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Requejo-Salinas N, Fernández-Matías R, Cadogan A, Chester R, Roy JS, Struyf F, Bateman M, Balster S, Haik MN, Seitz AL, Bisset L, Camargo PR, Brismée JM, May S, Walker T, Wassinger C, Lenssen R, Powell JK, McCreesh K, Gibson J, Ludewig PM, La Touche R, Lluch-Girbés E. Neck or Shoulder? Establishing Consensus for Spine Screening in Patients With Shoulder Pain: An International Modified Delphi Study. Phys Ther 2025; 105:pzae133. [PMID: 39239842 DOI: 10.1093/ptj/pzae133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Revised: 05/27/2024] [Accepted: 07/31/2024] [Indexed: 09/07/2024]
Abstract
OBJECTIVE There is no established consensus for screening the spine in patients with shoulder pain. The aim of this study was to explore the role of the spine in shoulder pain and generate a set of recommendations for assessing the potential involvement of the spine in patients with shoulder pain. METHODS A modified Delphi study was conducted through use of an international shoulder physical therapist's expert panel. Three domains (clinical reasoning, history, and physical examination) were evaluated using a Likert scale, with consensus defined as Aiken Validity Index ≥0.7. RESULTS Twenty-two physical therapists participated. Consensus was reached on a total of 30 items: clinical reasoning (n = 9), history (n = 13), and physical examination (n = 8). The statement that spinal and shoulder disorders can coexist, sometimes influencing each other and at other times remaining independent issues, along with the concept of radiating pain as an explanatory phenomenon for the spine contribution to shoulder pain, achieved the highest degree of consensus. CONCLUSION International physical therapists shoulder experts reached consensus on key aspects when screening the spine in people with shoulder pain, including consideration of the distal location of symptoms relative to the shoulder, the presence or previous history of neck pain, the changes in symptoms related to neck movements, and the presence of neuropathic-like symptoms. They also acknowledged the importance of assessing active cervical or cervicothoracic movements and the usefulness of the Spurling test and symptom modification techniques applied to the spine. IMPACT This consensus holds implications for both clinical practice and research. In research, applying these considerations may ensure more homogenous samples, thereby enhancing the investigation of outcomes in shoulder pain populations. In clinical practice, determining the need for spine screening and its potential impact on prognosis and management could significantly influence patient care.
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Affiliation(s)
- Néstor Requejo-Salinas
- Department of Physical Therapy, Superior Center for University Studies La Salle, Autonomous University of Madrid, C/ La Salle, 10, 28023 Madrid, Spain
- International Doctoral School, Rey Juan Carlos University, Alcorcón, Spain
| | - Rubén Fernández-Matías
- Research Unit, Hospital Universitario Fundación Alcorcón, Alcorcón, Calle Budapest 1, 28922 Alcorcón, Madrid, Spain
| | - Angela Cadogan
- Advance Physiotherapy, 156 Bealey Avenue, Christchurch 8013, New Zealand
| | - Rachel Chester
- School of Health Sciences, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK
| | - Jean-Sébastien Roy
- Center for Interdisciplinary Research in Rehabilitation and Social Integration (Cirris), Québec City, Canada
- Faculty of Medicine, Université Laval, Québec City, Canada
| | - Filip Struyf
- Department of Rehabilitation Sciences and Physiotherapy, University of Antwerp, Wilrijk, Belgium
| | - Marcus Bateman
- Derby Shoulder Unit, University Hospitals of Derby & Burton NHS Foundation Trust, Derby, UK
| | - Simon Balster
- Melbourne Shoulder Group, Monash University, Prahran, Victoria, Australia
| | - Melina Nevoeiro Haik
- Department of Physical Therapy, Federal University of São Carlos, São Carlos, Brazil
| | - Amee L Seitz
- Department of Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Leanne Bisset
- School of Health Sciences and Social Work, Griffith University, Gold Coast, Australia
| | - Paula Rezende Camargo
- Laboratory of Analysis and Intervention of the Shoulder Complex, Department of Physical Therapy, Universidade Federal de São Carlos, São Carlos, SP, Brazil
| | - Jean-Michel Brismée
- Center for Rehabilitation Research, Texas Tech University Health Sciences Center, Lubbock, Texas, USA
| | - Stephen May
- Independent Physiotherapy Consultant, Sheffield, UK
| | - Tom Walker
- IG Medical, Ilkley Moor Medical Practice, West Yorkshire, England
| | - Craig Wassinger
- Physical Therapy, East Tennessee State University, Johnston City, Tennessee, USA
| | - Ross Lenssen
- Melbourne Shoulder Group, Monash University, Prahran, Victoria, Australia
| | - Jared K Powell
- Faculty of Health Science and Medicine, Bond Institute of Health and Sport, Bond University, Robina, Queensland, Australia
| | - Karen McCreesh
- School of Allied Health, University of Limerick, Limerick, Ireland
- Ageing Research Centre, Health Research Institute, University of Limerick, Limerick, Ireland
| | | | - Paula M Ludewig
- Division of Rehabilitation Science, Dept. of Rehabilitation Medicine, University of Minnesota, Minneapolis, Minnesota, USA
- Division of Physical Therapy, Dept. of Rehabilitation Medicine, University of Minnesota, Minneapolis, Minnesota, USA
| | - Roy La Touche
- Department of Physical Therapy, Superior Center for University Studies La Salle, Autonomous University of Madrid, C/ La Salle, 10, 28023 Madrid, Spain
- Neuroscience and Craneofacial Pain Institute (INDCRAN), Madrid, Spain
| | - Enrique Lluch-Girbés
- Physiotherapy in Motion, Multi-Speciality Research Group (PTinMOTION), Department of Physiotherapy, Faculty of Physiotherapy, University of Valencia, Valencia, Spain
- Pain in Motion International Research Group, Vrije Universiteit Brussel, Brussels, Belgium
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Silver J, Mancini M, Pavano C, Bauer J, Barkay G, Moss I, Mallozzi S. C5 nerve root palsy (without prior cervical decompression) case series: 9 patients with critical delay to presentation. J Back Musculoskelet Rehabil 2024; 37:811-815. [PMID: 38250753 DOI: 10.3233/bmr-230182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2024]
Abstract
BACKGROUND Distinguishing between cervical nerve root and intrinsic shoulder pathology can be a difficult task given the overlapping and often coexisting symptoms. OBJECTIVE The objective of this study was to highlight the often-complicated presentation of these symptoms and the subsequent potential for delay in care regarding this subset of patients. METHODS A total of 9 patients, managed by one of two different surgeons, were identified with a history of C5 nerve root palsy. A chart review was conducted, and the following information was recorded: presenting complaint, time from symptom onset to diagnosis, time from symptom onset to presentation to a spine surgeon, first specialist seen for symptoms, non-spinal advanced imaging and treatment conducted before diagnosis, preoperative and postoperative exam, time to recovery, and type of surgery. RESULTS We observed an average time from onset of symptoms to presentation to a spine surgeon to be 31.6 weeks. These patients' time to full recovery after cervical decompression was 15 weeks. CONCLUSION : We observed a critical delay to presentation in this series of patients with C5 nerve palsy. C5 nerve palsy should remain an elemental part of the differential diagnosis in the setting of any shoulder or neck pain presenting with weakness.
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