Dr. Kevin Yip

Dr Kevin Yip
Orthopaedic Surgeon
MBBS(UK), FRCS(EDIN), FAM(SING), FHKCOS(ORTHO)

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Referred Pain From The Cervical Spine

 SYMPTOMS

There is usually exercise- or movement related radiating pain and dysfunction of the shoulder, with or without preceding trauma and most often associated with discomfort or pain in the neck. Neurological signs from levels C5-C7 of the cervical spine may or may not be present in the shoulder, elbow and hand. The pain can also start as excruciating localised pain in the shoulder, with no clinical symptoms in the neck. In contact sports like rugby or after falls, acute injuries to the spine are always dangerous and must be dealt with immediately at the highest possible level of expertise. Such injuries are not dealt with further in this book 

AETIOLOGY

This is an entrapment of the C5-C7 nerve roots along the canals from the cervical spine. An underlying disc prolapse, spinal stenosis or instability from lysis or listesis may be involved. In rare cases tumours may be the cause.

CLINICAL FINDINGS

The onset can be gradual and worsen by the day from a spinal stenosis, be intermittent from an unstable segment or acute from a prolapsed disc, even though a mix of clinical problems may exist. The shoulder and range of motion of the cervical spine may be normal, which makes the diagnosis very difficult. Pain in the shoulder with normal clinical findings must raise suspicion of this injury. Whenever there is shoulder pain with distal symptoms in the arm, normal shoulder examination and no preceding trauma, the cervical spine must be examined thoroughly. Examine the neck by looking at the active range of motion in all directions, repeated against manual resistance and gentle compression tests that may or may not provoke symptoms.

INVESTIGATIONS

This is a clinically difficult diagnosis. X-rays should be taken in different planes to rule out bony pathology. MRI is helpful for spinal stenosis and disc hernia but is usually not helpful if the pain is caused by dynamic instability problems. Individual discussion with the radiologist is important

TREATMENT

If problems in the cervical spine are suspected of causing the shoulder pain and dysfunction, they must be ruled out before any treatment to the shoulder is given.

REFERRALS

Refer to Dr Kevin Yip (+65 9724 1219) senior consultant orthopaedic surgeon to evaluate the diagnosis and for consideration of surgery. In most cases a thorough rehabilitation programme including specific treatment, thoraco-scapular control training, strength, flexibility and posture training is required. In severe cases surgery is required.

EXERCISE PRESCRIPTION

Some sports and activities may be possible but secondary symptoms due to compensatory movements are common and must be addressed

EVALUATION OF TREATMENT OUTCOMES

Normal clinical symptoms and signs.

DIFFERENTIAL DIAGNOSES

Many shoulder injuries can cause neck problems and vice versa. The primary cause of the problems must be found.

LONG-TERM PROGNOSIS

Excellent-Poor, depending on the underlying problem.

SYMPTOMS

There is usually diffuse exercise or movement-related radiating pain and  dysfunction of the shoulder, with or without preceding trauma.

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