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

Study Design: Systematic review. Objective: To assess the current literature regarding the relationship between the shoulder and the spine with regard to (1) overlapping pain pathways; (2) differentiating history, exam findings, and diagnostic findings; (3) concomitant pathology and optimal treatments; and (4) cervical spine-based etiology for shoulder problems. Methods: A systematic literature search was performed according to the guidelines set forth by the Cochrane Collaboration. Studies were included if they examined the clinical, anatomical, or physiological overlap between the shoulder and cervical spine. Two reviewers screened and selected full texts for inclusion according to the objectives of the study. Quality of evidence was graded using OCEBM (Oxford Center for Evidence Based Medicine) and MINORS (Methodological Index for Nonrandomized Studies) scores. Results: Out of 477 references screened, 76 articles were included for review and grouped into 4 main sections (overlapping pain pathways, differentiating exam findings, concomitant/masquerading pathology, and cervical spine-based etiology of shoulder pathology). There is evidence to suggest cervical spine pathology may cause shoulder pain and that shoulder pathology may cause neck pain. Specific examination tests used to differentiate shoulder and spine pathology are critical as imaging studies may be misleading. Diagnostic injections can be useful to confirm sources of pain as well as predicting the success of surgery in both the shoulder and the spine. There is limited evidence to suggest alterations in the relationship between the spine and the scapula may predispose to shoulder impingement or rotator cuff tears. Moreover, cervical neurological lesions may predispose patients to developing rotator cuff tears. The decision to proceed with shoulder or spine surgery first should be delineated with careful examination and the use of shoulder and spine diagnostic injections. Conclusion: Shoulder and spine pathology commonly overlap. Knowledge of anatomy, pain referral patterns, shoulder kinematics, and examination techniques are invaluable to the clinician in making an appropriate diagnosis and guiding treatment. In this review, we present an algorithm for the identification and treatment of shoulder and cervical spine pathology.

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The Relationship Between the Critical Shoulder Angle and the Incidence of Chronic, Full-Thickness Rotator Cuff Tears and Outcomes After Rotator Cuff Repair: A Systematic Review

Arthroscopy The Journal of Arthroscopic and Related Surgery ◽

10.1016/j.arthro.2019.05.044 ◽

2019 ◽

Vol 35 (11) ◽

pp. 3135-3143.e4 ◽

Cited By ~ 10

Author(s):

Shgufta Docter ◽

Moin Khan ◽

Seper Ekhtiari ◽

Christian Veillette ◽

Ryan Paul ◽

...

Keyword(s):

Systematic Review ◽

Rotator Cuff ◽

Rotator Cuff Repair ◽

Rotator Cuff Tears ◽

Full Thickness ◽

Critical Shoulder Angle ◽

The Relationship ◽

Cuff Repair ◽

Shoulder Angle

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The Relationship between Clinical Tests, Ultrasound Findings and Selected Field-Based Wheelchair Skills Tests in a Cohort of Quadriplegic Wheelchair Rugby Athletes: A Pilot Study

Applied Sciences ◽

10.3390/app11094162 ◽

2021 ◽

Vol 11 (9) ◽

pp. 4162

Author(s):

Lucrezia Tognolo ◽

Alfredo Musumeci ◽

Andrea Pignataro ◽

Nicola Petrone ◽

Michael Benazzato ◽

...

Keyword(s):

Rotator Cuff ◽

Shoulder Joint ◽

Rating Scale ◽

Clinical Tests ◽

Wheelchair Rugby ◽

Manual Wheelchair ◽

Shoulder Pathology ◽

Cord Injury ◽

Pathologic Findings ◽

The Relationship

Manual wheelchair use may determine shoulder joint overload and rotator cuff injury. Chronic shoulder pathologies can also influence the propulsion ability of wheelchair athletes with spinal cord injury (SCI) during sport activities. However, the relationship between shoulder pathology and wheelchair performances has never been explored. Therefore, the study aimed to investigate the correlation between shoulder pathologic findings with clinical tests and ultrasonography evaluation and the results of wheelchair performance tests. Nineteen quadriplegic wheelchair rugby players were evaluated to investigate the association between clinical and ultrasound shoulder pathologic findings and their correlation with the performance of field-based selected wheelchair skills tests (WSTs). The outcome measures were the International Wheelchair Rugby Classification Score, dominant and non-dominant Physical Examination Shoulder Score, and dominant and non-dominant Ultrasound Shoulder Pathology Rating Scale (USPRS). The WST was measured at the beginning and at one-year follow-up. A statistically significant correlation was found between the time since SCI and dominant USPRS (p < 0.005). The non-dominant USPRS was strongly related to WST at the beginning (p < 0.005) and the end of the study (p < 0.05). Data suggest that the severity of the non-dominant shoulder pathology detected on the ultrasound is related to lower performance on the WST. Chronic manual wheelchair use could be responsible for dominant SCI shoulder joint and rotator cuff muscle damage, while non-dominant USPRS could be related to performance on the WST.

