The association between cervical spine pathology and rotator cuff dysfunction.
METHODS
Retrospective cohort study.


OBJECTIVE
To investigate the relationship between cervical spine (C-spine) and rotator cuff (RTC) pathology.


BACKGROUND
Cervical spine and RTC pathology cause significant shoulder pain in isolation and in tandem, but there is limited information about the relationship between these 2 entities.


METHODS
Patients with a diagnosis of C-spine and/or RTC pathology between 2005 and 2011 were identified using a large national database composed of private payer as well as Medicare patient records. Patients with concomitant C-spine and RTC diagnoses were then stratified by age group and sex. Patients with lumbar spine (L-spine) and RTC pathology were used as a comparative group, and multivariate logistic regression was used for statistical analysis.


RESULTS
Concomitant C-spine and RTC diagnoses were identified in 86,928 patients representing 13% of 679,112 patients with a RTC diagnosis and 16% of 531,177 patients with a C-spine diagnosis. The association between C-spine and RTC pathology increased significantly with age as RTC diagnoses were present in 13% of patients with C-spine pathology younger than 60 years old but increased to 25% in C-spine patients older than 60 years (P<0.0001). For patients over 60 years old who developed a new C-spine diagnosis, 11% would develop a new RTC diagnosis or undergo an operation for a RTC disorder within 5 years. Lumbar diagnosis codes (2,297,480 patients) were over 4 times more common than C-spine codes but RTC pathology had a significantly higher correlation with C-spine pathology than L-spine pathology (odds ratio, 2.32) and patients with C-spine pathology were more likely to develop new rotator cuff pathology (odds ratio, 1.53).


CONCLUSIONS
The association between cervical spine and RTC pathology is significantly greater than that between L-spine and RTC pathology and increases substantially with patient age. Further studies are needed to elucidate the cause of this relationship.
Department of Orthopaedic Surgery, University of California-San Francisco, San Francisco, CA.
Alan L
AL
Zhang
Alexander A
AA
Theologis
Bobby
B
Tay
Brian T
BT
Feeley
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000375:Aging / Q000473:pathology; D002574:Cervical Vertebrae / Q000473:pathology*; D002648:Child; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008159:Lumbar Vertebrae / Q000473:pathology; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D017006:Rotator Cuff / Q000473:pathology*; D020069:Shoulder Pain / Q000209:etiology / Q000473:pathology; D013122:Spinal Diseases / Q000150:complications* / Q000453:epidemiology; D016896:Treatment Outcome; D055815:Young Adult