Can cervical radiculopathy (inflammation of a nerve root in the cervical spine) cause shoulder pain?

From the Guidelines

Cervical radiculopathy is a significant cause of shoulder pain, and it is essential to consider this condition in the differential diagnosis of shoulder pain, especially when accompanied by neck pain and radiating symptoms down the arm. Cervical radiculopathy is defined as a syndrome of pain or sensorimotor deficits due to dysfunction of a cervical spinal nerve, the roots of the nerve, or both, with a clinical presentation that typically includes a combination of neck pain with pain in one arm, accompanied by varying degrees of sensory or motor function loss in the affected nerve-root distribution 1. The condition may result from compressive causes related to narrowing of the neural foramina, such as by facet or uncovertebral joint hypertrophy, or from associated disc bulging or herniation and degenerative spondylosis in the absence of a history of diabetes or red flag symptoms 1.

Some key points to consider in the diagnosis and management of cervical radiculopathy include:

• The average annual age-adjusted incidence of cervical radiculopathy is 83.2 per 100,000 people, making it less prevalent than cervical or neck pain 1
• A recent meta-analysis found limited evidence for a correlation between physical examination findings and MRI evidence of cervical nerve root compression, which may be due to a high rate of both false-positive and false-negative findings on MRI in the setting of suspected cervical radiculopathy 1
• Most cases of acute cervical neck pain with radicular symptoms resolve spontaneously or with conservative treatment measures, and imaging may not be required at the time of initial presentation in the absence of red flag symptoms 1
• Red flag symptoms, such as trauma, malignancy, prior neck surgery, spinal cord injury, systemic diseases, and neurological deficits, should be carefully evaluated, and their presence may necessitate immediate imaging and further investigation 1

In terms of management, a multimodal approach is recommended, including:

• Initial treatment with NSAIDs, such as ibuprofen or naproxen, for 1-2 weeks to reduce inflammation
• Physical therapy focusing on gentle neck stretches, posture correction, and strengthening exercises for 6-8 weeks
• Muscle relaxants, such as cyclobenzaprine, for associated muscle spasms
• A short course of oral steroids, such as prednisone, for severe pain
• Epidural steroid injections for temporary relief in cases that do not respond to conservative measures
• Surgery reserved for cases with progressive neurological deficits or persistent severe pain despite conservative management.

From the Research

Cervical Radiculopathy and Shoulder Pain

• Cervical radiculopathy is a common clinical scenario that can cause neck pain, arm pain, or both 2.
• The condition is defined as a syndrome of pain and/or sensorimotor deficits due to compression of a cervical nerve root 3.
• Patients with cervical radiculopathy may present with arm pain or paresthesias in the dermatomal distribution of the affected nerve, which may or may not be associated with neck pain and motor weakness 3.
• Cervical radiculopathy can be a cause of shoulder pain, as the pain can radiate from the neck into the distribution of the affected root 4.

Diagnosis and Treatment

• Diagnosis of cervical radiculopathy is made by combining elements from the patient's history, physical examination, and supplementary tests 5.
• The Spurling and shoulder abduction tests are commonly used to identify cervical radicular pain 5.
• Treatment options include conservative management, non-operative modalities such as physical therapy, steroid injections, and operative intervention 2, 3, 6.
• Most patients will significantly improve from non-surgical active and passive therapies, but surgical treatment may be necessary for patients with clinically significant motor deficits or debilitating pain that is resistant to conservative modalities 3, 4.

Clinical Syndromes and Differential Diagnosis

• Cervical radiculopathy must be considered in the differential diagnosis of shoulder pathology and peripheral nerve entrapment syndromes 2.
• The natural history of cervical radiculopathy and options for management are important considerations in the treatment of patients with this condition 2.
• Understanding the pathophysiology, diagnosis, treatment indications, and treatment techniques is essential for rapid diagnosis and care of patients with cervical radiculopathy 3.