Shoulder cervix is defined as the state of compression of the nerve roots of the cervical spine, accompanied by pain in the neck, which may radiate towards the upper limb. The compression of the nerve roots is most often caused by a hernia of the intervertebral disc or the presence of bone spurs (osteophytes) in the course of degenerative disease of the spine (spondylosis). The pain may be accompanied by sensory disturbances, numbness, and muscle weakness in the shoulder girdle and / or upper limb. Pain and motor deficits are typical of the anatomical area supplied by nerve fibers belonging to the compressed nerve root. It is not uncommon that there are mixed symptoms resulting from the multi-level compression of nerve structures.
Make an appointment now - with a doctor specializing in the treatment of shoulder pain at our hospital
[title]
[image-intro]
[readmore text="Read more"]{/article}
[title]
[image-intro]
[readmore text="Read more"]{/article}
Diagnostics is performed by an orthopedist or neurosurgeon and includes an interview, specific tests for the cervical spine and the analysis of additional tests. In the acute phase of pain symptoms, rest and use of painkillers are recommended. Rehabilitation proceedings are gradually being implemented. In the event of unsuccessful conservative treatment or significant progression of neurological symptoms, the doctor may decide to undergo surgery to decompress the pinched nerve structures.
Cervical spine - anatomy
The cervical spine consists of seven vertebrae (C1-C7) arranged in a physiological forward curve - it is the so-called cervical lordosis. The arched shape of the spine increases its strength and ensures optimal biomechanical conditions.
The apical vertebra (atlas) creates a direct connection to the skull by means of articular surfaces. This vertebra, exceptionally, does not have a developed shaft or a spinous process. The second cervical vertebra (rotator) has a characteristically extended upward shaft (rotor tooth), which sinks into the ring of the apical vertebra. Such a combination allows for a wide range of torsional movements of the head (to the right and left).
The remaining cervical vertebrae (C2-C7) are connected with each other by intervertebral discs (colloquially "discs") and intervertebral joints. Each disc consists of a centrally located nucleus pulposus and a surrounding fibrous ring. During neck movements, the nucleus pulposus slightly shifts within the intervertebral disc, allowing smooth movement. The resilience of the intervertebral discs provides amortization of the loads transferred from the spine to the skull. The vertebrae are additionally connected with each other by means of intervertebral joints connecting the upper and lower articular processes of the adjacent vertebrae.
The vertebrae on top of each other form a channel for the inside spinal cord. Nerve roots responsible for conducting sensory and motor stimuli exit the spinal cord through the intervertebral openings.
The causes of shoulder pain
In most cases, the occurrence of shoulder cyst is caused by degenerative changes in the spine - hernia of the intervertebral disc and / or degeneration of the intervertebral joints. The accelerated development of degenerative changes is usually caused by the habit of poor sitting position with the head tilted and / or put forward, e.g. when using a smartphone or laptop. This leads to an overload of the neck muscles and, in the longer term, to shallowing of the physiological lumbar lordosis. The intervertebral discs lose their elasticity and resistance to loads. The nucleus pulposus may protrude beyond the intervertebral disc (hernia formation) and pressure on the nerve root or spinal cord.
The disturbance of the shock-absorbing function of the intervertebral discs also results in an increased load on the intervertebral joints. Displacement of the vertebrae and the development of instability of the spine segments may occur. The intervertebral openings narrow, and bone spurs (osteophytes) form at the edges of the vertebral bodies. This increases the risk of a conflict between deformed bone elements and nerve roots.
Less common causes of compression of nerve structures include neoplastic tumors and the effects of acute injuries of the cervical spine.
Shoulder gash - symptoms
Shoulder pain is radiating to a specific upper limb dermatome, an area innervated by a given nerve root:
C2-C3: pain in the back of the head and the top of the neck,
C4: lower nape, trapezius muscle,
C5: neck, shoulder area and the front surface of the arm,
C6: nape, lateral surface of the upper arm and forearm, thumb, finger one,
C7: neck, posterior surface of the upper arm, posterior lateral part of the forearm, second and third fingers,
C8: neck, medial part of the upper arm and forearm, fourth and fifth finger,
Th1: medial part of the forearm.
