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Shoulder or Neck Pain

Written on October 22, 2008 at 7:30 am, by Eric Cressey

Mark Comerford made a really good point last weekend when he was talking about differentiating between neck and shoulder-related upper extremity pain. In many cases, the symptoms are very similar. For instance, both labral problems and cervical spine impingement can cause numbness into the lower arm. And, both rotator cuff tendinopathies and tears and cervical spine issues can refer pain to the medial border of the scapula.

Comerford noted (and it holds true in everyone that I’ve seen) that when you have something from the cervical spine (neck), weakness is greater than pain. Conversely, if it’s a problem of shoulder origin, there is generally more pain than weakness. Simple, but I’ve never heard of anyone actually put it out there. Smart dude.

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  • CincinnatiDC

    Eric,
    I have to agree and disagree with the “Shoulder vs. Neck Pain” post. Most of my patients with medial scapular border pain with 0 neck pain turn out to be cervical spine disc herniations or lateral recess stenosis. I would say 99%. Most of these neck cases have no pain or weakness into the arm. The only finding is usually a weak C7 deep tendon reflex, but I actually only find this on 1/3 of the cases. As for symptoms from shoulder pathology the most common symptom is referred pain at the deltoid tuberosity along with weakness in the arm. Deltoid tuberosity pain is an automatic shoulder MRI order for me if I am unable to get reduction in symptoms with 2 weeks of conservative care. MRI most commonly shows supraspinatus tear.

  • PhysioRob

    The best approach to differentiate neck pain from shoulder pain is the use of a set of clinical prediction rules. Wainner et al (2003) found 4 key tests are best to determine if a patient has a cervical radiculopathy: positive head distraction test, positive upper limb tension test, less than 60 degrees rotation to the painful side and positive Spurling’s Test A. If 4/4 of these tests are positive the authors demonstrated a .99 specificity.

    If these tests are negative I move on to my special tests of the shoulder. Hawkins, Neers, Drop Arm Test and Painful Arc. If these are positive I am certain I am dealing with pain originating from the shoulder.


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