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Journal of Neurology and Neurorehabilitation Research | Volume 3
November 26-27, 2018 | Dubai, UAE
Spine and Spine Disorders
Addiction Research and Therapy
3rd International Conference on
International Conference on
Joint Event
&
Cervical spine fusion and shoulder pain: A new algorithm
Lorena Pena Larrea
Hospital Universitario Central de Asturias, Spain
T
he complex problem of combined neck and shoulder pain
is not rarely seen in our patients as the main complaint.
Some of them need a shoulder procedure (subacromial
decompressions or rotator cuff repairs) and an anterior cervical
spine fusion. This select group of complex patients illustrates
the diagnostic studies required to determine whether the pain
comes primarily from the cervical spine, shoulder, or both. Our
goal is a good pain relief in these patients.
On the one hand, some patients suffer nearly equal neck and
shoulder pain as the chief complaint. On the other hand, the
initial complaint in some others is predominantly neck painwith
only minor shoulder involvement. Sometimes, the shoulder
pain becomes more significant after the anterior cervical fusion.
This newalgorithmemphasizes theneed for a careful evaluation
of patients with combined neck-shoulder pain syndrome in a
systematic approach allowing appropriate treatment.
Many patients who have neck-shoulder pain syndrome offer a
diagnostic and therapeutic challenge, particularly when there is
dual pathology. It is potentially a frustrating situation for both
patient and surgeon when the pain is present at more than one
site. Frequently, the primary pathology in such a case is either
in the cervical spine or in the shoulder, so the patient responds
to appropriate measures directed at the site responsible for the
pain. It is well known that the cervical spine can be responsible
for referred pain to the shoulder and even down the arms. This
often occurs in a radicular pattern and can be exacerbated by
certain neck motions. Such radiating pain may eventuate in
secondary shoulder pathology such as tendinitis or adhesive
capsulitis, often leaving the patient with symptoms emanating
from both sites. Occasionally there are separate cervical and
shoulder pathologies that may arise either simultaneously or
sequentially, accounting for pain from both the cervical spine
and shoulder. As a rule, shoulder pathology does not refer
pain into the neck but may cause pain along the scapula and
trapezius muscles.
If the surgeon hopes to help these patients, a careful evaluation
must be performed to find the source of the primary pathology.
Physical examination suggests that the cervical spine should
be investigated if patients have localized posterior cervical
spine tenderness and a painful diminished range of motion of
the neck. Similarly, physical examination findings of localized
tenderness, impigement-aggravated signs, diminishedmotions,
and/or weakness in the shoulder suggests the shoulder as the
primary source of pathology. Occasionally, dual findings are
present, presenting a confusing picture.
The purpose of this speech is to suggest a guideline for
investigation and treatment of these patients, something like a
protocol to work with and follow. A careful evaluation is critical
to identify the primary pathology and to direct treatment to
that particular site.
Speaker Biography
Lorena Pena Larrea has completed her PhD from University of Navarra; Spain and she
is doing Post-doctoral studies from the University of Oviedo. She has presented more
than 20 posters and oral communications in national and international congresses.
e
:
lpena@alumni.unav.es