Pain is associated with mechanical irritation of the nerve and local inflammation. Increased production of inflammatory mediators (TNFα, IL-6) aggravates swelling and damage to nerve fibers. Some people may experience only sensory disturbances and muscle paresis without the presence of severe pain.
Diagnosis
The doctor conducts a detailed interview with the patient, which concerns the circumstances of the pain, location and variability of symptoms under the influence of various factors. Then he performs a physical examination taking into account, inter alia, assessment of the range of motion of the cervical spine and tests to differentiate the presence of various pathologies in the area of the neck, shoulder and upper limb.
Imaging studies
The doctor assesses X-rays of the spine, which show deformations of bone structures (osteophytes, narrowing of the intervertebral holes). However, magnetic resonance imaging of the spine (MRI) is of the greatest diagnostic value. This test allows you to see the cause of the nerve compression (e.g. hernia of the intervertebral disc). Magnetic resonance imaging is the gold diagnostic standard before qualifying a patient for surgical nerve root decompression.
Neurophysiological examination
Additionally, tests may be ordered to determine the electrophysiological activity of nerves and muscles. The aim of these tests is to confirm the clinical diagnosis and eliminate other conditions with similar symptoms (e.g. carpal tunnel syndrome, ulnar nerve canal syndrome, Guyon's canal syndrome).
Differentiation - serious pathologies
- In the event of weight loss without cause, repeated low-grade fever, or ongoing cancer, the physician should consider extending the diagnosis of the primary tumor or bone metastases.
- The presence of symptoms typical of spinal cord injury (e.g. Babinski's symptom) is an urgent indication for surgical decompression.
- The constant, sharp, bursting nature of the pain that does not ease with repositioning of the cervical spine may indicate carotid or vertebral artery dissection or the presence of an abscess in the surrounding spinal tissues.
Shoulder Gap - Treatment
Rehabilitation
In the period of acute pain, the procedure consists of resting, using painkillers and anti-inflammatory drugs. It may be necessary to wear a soft collar temporarily to relieve the secondly tense muscles in the nape and neck. Supportive, there are treatments in the field of physical therapy with an analgesic effect. As soon as possible, specialized rehabilitation exercises are started, whose task is to reposition the protruding nucleus pulposus and decompress the compressed nerve root. The next stage is exercises to improve the activation of the muscles responsible for the active stabilization of the cervical spine.
Administering a steroid block
If there is no improvement after the rehabilitation treatment, the neurosurgeon may inject the spine with a steroid. Root pain relief is achieved in most patients.
Surgery
Significant compression of the nerve root causing paresis, no effects of conservative treatment and symptoms suggesting the accompanying compression of the spinal cord are the basis for the surgery. Eligibility for surgery requires correlation between clinical symptoms and MRI results. The type and scope of the procedure as well as the selection of the appropriate technique depends on the patient's individual anatomical conditions, the extent of pathological changes and the neurosurgeon's expertise in various methods of nerve root decompression.
Source:
1. Litak J, Grochowski C, Kulesza B et al. The cervical spine pain in radiculopathy. Journal of Education, Health and Sport. 2016;6(11):500-510.
2. Łukaszewska M, Łukaszewski B, Nazar J et al. Radikulopatia szyjna. Polski Przegląd Nauk o Zdrowiu 1(38) 2014.
Frequently asked questions about shoulder pain:
In the course of a shoulder, the nerve root is compressed by a hernia of the nucleus pulposus or a bone growth (osteophyte). Moreover, the nerve root may become jammed in the narrowed intervertebral opening. The most common cause of the described structural changes is the degenerative disease of the spine resulting from bad habits (the position of the head tilted forward and forward). Less commonly, pressure can be caused by the mass of the cancerous tumor.
A typical symptom of shoulder pain is unilateral pain radiating from the nape of the neck to the upper limb (shoulder, elbow, forearm or fingers). Pain may be accompanied by sensory disturbances, numbness and weakness in the muscles of the shoulder girdle and / or upper limb. The severity of the pain usually depends on the current position of the cervical spine.
In most patients, adequate management is oral painkillers and anti-inflammatory drugs, physical therapy and specialist spine rehabilitation. If necessary, the doctor performs a local injection of the spine with a steroid (cervical spine blockade). In the event of unsuccessful conservative treatment or aggravation of neurological deficits, a surgical procedure to decompress the compressed nerve structures is considered.
