Neck/Shoulder Differentiation Flashcards
Radicular Pain with Radiculopathy - overview
shoulder pain greater than neck pain
local tenderness is due to nerve trunk hyperalgesia and neurogenic inflammation
pain brought on more with arm movement than neck movement
restricted movement is due to guarding of neural tissue
less associated symptoms when a C4/5 problem
Radicular Pain with Radiculopathy - Key Signs
shoulder movement affected by neck position
sustained IVF closing produces pain
sustained IVF opening maybe relieves pain
positive NDT
positive neural palpation
arm squeeze test positive
positive neural integrity test
Radicular Pain with Radiculopathy - Misleading Info
distribution doesn’t always follow dermatome maps
lots of variation in presentation
integrity testing is limited - doesn’t pick up everything
ROM reduced - due to guarding, not actual restriction
Radicular Pain Only - overview
should pain greater than neck pain
shoulder has a lot of neuromechanical laod
nerve trunk hyperalgesia causes local tenderness
pain more associated with arm loading than neck pain
less associated symptoms
Radicular Pain Only - Key Signs
shoulder movement affected by neck position positive NDT positive neural palpation negative neural integrity moving neck may not give shoulder pain don't move well into IVF opening don't control IVF closing
Radicular Pain Only - Misleading Info
local tenderness
marked movement limitation
neck assessment doesn’t reproduce arm pain
cervical assessment not looking for concordant pain - assessing whether neck mechanics are contributing factor
all nerve tissue likely to be sensitive - hard to differentiate between specific nerves
meed to make nerve testing more discriminatory - do each component separately
Somatic Referred Pain - Overview
low cervical spine and thoracic spine may refer into the shoulder
moving the arm loads somatic neck structures
pattern of pain influenced by individual’s knowledge and beliefs - sense making
Somatic Referred Pain - Key Signs
shoulder movement not influenced by neck movements
stressing the cervical spine reproduces concordant pain
- accessory movements best
evidence of cervical dysfunction
treating the neck relieves their shoulder pain
Somatic Referred Pain - Misleading Info
didn’t stress neck enough or correctly - means don’t find pain
need to do PAIVM assessment in multiple positions/directions
poor PAIVM technique
chasing concordant pain - if have non-concordant pain, means not somatic referral
need to assess thoracic spine as well
Other Presentation - Overview
common presentation doesn’t fit into other categories
unsure of cause
Other Presentation - Key Signs
no neural sensitivity or functional loss
don’t reproduce shoulder pain when stress the neck
signs of cervical dysfunction
restricted shoulder movement due to pain
non-capsular pattern of shoulder restriction
- no ER, full abduction, ER improves when placed into abduction
not influenced by neck position
Other Presentation - Key Signs
no neural sensitivity or functional loss
don’t reproduce shoulder pain when stress the neck
signs of cervical dysfunction
restricted shoulder movement due to pain
non-capsular pattern of shoulder restriction
- no ER, full abduction, ER improves when placed into abduction
not influenced by neck position
Other Presentation - Misleading Info
not about looking for concordant pain
- looking for localised problem in the neck
- not looking for shoulder pain
make sure not actually acute shoulder pain
have to give reassessment a chance - treat until change occurs, don’t reassess if nothing has changed
Other Presentation - Misleading Info
not about looking for concordant pain
- looking for localised problem in the neck
- not looking for shoulder pain
make sure not actually acute shoulder pain
have to give reassessment a chance - treat until change occurs, don’t reassess if nothing has changed
Frozen Shoulder
cervical neural tests negative cervical somatic tests negative active and passive movement restriction not influenced by neck position capsular pattern no change after treat the neck/thoracic spine
