When Shoulder Pain is a Pain in the Neck!

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By Mr Harry Brownlow, March 2018

We had a really interesting meeting last week when I, a shoulder surgeon, Mr Patrick McKenna, a spinal surgeon, and Dr Kate Hutchings, a sports physician, met with 70 physiotherapists to discuss the common problems of shoulder and neck pathology.

We learnt about how common shoulder problems can masquerade as neck pathology since many people with shoulder complaints feel pain extending beyond the elbow and into the hand. Indeed tingling, pins and needles, and numbness are common symptoms in people with shoulder impingement and frozen shoulder. We are typically taught that shoulder pain only refers to the upper arm but that is clearly not true when we review the pain maps produced by shoulder patients. It is very interesting, and not easy to explain, how shoulder pathology can cause symptoms which seem quite neurological.

Mr McKenna explained the value of the Abduction Extension Cervical Nerve Root Stretch Test (AECNRST) which is both highly sensitive and specific for the diagnosis of nerve root tension. In most cases this will settle with time and physiotherapy. The use of selective nerve root blocks was considered to be both diagnostic and therapeutic in many cases. On rare occasions there is need for a cervical disc replacement which has a proven track record for relieving pain and reducing the risk of addition wear on the discs above and below (which is the problem with a localised cervical fusion).

Dr Hutchings presented several fascinating clinical examples of shoulder/neck pain arising from unusual sources such as thoracic outlet syndrome, suprascapular nerve entrapment, Pancoast’s tumour, and Parsonage Turner syndrome. She explained how we might diagnose and manage these important conditions.

It was agreed that when faced with the clinical dilemma of shoulder or neck pathology it was important to start with red flag symptoms and signs. Once these had been excluded then the general approach was to address the neck first before tackling the shoulder. We all agreed that MRI was a vital investigation but that it did not have to be employed in every case, and indeed that the results of an MRI can, in some instances, cause unnecessary stress and confusion for the patient.