Implicación de la columna cervical en el dolor muscoesquelético de hombro

Abstract

Background: shoulder pain is the third most common cause of musculoskeletal disorders and the main cause of non-traumatic upper limb pain. Properly diagnosing this entity is still challenging for physical therapists as there is no homogeneity or uniformity in diagnosis labelling and clinical criteria. Objectives: quantifying Cervical Spine Implication in shoulder pain. Observing shoulder symptoms modification and symptoms reproduction after a cervical spine screening in relation with shoulder pain. Analysing if Cervical Spine Implication diagnosis may coexist with other shoulder pain labelling or even be considered as a unique diagnosis itself. Methods: patients from Shoulder Unit of Cemtro Clinic and Hospital Universitario Príncipe de Asturias were examined after signing informed consent. The cervical spine screening was performed in order to observe symptoms modification or reproduction with this approach. Cervical Spine Implication was considered if a >30% shoulder symptoms modification was recorded after the cervical spine screening. Pain (NPRS scale), selfreported shoulder function (SPADI), active shoulder range of motion (inclinometer), active neck range of motion (Cervical Range of Motion measuring device) and symptoms expansion (body chart) were recorded as dependent variables. Also, a proposal of a shoulder pain diagnosis based on functional subclassification was carried out in all subjects. This considered terms as acromioclavicular joint pain, stiff shoulder, unstable shoulder, rotator cuff related shoulder pain or “others”. Results: 60 patients were examined from February 2020 to June 2022. Descriptive analysis showed a 50% prevalence of Cervical Spine Implication phenomenon. Symptoms reproduction was found in 60% of Cervical Spine Implication patients. Statistically and clinically significant changes were found in Cervical Spine Implication patients in pain (p<0,001), and statistically significant changes in shoulder flexion and abduction (p<0,001), in shoulder internal rotation (p=0,02) and external rotation at 0º abduction (p=0,008), in neck extension (p=0,018) and right-side bending (p=0,005). No statistically significant changes were observed in Cervical Spine Implication patients in shoulder strength or self-reported shoulder function. Cervical Spine Implication diagnosis was associated with centralization phenomenon (p=0,002), previous neck pain (p=0,007), rotator cuff related shoulder pain diagnosis (p=0,002), female gender (p=0,037), weight (p=0,002) and height (p=0,010). Rotator cuff related shoulder pain was the most prevalent diagnostic subgroup (46,7% of all patients), in which Cervical Spine Implication phenomenon was present in 71,4% of them. Conclusions: Cervical Spine Implication is a prevalent phenomenon in musculoskeletal shoulder pain where patients experience mainly symptoms modification, but also symptoms reproduction after a cervical spine screening. It seems it may coexist with other diagnosis or even be considered as a unique diagnosis itself. Future research with larger samples including prospective designs with longer follow-ups and randomized clinical trials are required.