Unrecognized Shoulder Disorders in Treatment of Cervical Spondylosis Presenting Neck and Shoulder Pain

Abstract

ObjectiveCervical spondylosis and shoulder disorders share with neck and shoulder pain. Differentiating between the two can be challenging and patient with combined pathologies is less likely to have pain improvement even after successful cervical operation. We investigated clinical characteristics of the patients who were diagnosed as cervical spondylosis however, were turned out to have shoulder disorders or the patients whose pain was solely originated from shoulder.MethodsBetween January 2008 and October 2009, the patients presenting neck and shoulder pain with diagnosis of cervical spondylosis were enrolled. Among them, the patients who met following inclusion criteria were grouped into shoulder disorder group and the others were into cervical spondylosis group. Inclusion criteria were as follows. (1) To have residual or unresponsive neck and shoulder pain despite of optimal surgical treatment due to concomitant shoulder disorders. (2) When the operation was cancelled for the reason that shoulder and neck pain was proved to be related with unrecognized shoulder disorders. The authors retrospectively reviewed and compared clinical characteristics, level of pathology, diagnosis of cervical spondylosis and shoulder disorders.ResultsA total of 96 patients were enrolled in this study. Shoulder disorder group was composed of 15 patients (15.8%) and needed additional orthopedic treatment. Cervical spondylosis group was composed of 81 patients (84.2%). There was no significant differences in mean age, sex ratio and major diagnosis in both shoulder disorder and cervical spondylosis group (p=0.33, 0.78, and 0.68 respectively). However, the distribution of pathologic levels was found to be significantly different (p=0.03). In shoulder disorder group, the majority of lesions (15 of 19 levels, 78.9%) were located at the level of C4-5 (36.8%) and C5-6 (42.1%). On the other hand, in cervical spondylosis group, C5-6 (39.0%) and C6-7 (37.1%) were the most frequently observed level of lesions (80 of 105 levels, 16.1%).ConclusionIt is very important for spine surgeons to perform a complete history taking and physical examination using the special tests, and to discover the underlying shoulder disorders causing of symptom in treatment of cervical spondylosis presenting neck and shoulder pain.

Overlapping, Masquerading, and Causative Cervical Spine and Shoulder Pathology: A Systematic Review

“…In this study, there was a significant difference in the cervical levels involved, with the shoulder cohort having a higher involvement of the C4-5 level (37%) than the C5-6 level (15) ( P = .03). 67 This result is interesting considering that the most common level for cervical spondylosis is typically C5-C6. 68 It should be noted that the studies which examine the treatment of concomitant shoulder and spine pathology are dated, observational, and subject to both bias and diagnostic flaws and thus must be interpreted with care.…”

A Case Report of Silent Cervical Spondylosis with Neck Pain

“…The overwhelming amount of neck pain is not caused by endogenous anatomy, and it was called "non-specific" or "mechanical." Non-specific cervical discomfort is responsible for a huge quantity of direct health insurance expenditures, referrals to primary health facilities, leave due to illness, and the associated lack of productivity [11]. Most of the non-specific neck pain is not related to neurological symptoms of nerve compression or with significant illness.…”

Shoulder and Neck Pain: Interdisciplinary Aspects of Treatment

“…Как следует из представлен-ных данных, наиболее сложной в тактическом отношении когортой пациентов являются люди с наличием спонди-леза С [5][6] . С целью дифференциальной диагностики авто-ры применяли клинические тесты Нира (theNeer'stest), Хоукинса (theHawkins'test) и Джоуба (theJobe'stest) для выделения патологии плеча и пробы Спарлинга (Spurling'stest) и Бэкоди (theBakody'stest) для верифика-ции собственно шейного спондилеза [32].…”