Laurie's Blogs.

I was looking through some recent journal articles and I found a topic that caught my attention.  Essentially correlations between one finding and another finding.  

The article that got me thinking was this one:


The incidence of impingement syndrome in cases of cervical radiculopathy: An analysis of 220 cases

Dernek, Bahar | Aydoğmuş, Suavi | Duymuş, Tahir Mutlu | Adıyeke, Levent | Yardımcı, Merve Yıldız | Kesiktaş, Fatma Nur | Sindel, Dilsad | Ketenci, Aysegul

Journal of Back and Musculoskeletal Rehabilitation, vol. 33, no. 3, pp. 363-366, 2020

BACKGROUND: We hypothesized that cervical radiculopathy (CR) has a role in subacromial impingement syndrome (SAIS) etiology, which cannot be directly connected to anatomical causes.

OBJECTIVE: We aimed to investigate the presence of cervical radiculopathy in patients with SAIS diagnosed clinically and radiologically.

METHODS: Patients who had a clinical and radiological SAIS diagnosis between 2014 and 2016 were included in the study. Patients with secondary causes that led to SAIS were excluded. Cervical MRI of all patients with SAIS was examined for cervical radiculopathy.

RESULTS: A significant (p < 0.05) relationship was found between SIAS and the presence of root compression on the same side. 35% of the patients with SIAS had root compression on the same side.

CONCLUSIONS: Cervical radiculopathy and shoulder impingement syndrome can be easily confused due to the similarity of the symptoms and the anatomical proximity of the lesions. Although both diseases can occur with different mechanisms, we believe that there is a cause and effect relationship between them.

This article sums up my neck and right shoulder issues perfectly!  The issue is currently made worse because I’ve not been to yoga for MONTHS.  In yoga, we spend a lot of time in a forward fold or down dog, or other head down postures that traction my neck and subsequently improve neck AND shoulder pain.  So, I’m going to have to spend more time upside down I think!



Anyways, it made me think about dogs and whether or not I see this in dogs.  Well, yes and no!

Yes, I think that a cervical nerve root impingement can cause a front leg lameness that MIGHT look like a shoulder lameness.  But no, there is no ‘impingement’ that can happen at the dog’s shoulder because they don’t have a clavicle and their alignment and anatomy is different enough so as to no allow for a true shoulder impingement.

Yes, a rib dysfunction (especially Ribs 1 – 4) can cause a front leg lameness that looks like a shoulder lameness.  But no, the rib problem does not cause a soft tissue lesion in the shoulder.

Lastly, (and thank you to Dr. David Lane for alerting me to this one), a medial shoulder hypermobility issue can cause altered use and posturing of the shoulder and neck muscles (in particular the scalene muscles) that can causes an apparent elevation (and pain) on rib 1.  In this case, you have a genuine ‘Two for the Price of One’.  You need to treat both the shoulder and the rib one (or more specifically the Scalenes).

So, the point is that you need to look more broadly when assessing and treatment planning for your cases. 

I’d love to hear of any other correlations you’ve made in your practice.  I’ve got a few more to share over the next couple of weeks!