The dervan upper limb dermatome syndrome pilot study of high incidence of cervical disc disease in patients presenting with primary shoulder pain & restriction of movements

Abstract

Introduction: Shoulder pain is among the most common complaints in the orthopedic outpatient department. It can be due to local pathology or a referred pain from cervical disc degeneration. Frequently, neck and shoulder pathologies may co-exist causing a dilemma regarding treatment approach. Although there are many studies published in literature, we think ours is the first published Indian study to make the observation of concomitant cervical disc degeneration in patients with ipsilateral shoulder pain.Materials & Methods: 39 patients with shoulder pain without any history of trauma, attended the OPD of Walawalkar hospital, Dervan. Of the 3 patients 32 agreed to be part of this pilot study. They underwent x rays & MRI of the shoulder as well as cervical spine.Results: All patients who presented in the orthopaedicopd with complaints of atraumatic shoulder pain, showed varying degrees of cervical disc disease. The commonest affected cervical spine pathological segment was C5-C6 i.e 92 % with two patients having C6-C7 disc disease i.e 8 %.Grading of disc disease was 78.1 % grade 28, 6 patients had grade 3 disc disease, 18.75 %, and only 1 patient had a grade 1 disease with typical signs of chemical radiculopathy with shoulder pain & restriction.X Ray of shoulder showed normal acromiohumeral distance of more than 7 mm in more than 70 % of patients and less than 2 mm in only 1 patient who also incidentally had grade 3 disc disease.MRI of shoulder showed 78 % patients with grade 2 or less of Goutallier grading [9] and all patients of Grade 3 disc disease having grade 3 Goutallier grading and a positive Tangent sign [10]. (18.75 %)This may open another vista in investigation of degenerative rotator cuff disease mimicking grading and severity of cervical disc disease although that is not the primary objective of this paper. We aimed to bring to light the concomitant cervical spine pathology in patients presenting with shoulder pain in this original research. Conclusion: This study found an unusually high rate of coexistent shoulder and cervical spine pathologies. Almost all patients had some form of cervical disc disease and on deeper questioning related signs and symptoms of cervical spondylosis concurrently or a few weeks ago. It undermines the need for investigating this important contributor, the cervical spine, to clinically diagnose the enigma of shoulder pain.