Insights & Injuries:

A blog by Dr. Dolf R. Ichtertz, Nebraska Hand & Shoulder Institute

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The Neck & Shoulder Pathology Masquerade22 January, 2014
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“Neck-Shoulder Crossover- How often do neck and shoulder pathology masquerade as each other?” by Sembrano, M.D., et al., American Journal of Orthopaedics, September 2013.  

In a university setting 694 new patients were evaluated between a shoulder clinic and a spine clinic.  One out of 25 patients where identified wherein the neck would cause a person’s shoulder pain or the person’s shoulder would be causing the neck pain.  This type of study unfortunately suffers a major problem with sampling bias.  I think that the crossover possibility in patients treated in Nebraska is probably much higher than what identified in this study; age of the patient, genetic composition of the population, type of activities that tend to predominant in a population, etc. are going to impact the problems that patients present with.  Nevertheless, we need to keep in mind the possibility of crossover.  

Something I have noticed for years and which has received very little attention in the medical literature is the need to carefully scrutinize a person coming in with neck or shoulder pain that may be coming from a compressed nerve at the elbow (ulnar nerve) or the wrist (median or ulnar nerve).  Median and ulnar nerve entrapment do, in fact, frequently cause neck or shoulder pain but usually in conjunction with numbness.  However, in a small percentage of patients the only complaint of the person coming in is neck and/or shoulder pain, but it may not be coming from pathology localized in the neck or shoulder.  It requires nerve conduction study and possibly EMG in addition to a careful physical examination and x-ray to determine what is going on in these patients.  
In summary, when someone comes to the doctor complaining of neck or shoulder pain they must be carefully evaluated from their neck all the way to their fingertips to make the correct diagnosis and help the person solve the problem.  

Kummel, B.M., Zazanis, George A.: “Shoulder Pain as the Presenting Complaint in Carpal Tunnel Syndrome.”  Clinical Orthoapedics, May 1973; 92, 227.

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Nebraska Hand and Shoulder Institute, P.C.

Nebraska Hand and Shoulder Institute, P.C.
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