SIB #403-Cervical Spine and Shoulder Pathology

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

The Facts:

a. The authors reviewed the literature regarding the link of shoulder pain to the spine.

b. Their review included 76 articles.

c. They noted a number of relevant facts including: “The phenomenon of referred pain occurs when nerve fibers from different locations in the body synapse on the same second order neurons.  Pain from the shoulder is relayed through the brachial plexus and into the cervical nerve roots, particularly at the C5-6 level.”

d. “Head forward posture results in overuse injury to the shoulder.”

e. “The spine and shoulder have an integral biomechanical relationship.”

f. “Spinal malalignment specifically in the thoracic region seems to negatively impact the shoulder. Culham and Peat showed that altered cervical and thoracic sagittal alignment changes the kinematics and resting posture of the scapula.”

g. “Greenfield et al reported that patients with overuse injury to the shoulder were more likely to have a head forward posture that correlates with increasing thoracic kyphosis.”

h. “Muscular forces across the shoulder are altered by changes in spinal alignment. Spinal posture has been shown to affect the rate of rotator cuff tears.”

i. In their conclusion they also note, “Injury to the nerve, disc, facet complex, or paravertebral soft tissues from C3-7 can refer pain to the posterior shoulder.” 

Take Home: Changes in spinal alignment also change the mechanics of the shoulder and this can cause shoulder problems. Additionally shoulder pathology may refer pain to the neck.

Reviewer's Comments: There is a complex interplay between different areas of the body. Spinal alignment is one of the things that can be important. Once again we note that structure is important and the scientific community knows it. This is a big article and we cannot do it justice in our limited space. I suggest you read read the full text (see link below) and in particular play attention to figure 4 which shows how forward head posture affects the scapula and rotator cuff.

Reviewer:  Roger Coleman DC

Editor: Mark R. Payne DC 

Reference: Karsuura Y, Bruce J, Taylor S, Gullota L, Kim HJ. Overlapping, Masquerading, and Causative Cervical Spine and Shoulder Pathology: A Systematic Review. Global Spine J. 2020 Apr;10(2):195-208. doi: 10.1177/2192568218822536. Epub 2019 Feb 17. 

Link to Abstract: https://www.ncbi.nlm.nih.gov/pubmed/32206519 

Link to Full Text: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7076593/pdf/10.1177_2192568218822536.pdf