Clinical Neurology in Practice: The Shoulder (Part 2)

The shoulder's intricate neuroanatomy and biomechanics render it uniquely vulnerable to a broad spectrum of neurological disorders, from central lesions to peripheral nerve injuries. While Part 1 of this series established the anatomic and neurological foundations of shoulder function, Part 2 focuses on the pathologic landscape of neurological shoulder affections. These conditions-ranging from rare central syndromes to common peripheral neuropathies-often present diagnostic challenges due to overlapping clinical features with orthopedic and rheumatological disorders. A systematic understanding of their distinct manifestations is essential for accurate diagnosis and targeted management.

This review synthesizes historical insights with contemporary clinical evidence to explore neurological pathologies involving the shoulder. Key topics include central nervous system syndromes, peripheral nerve pathologies, neuromuscular junction and muscle disorders, postneurological injury complications, and therapeutic strategies (emerging research directions and multidisciplinary approaches to optimize patient outcomes, including rehabilitation protocols and surgical interventions). The review integrates practical tools for clinical evaluation, such as illustrated anatomic landmarks, reflex testing protocols, and differential diagnostic algorithms, while bridging historical observations with modern diagnostic techniques.

By synthesizing anatomic precision with clinical applicability, this paper equips neurologists to recognize and manage neurological shoulder pathologies. The framework presented-combining historical depth with evidence-based techniques-aims to refine diagnostic accuracy, inform targeted interventions, and improve patient outcomes. Together with Part 1, this series provides a comprehensive resource for understanding the shoulder's role in neurological practice, from foundational anatomy to advanced pathologic management.