Overlapping, Masquerading, and Causative Cervical Spine and Shoulder Pathology: A Systematic Review

Area of Science:

• Orthopedics
• Neurology
• Pain Management

Background:

• The shoulder and cervical spine share complex anatomical and physiological connections.
• Understanding this relationship is crucial for accurate diagnosis and effective treatment of musculoskeletal pain.

Purpose of the Study:

• To systematically review the literature on the relationship between shoulder and spine pathology.
• To explore overlapping pain pathways, diagnostic differentiation, concomitant conditions, and treatment strategies.
• To investigate cervical spine etiology for shoulder problems.

Main Methods:

• Systematic literature search adhering to Cochrane Collaboration guidelines.
• Inclusion of studies examining clinical, anatomical, or physiological overlap between shoulder and cervical spine.
• Quality assessment using Oxford Center for Evidence Based Medicine (OCEBM) and Methodological Index for Nonrandomized Studies (MINORS) scores.

Main Results:

• 76 articles reviewed, confirming that cervical spine pathology can cause shoulder pain and vice versa.
• Examination tests are critical for differentiating shoulder and spine pathology, as imaging can be misleading.
• Diagnostic injections aid in confirming pain sources and predicting surgical success; cervical neurological lesions may predispose to rotator cuff tears.

Conclusions:

• Shoulder and spine pathologies frequently overlap, necessitating a comprehensive clinical approach.
• Knowledge of anatomy, pain referral patterns, kinematics, and examination techniques is vital for diagnosis and treatment.
• An algorithm is presented to aid clinicians in identifying and managing shoulder and cervical spine pathology.