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The Journal of Bone and Joint Surgery (American) 85:635-638 (2003)
© 2003 The Journal of Bone and Joint Surgery, Inc.

Scientific Article

Shoulder Impingement Presenting as Neck Pain

Jerrold M. Gorski, MD and Lawrence H. Schwartz, MD

Investigation performed at the Department of Orthopaedic Surgery, Winthrop University Hospital, Stonybrook University School of Medicine, Mineola, New York

Jerrold M. Gorski, MD
181 East Jericho Turnpike, Mineola, NY 11501. E-mail address: jgorskimd{at}hotmail.com

Lawrence H. Schwartz, MD
Department of Radiology, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10021

The authors did not receive grants or outside funding in support of their research or preparation of this manuscript. They did not receive payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.

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°) 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.

Level of Evidence: Diagnostic study, Level IV-2 (poor reference standard). See Instructions to Authors for a complete description of levels of evidence.



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