Check your spine; you may not have to shoulder the pain

Is your shoulder pain coming from your spine?

Shoulder pain is an extremely common ailment and one that can be disabling. Most people will experience shoulder pain at some point, with upwards of two-thirds of the population being affected during their lifetimes.

A variety of imaging studies, orthopedic tests and other forms of assessment are available to diagnose shoulder pain. Through these investigations come labels such as rotator cuff tendinosis, bursitis and impingement, to name a few. However, with the high rate of false positives among those tests, it can be difficult to accurately diagnose shoulder pain. And despite advances in technology and treatment, a sizable percentage of patients do not fully recover.

One reason for the high prevalence of chronic shoulder symptoms is a failure to account for the spine, particularly the neck and upper back. Those areas can be the source of shoulder pain in some people, even in the absence of neck or upper back pain. Despite being referred from the spine, this pain is routinely mislabeled as a diagnosis specific to the shoulder (e.g., rotator cuff tendonitis, bursitis, etc.)

Research has shown that nearly 50% of people with shoulder pain have a spinal source for their symptoms. The implications are profound. If the spine isn’t adequately addressed it is doubtful that a full recovery will be made. In those instances, patients will go from treatment to treatment directed at the shoulder when their spine is the culprit. Shoulder surgery may be the end result, which is often unsuccessful because the cause of symptoms wasn’t addressed.

The best way to determine if the neck or upper back is the source of shoulder pain is a McKenzie Method assessment, which has a built-in spinal screening process for patients with extremity pain. By having a patient move or position their neck or upper back in a specific way and observing if it affects their shoulder pain, these specialists can rule the spine in or out as the reason for symptoms. In addition, this form of testing can uncover the most effective treatment for those with a spinal source.

Even though a thorough assessment is the best way to establish a spinal connection, certain features of a patient’s presentation make it more likely that their shoulder pain is referred from their neck or upper back. These include:

· A pain pattern that includes the shoulder blade.

· Pins and needles are in the affected extremity, for example, in the hand or fingers.

· The ability to comfortably lie on the side of symptoms.

· Pain that is felt in both shoulders, especially if both sides appeared at the same time.

Not all those features need to be present for someone to have a spinal source for their shoulder pain. If you have one or more, however, there is a high possibility that the spine plays some role. Additionally, if your symptoms have been resistant to treatments directed at the shoulder, there is a good chance that your spine is a relevant player. Either way, it would be worth getting a McKenzie Method assessment to determine if you fall into that group. It may be your only chance of recovery.

Dr. Jordan Duncan is from Kitsap County and writes a monthly health column for Kitsap News Group. He is the owner of Silverdale Sport & Spine.