Shoulder Pain and Dysesthesia of the Hand: A Prospective Evaluation of 1201 Consecutive Patients Presenting for Shoulder Surgery.

Abstract

Background: The purpose of this study was to determine the prevalence and severity of numbness and tingling in the hand in patients presenting with disorders of the shoulder. This study also aimed to explore the potential associations of diagnosis of shoulder disorder, age, sex, duration of shoulder symptoms, work cover status, shoulder pain, shoulder function, and side of affected shoulder with hand dysesthesia to begin understanding the pathophysiology of this symptomology.

Methods: This prospective cohort study was conducted at a single campus. The prevalence and severity of hand paresthesia and numbness were assessed using the modified Boston Carpal Tunnel Questionnaire. Shoulder status and pain were assessed using the L'Insalata Shoulder Questionnaire. Post hoc, patients were grouped by their diagnosis confirmed at surgery. Multivariate regression analyses were used to identify significant factors associated with hand dysesthesia.

Results: A total of 1201 patients were included in the analysis. 22% to 45% of patients reported hand paresthesia and numbness, mostly of slight to medium severity, even though their primary diagnosis was a disorder of the shoulder. Patients with adhesive capsulitis had the highest prevalence of hand paresthesia (45%) and numbness (40%) while patients undergoing anatomic total shoulder arthroplasty had the lowest prevalence of preoperative hand paresthesia (22%) and numbness (22%). Multiple logistic regression analysis identified pain at rest as the most significant factor associated with of hand paresthesia and numbness. With each increasing level of pain at rest, patients were three times more likely to report hand paresthesia (OR: 3.00, 95% CI: 1.33 - 6.79) and numbness (OR: 3.02, 95% CI: 1.34 - 6.79). Patients with adhesive capsulitis were twice as likely to report hand numbness (OR: 1.59, 95%CI: 1.01 - 2.49) compared to patients with other shoulder disorders. Patients with self-reported stiff shoulders were also two times more likely to report worse hand paresthesia (OR: 1.66, 95%CI 1.03 to 2.66). Younger age, and deficit in shoulder internal rotation strength and range of motion were weak predictors of hand numbness and paresthesia.

Conclusion: Approximately one-third of patients with common shoulder disorders also reported paresthesia and numbness in the ipsilateral hand, mostly of slight to moderate severity. Patients with adhesive capsulitis, painful, stiff, and weaker shoulders, were more likely to experience hand symptoms.