoracic sagittal alignment changes the kinematics and resting posture of the scapula.”
g. “Greenfield et al reported that patients with overuse injury to the shoulder were more likely to have a head forward posture that correlates with increasing thoracic kyphosis.”
h. “Muscular forces across the shoulder are altered by changes in spinal alignment. Spinal posture has been shown to affect the rate of rotator cuff tears.”
i. In their conclusion they also note, “Injury to the nerve, disc, facet complex, or paravertebral soft tissues from C3-7 can refer pain to the posterior shoulder.”
Take Home: Changes in spinal alignment also change the mechanics of the shoulder and this can cause shoulder problems. Additionally shoulder pathology may refer pain to the neck.
Overlapping, Masquerading, and Causative Cervical Spine and Shoulder Pathology: A Systematic Review
Global Spine J. 2020 Apr;10(2):195-208. doi: 10.1177/2192568218822536. Epub 2019 Feb 17.
Katsuura Y1,2,3, Bruce J1, Taylor S2,3,4, Gullota L2,3,4, Kim HJ2,3,4.
Abstract
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 shoulder problems.
METHODS:
A systematic literature search was performed according to the guidelines set forth by the Cochrane Collaboration. Studies were included if they examined the clinical, anatomical, or physiological overlap between the shoulder and cervical spine. Two reviewers screened and selected full texts for inclusion according to the objectives of the study. Quality of evidence was graded using OCEBM (Oxford Center for Evidence Based Medicine) and MINORS (Methodological Index for Nonrandomized Studies) scores.
RESULTS:
Out of 477 references screened, 76 articles were included for review and grouped into 4 main sections (overlapping pain pathways, differentiating exam findings, concomitant/masquerading pathology, and cervical spine-based etiology of shoulder pathology). There is evidence to suggest cervical spine pathology may cause shoulder pain and that shoulder pathology may cause neck pain. Specific examination tests used to differentiate shoulder and spine pathology are critical as imaging studies may be misleading. Diagnostic injections can be useful to confirm sources of pain as well as predicting the success of surgery in both the shoulder and the spine. There is limited evidence to suggest alterations in the relationship between the spine and the scapula may predispose to shoulder impingement or rotator cuff tears. Moreover, cervical neurological lesions may predispose patients to developing rotator cuff tears. The decision to proceed with shoulder or spine surgery first should be delineated with careful examination and the use of shoulder and spine diagnostic injections.
CONCLUSION:
Shoulder and spine pathology commonly overlap. Knowledge of anatomy, pain referral patterns, shoulder kinematics, and examination techniques are invaluable to the clinician in making an appropriate diagnosis and guiding treatment. In this review, we present an algorithm for the identification and treatment of shoulder and cervical spine pathology.
© The Author(s) 2019.
KEYWORDS:
cervical spine pain; exam; radiculopathy; rotator cuff tear; shoulder pain; suprascapular neuropathy
PMID: 32206519 PMCID: PMC7076593 DOI: 10.1177/2192568218822536