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Diagnostic accuracy of ultrasound for rotator cuff tears in adults: A systematic review and meta-analysis

Clinical Radiology ◽

10.1016/j.crad.2011.05.007 ◽

2011 ◽

Vol 66 (11) ◽

pp. 1036-1048 ◽

Cited By ~ 97

Author(s):

T.O. Smith ◽

T. Back ◽

A.P. Toms ◽

C.B. Hing

Keyword(s):

Systematic Review ◽

Rotator Cuff ◽

Diagnostic Accuracy ◽

Meta Analysis ◽

Rotator Cuff Tears

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The optimal treatment for stage 2–3 Goutallier rotator cuff tears: A systematic review of the literature

Journal of Orthopaedics ◽

10.1016/j.jor.2018.01.042 ◽

2018 ◽

Vol 15 (2) ◽

pp. 283-292

Author(s):

Freek Hollman ◽

Nienke Wolterbeek ◽

Petra E. Flikweert ◽

Kiem G. Auw Yang

Keyword(s):

Systematic Review ◽

Rotator Cuff ◽

Optimal Treatment ◽

Rotator Cuff Tears ◽

Review Of The Literature

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Full-Thickness Rotator Cuff Tears: What Is the Rate of Tear Progression? A Systematic Review

Arthroscopy The Journal of Arthroscopic and Related Surgery ◽

10.1016/j.arthro.2018.07.031 ◽

2019 ◽

Vol 35 (1) ◽

pp. 228-234 ◽

Cited By ~ 5

Author(s):

Cory A. Kwong ◽

Yohei Ono ◽

Michael J. Carroll ◽

Lee W. Fruson ◽

Kristie D. More ◽

...

Keyword(s):

Systematic Review ◽

Rotator Cuff ◽

Rotator Cuff Tears ◽

Full Thickness

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Supraspinatus-to-Glenoid Contact Occurs During Standardized Overhead Reaching Motion

Orthopaedic Journal of Sports Medicine ◽

10.1177/23259671211036908 ◽

2021 ◽

Vol 9 (10) ◽

pp. 232596712110369

Author(s):

Gaura Saini ◽

Rebekah L. Lawrence ◽

Justin L. Staker ◽

Jonathan P. Braman ◽

Paula M. Ludewig

Keyword(s):

Rotator Cuff ◽

Pearson Correlation ◽

Supraspinatus Tendon ◽

Contact Angles ◽

Magnetic Resonance Images ◽

Rotator Cuff Tears ◽

Internal Impingement ◽

Glenoid Morphology ◽

Minimum Distances ◽

The Relationship

Background: Rotator cuff tears may result from repeated mechanical deformation of the cuff tendons, and internal impingement of the supraspinatus tendon against the glenoid is one such proposed mechanism of deformation. Purpose: To (1) describe the changing proximity of the supraspinatus tendon to the glenoid during a simulated overhead reaching task and (2) determine the relationship between scapular morphology and this proximity. Additionally, the patterns of supraspinatus-to-glenoid proximity were compared with previously described patterns of supraspinatus-to-coracoacromial arch proximity. Study Design: Descriptive laboratory study. Methods: Shoulder models were created from magnetic resonance images of 20 participants. Standardized kinematics were imposed on the models to simulate functional reaching, and the minimum distances between the supraspinatus tendon and the glenoid and the supraspinatus footprint and the glenoid were calculated every 5° between 0° and 150° of humerothoracic elevation. The angle at which contact between the supraspinatus and the glenoid occurred was documented. Additionally, the relationship between glenoid morphology (version and inclination) and the contact angle was evaluated. Descriptive statistics were calculated for the minimum distances, and glenoid morphology was assessed using Pearson correlation coefficients and simple linear regressions. Results: The minimum distances between the tendon and the glenoid and between the footprint and the glenoid decreased as elevation increased. Contact between the tendon and the glenoid occurred in all participant models at a mean elevation of 123° ± 10°. Contact between the footprint and the glenoid occurred in 13 of 20 models at a mean of 139° ± 10°. Less glenoid retroversion was associated with lower tendon-to-glenoid contact angles ( r = –0.76; R 2 = 0.58; P < .01). Conclusion: This study found that the supraspinatus tendon progressively approximated the glenoid during simulated overhead reaching. Additionally, all participant models eventually made contact with the glenoid by 150° of humerothoracic elevation, although anatomic factors influenced the precise angle at which contact occurred. Clinical Relevance: Contact between the supraspinatus and the glenoid may occur frequently within the range of elevation required for overhead activities. Therefore, internal impingement may be a prevalent mechanism for rotator cuff deformation that could contribute to cuff pathology.

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