Cervical contribution in musculoskeletal shoulder pain. A review of the literature

Abstract

Shoulder pain is the third most common cause of musculoskeletal pain and the primary cause of non-traumatic pain in the upper limb. Accurately diagnosing this condition remains a challenge for clinicians due to the lack of consistency and uniformity in the existing diagnostic labelling and the criteria used. In this regard, current scientific evidence does not consistently support pathoanatomical models, as imaging tests and orthopaedic examinations might not provide relevant information for diagnosing shoulder pain. Therefore, it may be necessary to carry out subclassification-based diagnosis of patients who share reliably reproducible characteristics. In this context, shoulder pain might be, at least, partially attributed to a cervical contribution. Nevertheless, this potential diagnosis is poorly considered and often misdiagnosed in clinical practice. This might lead to an erroneous decision-making process and poor patient management, compromising both treatment and prognosis. Consequently, this review presents the neurophysiological, biomechanical and clinical reasoning-related characteristics that justify the pertinence of the cervical contribution in musculoskeletal shoulder pain.