A few tips to quickly determine whether shoulder pain is caused by cervical spondylosis

This is the 4215th article of Da Yi Xiao Hu

Some patients suspect that they have cervical spondylosis because of recurrent pain in the neck and shoulders. In fact, there are many causes of chronic neck and shoulder pain, such as neck sprain or trauma, periarthritis of shoulder, stiff neck, chronic myofibrosarcoma, fasciitis, ligament strain and other soft tissue diseases, which can all cause neck and shoulder pain. In addition, deformity, infection, tumor, rheumatic inflammation, tuberculosis, etc. can also cause chronic neck and shoulder pain. So, how can we judge which one is the case?

Neck sprain and stiff neck are often caused by improper neck movement or poor sleeping position, which leads to local muscle sprain. Patients with neck sprain know the cause of neck injury. If they encounter a car accident or sudden braking, pain will occur immediately after the injury. The characteristics of stiff neck are: everything is normal before going to bed the night before, but you feel pain in the neck and shoulders when you wake up the next morning. One side of the muscle is strained due to poor sleeping position. The rotation of the neck to one side is limited due to pain, but rotation to the other side is not limited. The tender points are often located in the deep muscle injury sites on both sides of the cervical spine, which are more common in the upper part of the scapula or the trapezius muscle area, and are accompanied by muscle spasms. You can touch the cord-like spasmodic muscle bundles with obvious tenderness. Oral non-steroidal analgesics and muscle relaxants can be taken to improve symptoms. If the effect is not good, block therapy can be performed on the tender points.

Shoulder pain caused by diseases of the shoulder joint itself is usually confined to the shoulder joint, sometimes accompanied by pain in the upper arm, but generally not exceeding the elbow joint. When moving the shoulder joint, the pain will be aggravated due to stimulation of the diseased bones, tendons, muscles, joint capsules and other diseased tissues, resulting in limited joint movement and inability to perform full range of joint movement. Periarthritis of the shoulder is the most common shoulder pain disease in middle-aged and elderly people. It is characterized by significantly limited abduction and extension of the shoulder joint, and actions such as combing hair and unbuttoning underwear cannot be completed smoothly. In severe cases, the movement of the shoulder joint in all directions is limited, similar to the shoulder being "frozen". Therefore, periarthritis of the shoulder is also called "frozen shoulder", which can be relieved after a period of time. If shoulder pain and limited movement are not relieved for a long time, or even have a tendency to worsen, and the pain is severe at night, a magnetic resonance imaging of the shoulder joint should be performed in time to check for rotator cuff injury, joint inflammation or even tumors.

Shoulder joint display intention: history of frozen shoulder, rotator cuff injury, etc., this movement is limited

Neck and shoulder myofibromyitis has obvious causes such as cold, dampness, fatigue, sprains, etc. Local muscle stiffness, mainly soreness, a large range, usually no fixed tenderness point, and a clear sense of comfort when gently massaged. X-ray examinations often show no organic lesions of the spine and joints. If the pain is widespread, conventional treatment is ineffective, or there is swelling and pain in multiple joints, you should go to the rheumatology and immunology department to check for connective tissue diseases.

Cervical spondylotic radiculopathy may also cause shoulder pain, which is "radiating pain" caused by compression of the nerve roots. The pain is characterized by no tenderness in the local soft tissue, and normal shoulder joint movement. The pain radiates to the forearm or even the fingers as if a "muscle" is hanging, and may even be accompanied by numbness. Some patients experience less pain in their arms when they raise their upper limbs above their heads. If this kind of pain occurs, be careful of cervical spondylosis and go to the hospital for appropriate examinations. Of course, a small number of cervical spondylotic radiculopathy patients will experience deltoid muscle weakness, inability to abduct the upper limbs, and "limited movement" similar to frozen shoulder. However, this limited movement is not like frozen shoulder, where there is a "frozen" condition. It is only because of muscle weakness that limited abduction occurs. With the help of others, the range of motion can be achieved or close to normal.

Patients with radiculopathy have different distribution areas of pain and numbness depending on the compressed nerve roots.

To summarize the main points

1. Neck and shoulder pain caused by shoulder joint diseases. The range of motion of the shoulder is usually limited, and the pain worsens when the joint is moved, but does not extend downward beyond the elbow joint.

2. Cervical spondylosis causes neck and shoulder pain. The range of motion of the shoulder is generally not restricted. The pain will radiate pain and numbness along the nerve innervation area, and may extend beyond the elbow joint and radiate to the forearm and fingers.

3. In a few cases, patients may suffer from both shoulder joint and cervical spine diseases. Both of the above conditions may occur and patients should see a specialist for a clear diagnosis.

Author: Tian Bo, Li Juan

Instructor: Dong Jian

Unit: Department of Orthopedics, Zhongshan Hospital Affiliated to Fudan University

Institute of Medical Science Popularization, Fudan University

This article was funded by the following project: Shanghai Science and Technology Commission Science Popularization Project

(No.: 20DZ2312000, 21DZ2302900)