Unresolved Shoulder Pain - Look at the neck
Came across a good power point presentation of a case of shoulder pain not helped by surgery and how the neck should have been considered:
Available here
Suggestive findings were:
1) Reduced pain with arm in abduction (up and out to side) is seen in cervical radiculitis while shoulder rotator cuff has worsening pain in that position
2) Pain on full passive elevation suggests shoulder pathology see blog note here
3) Arm sensory changes and weakness without pain suggests cervical
4) shoulder impingement tests:
5) Shoulder SLAP lesion test for torn labrium (rim of shoulder joint)
as per Medscape at here
The SLAP test (SLAPprehension test) is performed by suddenly internally rotating the shoulder as the shoulder is adducted 30∞ in 90∞ of forward flexion (Figure 1). A positive test is noted with clicking in the shoulder and/or pain radiating down the biceps tendon or in the posterior aspect of the joint.“
“Although the numbers of patients in their study is insufficient to test the validity of the test, they found that six patients who had positive crank tests all had labral tears, and no patient with a negative crank test had a labral tear.” http://cme.medscape.com/viewarticle/408488_2
6) Shoulder instability - good discussion here
7) Neck radiculitis tests:
30% sensitivity and 93% specificity - so good when you get it but means nothing if you don’t get it.
8) pain in neck and pain that radiates BELOW the elbow.
9) Triggers in trapezius, rhomboid minor, supraspinatus muscle, deltoid, supinator and perhaps forearm extensors, and so on - seen in pre-clinical radiculitis written by Dr. Chen Gunn.
9) Selective nerve root injection can confirm
What can be frustrating is when there is a neck- shoulder complex with both being players.
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