title: An Evidence-Based Approach to Differentiating the Cause of Shoulder and Cervical Spine Pain.
abstract: Differentiating the cause of pain and dysfunction due to cervical spine and shoulder pathology presents a difficult clinical challenge in many patients. Furthermore, the anatomic region reported to be painful may mislead the practitioner. Successfully treating these patients requires a careful and complete history and physical examination with appropriate provocative maneuvers. An evidence-based selection of clinical testing also is essential and should be tailored to the most likely underlying cause. When advanced imaging does not reveal a conclusive source of pathology, electromyography and selective injections have been shown to be useful adjuncts, although the sensitivity, specificity, and risk-reward ratio of each test must be considered. This review provides an evidence-based review of common causes of shoulder and neck pain and guidelines for assistance in determining the pain generator in ambiguous cases.
authors.affiliation: Department of Orthopedics, Warren Alpert Medical School of Brown University, Providence, RI.
authors.forename: Steven L
authors.initials: SL
authors.lastname: Bokshan
authors.affiliation: Department of Orthopedics, Warren Alpert Medical School of Brown University, Providence, RI.
authors.forename: J Mason
authors.initials: JM
authors.lastname: DePasse
authors.affiliation: Department of Orthopedics, Division of Spine Surgery, Warren Alpert Medical School of Brown University, Providence, RI.
authors.forename: Adam E M
authors.initials: AE
authors.lastname: Eltorai
authors.affiliation: Department of Orthopedics, Division of Shoulder and Elbow Surgery, Warren Alpert Medical School of Brown University, Providence, RI.
authors.forename: E Scott
authors.initials: ES
authors.lastname: Paxton
authors.affiliation: Department of Orthopedics, Division of Shoulder and Elbow Surgery, Warren Alpert Medical School of Brown University, Providence, RI.
authors.forename: Andrew
authors.initials: A
authors.lastname: Green
authors.affiliation: Department of Orthopedics, Division of Spine Surgery, Warren Alpert Medical School of Brown University, Providence, RI. Electronic address: alandanielsmd@gmail.com.
authors.forename: Alan H
authors.initials: AH
authors.lastname: Daniels
mesh_terms: D002574:Cervical Vertebrae / Q000473:pathology; D003937:Diagnosis, Differential; D019317:Evidence-Based Medicine; D006801:Humans; D019547:Neck Pain / Q000175:diagnosis* / Q000209:etiology / Q000473:pathology; D012785:Shoulder Joint / Q000473:pathology; D020069:Shoulder Pain / Q000175:diagnosis* / Q000209:etiology / Q000473:pathology
keywords: Cervical spine; Differentiate; Dysfunction; Pain; Shoulder