An Evidence-Based Approach to Differentiating the Cause of Shoulder and Cervical Spine Pain

Am J Med. 2016 Sep;129(9):913-8. doi: 10.1016/j.amjmed.2016.04.023. Epub 2016 May 5.

Abstract

Differentiating the cause of pain and dysfunction due to cervical spine and shoulder pathology presents a difficult clinical challenge in many patients. Furthermore, the anatomic region reported to be painful may mislead the practitioner. Successfully treating these patients requires a careful and complete history and physical examination with appropriate provocative maneuvers. An evidence-based selection of clinical testing also is essential and should be tailored to the most likely underlying cause. When advanced imaging does not reveal a conclusive source of pathology, electromyography and selective injections have been shown to be useful adjuncts, although the sensitivity, specificity, and risk-reward ratio of each test must be considered. This review provides an evidence-based review of common causes of shoulder and neck pain and guidelines for assistance in determining the pain generator in ambiguous cases.

Keywords: Cervical spine; Differentiate; Dysfunction; Pain; Shoulder.

Publication types

  • Review

MeSH terms

  • Cervical Vertebrae / pathology
  • Diagnosis, Differential
  • Evidence-Based Medicine
  • Humans
  • Neck Pain / diagnosis*
  • Neck Pain / etiology
  • Neck Pain / pathology
  • Shoulder Joint / pathology
  • Shoulder Pain / diagnosis*
  • Shoulder Pain / etiology
  • Shoulder Pain / pathology