Shoulder pain is commonly attributed to rotator cuff tears,with an estimated 4.5 million US physician visits in 2002
for cuff problems. Although the tear may be treated conservatively at times, surgical repair is often recommended if physical therpy has not resulted in better function and relief of pain after 6-8 weeks, or when tears are large and accompanied by weakness. One hopes to intercede with repair in a symptomatic shoulder before muscle atrophy, fatty infiltration or retraction occur, as this impacts on repair success.
It's important to remember, however, that shoulder pain can also be produced by an extrinsic cause such as cervical radiculopathy. Indeed, neck arthritis and/or degenerative disc disease can both coexist with a rotator cuff disease and cause shoulder pain in the absence of a problem like bursitis, impingement, or a rotator cuff tear.
I have attached a review article below, if you would like to read more. It is not infrequent that I see patients who are referred by their Spine Doctor after neck surgery, or by their Internist---for either shoulder pain or trapezial discomfort. The 4th and 5th cervical nerve roots can become pinched by cervical spodylosis--osteophytes in the facet joints or the uncovertebral joints (joints of Luschka). Spondylosis can result in axial neck pain, as well as
cervical radiculopathy and cervical myelopathy. ‘‘Radiculopathy’’refers to the presence of pain, sensory changes,or motor deficits in a dermatomal distribution and can exist with or without neck pain. Myelopathy is diagnosed when long track signs in the upper and lower extremities are
present. Radiculopathy is generally produced by 1 of 2 mechanisms.Most commonly, disk herniation occursthrough an annular fissure, typically through the posteriorlateral disk. Alternatively, foraminal stenosis due to thedegenerative changes can impinge on the nerve root.
The localization of the arm pain is related to the level of root compression. A C4 radiculopathy can produce pain
radiating from the neck to the superior aspect of the shoulder and posteriorly to the scapula. Motor findings can be difficult to detect with this level of a lesion. Rotator cuff disease is more commonly mimicked by a C5radiculopathy. Pain in this situation is commonly localized
to the shoulder and weakness found in abduction and external rotation of the shoulder. Weakness from cervical radiculopathy is usually incomplete; profound weakness and atrophy are uncommon except in chronic neglected cases. This pattern of pain and weakness can also be produced by a suprascapular neuropathy. The diagnosis of a radiculopathy can be made with well definedsymptoms and neurologic examination with a corresponding structural lesion on an imaging study, generally a magnetic resonance imaging study. Electrophysiologic studies can be useful to confirm the diagnosis and to exclude other neurologic conditions. In a radiculopathy, fibrillation potentials and positive sharp waves will
typically be present in the paraspinal muscles and the
muscles of the involved myotome. Although the presence of spondylosis becomes progressively more common through life, the peak incidence
and prevalence of cervical radiculopathy are both in the sixth decade of life and then decline.Cervical radiculopathy is commonly treated nonoperatively,
at least initially, with measures such as analgesics, anti-inflammatory medication, muscle relaxants, corticosteroids, injections, and physical modalities including traction.Surgical treatment for cervical radiculopathy is typically indicated for persistent, disabling radicular pain, progressive
motor deficit, or disabling motor loss. Although the information in the literature on the prevalence of a combined disorder of rotator cuff tearing and
cervical radiculopathy is limited, any discussion of treatment is even more so.
My general approach includes conservative treatment for most cases of cervical radiculopathy---when also accompanied by a rotator cuff problem. Most patients who seek relief from their shoulder pain prefer to address the shoulder first, when surgical treatment is necessary. Thereafter, if incomplete pain relief is still problematic, neck surgery may be recommended. However, prior to any recommendation for shoulder surgery, I will typically have you see a "neck surgeon" first if physical therapy has not been helpful.
for cuff problems. Although the tear may be treated conservatively at times, surgical repair is often recommended if physical therpy has not resulted in better function and relief of pain after 6-8 weeks, or when tears are large and accompanied by weakness. One hopes to intercede with repair in a symptomatic shoulder before muscle atrophy, fatty infiltration or retraction occur, as this impacts on repair success.
It's important to remember, however, that shoulder pain can also be produced by an extrinsic cause such as cervical radiculopathy. Indeed, neck arthritis and/or degenerative disc disease can both coexist with a rotator cuff disease and cause shoulder pain in the absence of a problem like bursitis, impingement, or a rotator cuff tear.
I have attached a review article below, if you would like to read more. It is not infrequent that I see patients who are referred by their Spine Doctor after neck surgery, or by their Internist---for either shoulder pain or trapezial discomfort. The 4th and 5th cervical nerve roots can become pinched by cervical spodylosis--osteophytes in the facet joints or the uncovertebral joints (joints of Luschka). Spondylosis can result in axial neck pain, as well as
cervical radiculopathy and cervical myelopathy. ‘‘Radiculopathy’’refers to the presence of pain, sensory changes,or motor deficits in a dermatomal distribution and can exist with or without neck pain. Myelopathy is diagnosed when long track signs in the upper and lower extremities are
present. Radiculopathy is generally produced by 1 of 2 mechanisms.Most commonly, disk herniation occursthrough an annular fissure, typically through the posteriorlateral disk. Alternatively, foraminal stenosis due to thedegenerative changes can impinge on the nerve root.
The localization of the arm pain is related to the level of root compression. A C4 radiculopathy can produce pain
radiating from the neck to the superior aspect of the shoulder and posteriorly to the scapula. Motor findings can be difficult to detect with this level of a lesion. Rotator cuff disease is more commonly mimicked by a C5radiculopathy. Pain in this situation is commonly localized
to the shoulder and weakness found in abduction and external rotation of the shoulder. Weakness from cervical radiculopathy is usually incomplete; profound weakness and atrophy are uncommon except in chronic neglected cases. This pattern of pain and weakness can also be produced by a suprascapular neuropathy. The diagnosis of a radiculopathy can be made with well definedsymptoms and neurologic examination with a corresponding structural lesion on an imaging study, generally a magnetic resonance imaging study. Electrophysiologic studies can be useful to confirm the diagnosis and to exclude other neurologic conditions. In a radiculopathy, fibrillation potentials and positive sharp waves will
typically be present in the paraspinal muscles and the
muscles of the involved myotome. Although the presence of spondylosis becomes progressively more common through life, the peak incidence
and prevalence of cervical radiculopathy are both in the sixth decade of life and then decline.Cervical radiculopathy is commonly treated nonoperatively,
at least initially, with measures such as analgesics, anti-inflammatory medication, muscle relaxants, corticosteroids, injections, and physical modalities including traction.Surgical treatment for cervical radiculopathy is typically indicated for persistent, disabling radicular pain, progressive
motor deficit, or disabling motor loss. Although the information in the literature on the prevalence of a combined disorder of rotator cuff tearing and
cervical radiculopathy is limited, any discussion of treatment is even more so.
My general approach includes conservative treatment for most cases of cervical radiculopathy---when also accompanied by a rotator cuff problem. Most patients who seek relief from their shoulder pain prefer to address the shoulder first, when surgical treatment is necessary. Thereafter, if incomplete pain relief is still problematic, neck surgery may be recommended. However, prior to any recommendation for shoulder surgery, I will typically have you see a "neck surgeon" first if physical therapy has not been helpful.
