Referred pain distribution of the cervical zygapophyseal joints and cervical dorsal rami

Abstract

The purpose of this study was to determine the distribution of referred pain from the cervical zygapophyseal joints (C0/1 to C7/Th1) and the cervical dorsal rami (C3 to C7). The subjects were 61 patients who had occipital, neck, and shoulder pain of suspected zygapophyseal origin in whom pain was reproduced by injection of contrast medium into the joints or by electrical stimulation of the dorsal rami. Under fluoroscopic control, the zygapophyseal joints from C0/1 to C7/Th1 were stimulated by the injection of contrast medium and while electrical stimulation of the cervical zygapophyseal dorsal rami at segments C3 to C7 was performed during facet denervation. If injection or electrical stimulation reproduced the patient's usual pain, the distribution of referred pain was determined and the sites of referred pain were divided into 10 areas. A total of 181 joints and 62 segments were studied. Each joint and dorsal ramus produced referred pain with a characteristic distribution. The main distribution of referred pain was as follows. Pain in the occipital region was referred from C2/3 and C3, while pain in the upper posterolateral cervical region was referred from C0/1, C1/2, and C2/3. Pain in the upper posterior cervical region was referred from C2/3, C3/4, and C3, that in the middle posterior cervical region from C3/4, C4/5, and C4, and that in the lower posterior cervical region from C4/5, C5/6, C4, and C5. In addition, pain in the suprascapular region was referred from C4/5, C5/6, and C4, that in the superior angle of the scapula from C6/7, C6, and C7, and that in the mid-scapular region from C7/Th1 and C7.

Shoulder pain following tetraplegia: a follow-up study 2–4 years after injury

“…Scapula pain may result from myofascial disorders, 24 thoracic spine problems or be referred from spinal structures between C5 and T6. 25,24 Arm and scapula pain were the only areas in which a number of participants tended to use affective descriptors such as 'tiring', 'exhausting' and 'troublesome', which indicates different pain experiences to those with pain in other areas.…”

The importance of craniovertebral and cervicomedullary angles in cervicogenic headache

“…It was concluded that trigeminal pain is infrequently related to cervical disc pathology (15). Fukui et al (16) showed that the C2/3 to C7/ Th1 joints are related to a pain distribution pattern that does not involve trigeminal areas. C2/3 and C3 stimulation can produce occipital pain but no headache at the forehead (16).…”

“…Fukui et al (16) showed that the C2/3 to C7/ Th1 joints are related to a pain distribution pattern that does not involve trigeminal areas. C2/3 and C3 stimulation can produce occipital pain but no headache at the forehead (16). All these studies indicate that most neck lesions do not produce CH and cannot explain the CH source.…”

Musculoskeletal Imaging in Physical Therapist Practice

“…Although any detailed discussion of referred pain is beyond the scope of this article, there is general consensus that symptoms can be referred remotely from the origin of pathology, that pain can be referred from both somatic and visceral structures, and that palpation tenderness may indeed exist in the area of the referred pain. 2,23,[33][34][35]41,62,66,73 Diagnostic studies of referred-pain locations are likely to reveal only irrelevant pathology or appear normal. Careful planning and execution of the patient/client examination based on the unique presentation of each patient, with full consideration of the possibility of referred pain, will help reduce such examination errors.…”

“…50 Because the upper aspects of these spinal regions are known to refer symptoms distally, the potential exists to mistakenly correlate asymptomatic pathology at lower spinal levels with the pain that is being referred from higher spinal levels. [33][34][35] Sometimes the more obvious or more symptomatic area obscures the need for imaging of other injuries or pathology. Common examples include ankle sprains accompanied by foot fractures and lower extremities fractures accompanied by spinal fractures.…”