Clinical features and diagnosis analysis of 91 cases of neck shoulder upper extremity pain syndrome

Objective To analyze the clinical characteristics of complex neck shoulder upper extremity pain cases and to classify and summarize the diagnosis outcomes in order to improve the doctors' understanding of neck shoulder upper extremity pain and provide valuable reference for clinical work. Methods A retrospective analysis was performed on the clinical data of patients with neck, shoulder and upper extremity pain who were treated in the multidisciplinary consultation center of neck, shoulder and upper extremity pain in our hospital from July 2015 to March 2017. The general information, symptoms, signs, auxiliary examinations and diagnosis of the patients were classified and summarized. Results A total of 91 patients, 41 males and 50 females, met the inclusion criteria. The medical history ranged from 5 days to 30 years, with an average of 25.4 months. The most common age group was 47 to 67 years old (53 cases, 58.2%). Apart from pain, numbness (35%), weakness (13%), muscle atrophy (11%) and activity limitation (7%) were common symptoms. Of the 24 cases with positive Spurling's sign, 17 cases (70.8%) had cervical spondylotic radiculopathy. Diagnostic block of anterior and middle scalene muscles was performed in 11 cases, and thoracic outlet syndrome was diagnosed in 7 out of 8 positive cases. Among 48 cases of single diagnosis, 10 cases (21%) were cervical spondylosis, 9 cases (19%) were thoracic outlet syndrome, 9 cases (19%) were peripheral nerve disease, 7 cases (15%) were central nervous system disorder, 4 cases (8%) were tumors, 3 cases (6%) were infections and 6 cases (12%) were others. Among the other 29 cases of complex diagnosis, 16 cases (55.2%) had thoracic outlet syndrome with other diseases, including 8 cases of thoracic outlet syndrome with cervical spondylotic radiculopathy. 7 cases (24.1%) of cervical spondylotic radiculopathy combined with other diseases. Conclusion Complex neck, shoulder and upper extremity pain is more common in the middle-aged and elderly people, especially in women. Cervical spondylosis is the most common cause of complex neck, shoulder and upper extremity pain, and thoracic outlet syndrome accounts for a certain proportion. Cervical spondylotic radiculopathy or thoracic outlet syndrome are the main diagnostic modalities for some patients with complex neck shoulder and upper extremity pain. Spurling's sign and diagnostic block of anterior and middle scalene muscles contribute to the diagnosis of complex neck, shoulder and upper extremity pain. Key words: Pain; Diagnosis; Clinical features; Cervical spondylotic radiculopathy; Thoracic outlet syndrome