Citation

Gorski JM, Schwartz LH. J. Bone Joint Surg. Am. 2003; 85-A(4): 635-638.

Affiliation

Department of Orthopaedic Surgery, Winthrop University Hospital, Stonybrook University School of Medicine, Mineola, New York, USA. jgorskimd@hotmail.com

Copyright

(Copyright © 2003, Journal of Bone and Joint Surgery)

DOI

unavailable

PMID

12672838

Abstract

BACKGROUND: Chronic neck pain can be a difficult problem to evaluate and treat, as it can have several different causes. We studied a series of patients with neck pain near the superomedial aspect of the scapula that was referred pain from inflammation of the shoulder secondary to chronic impingement. We postulate that some patients with specific clinical findings and neck pain can benefit from treatment of shoulder impingement. METHODS: We conducted a retrospective review of the charts of thirty-four patients with neck pain who met three criteria for the diagnosis of shoulder impingement syndrome: (1) a positive impingement sign with pain referred to the neck, (2) radiographic abnormalities, and (3) relief of neck pain after injection of lidocaine and cortisone into the subacromial space. Subjective pain scores were determined before and after the injection. RESULTS: Thirty of the thirty-four patients obtained immediate relief of the neck pain following injection into the subacromial space, and the remaining four had substantial pain relief when they were evaluated three weeks following the injection. Avoidance of the shoulder impingement position (forward elevation of the arm above 90 degrees ) subsequently minimized recurrences. CONCLUSIONS: In selected patients, chronic neck pain may be caused by shoulder impingement, which can be easily diagnosed with standard techniques. The difficulty in making this diagnosis is that the patient presents with neck pain rather than with the typical shoulder pain. The differential diagnosis of chronic lower neck pain should include shoulder impingement syndrome, which can be identified by classic physical and radiographic signs and can be treated with injection into the subacromial space and avoidance of the shoulder impingement position.

Almost three-quarters of the patients in this series had been involved in an automobile accident. Chronic neck pain following an automobile accident has been putatively linked to the "whiplash" mechanism of acceleration/deceleration forces on the head and neck. However, no objective evidence of a pathological lesion in patients with whiplash has ever been found. In a review of the literature, the Quebec Task Force on Whiplash-Associated Disorders concluded that little is known about the cause and treatment of chronic neck pain. The shoulder can be injured along with the neck in an automobile accident. Collision forces are transferred to the shoulder from the arm while the individual is holding the steering wheel. Additional forces on the shoulder may result from inertial effects of a chest restraint. These forces can result in compression of the rotator cuff and subacromial bursa between the humeral head, the acromion, and the coracoacromial ligament, but the frequency of this proposed etiology of neck pain is unknown.

Language: en