Research Review by Dr. Shawn Thistle©

Date:

Oct. 2006

Study Title:

Cervical roots as origin of pain in the neck or scapular regions

Authors:

Tanaka Y et al.

Publication Information:

Spine 2006; 31(17): E568-E573.

Summary:

Neck, scapular, and arm pain are symptoms potentially resulting from cervical radiculopathy. Patients commonly describe pain in the neck or scapular region prior to the onset of neurological symptoms such as numbness and tingling or motor weakness in the arm and fingers.

Often, a diagnosis of mechanical neck pain is modified to a radiculopathy as the arm and finger symptoms appear. The time interval that normally exists between the onset of pain and the onset of radicular symptoms has led some to believe that the pain is not caused by nerve root compression, but by mechanical stress secondary to instability in the neck caused by arthritic changes to the disc and facet joints.

The authors of this study aimed to determine whether pain in the neck and scapular regions in patients with cervical radiculopathy originates from a compressed nerve root, and if the site of pain is helpful in determining the level of involvement.

This study had an interesting way to test this idea. Basically, if pain originates from the disc of facet joint, then surgical decompression of a nerve root would not relieve the pain - implicating a mechanical cause.

Conversely, if pain was originating from a compressed nerve root, then surgical decompression would relieve the pain. Further, if pain in a region of the scapula is relieved by nerve root decompression, referred pain patterns could be established.

In this prospective observational study, 50 patients (42 males and 8 females) with pain and arm/finger symptoms underwent single root decompression surgery alone. All patients had been treated conservatively for at least 4 months before undergoing surgery. Symptom duration averaged 7 months, and the involved nerve root levels were C5 in 9 patients, C6 in 14, C7 in 14, and C8 in 13. Nerve root levels were determined by classic arm/finger symptoms patterns, and associated pain was also recorded immediately before, and 1 month and 1 year after surgery.

Five regions were demarcated around the scapula - nuchal, suprascapular, interscapular, scapular, and superior scapular angle. Patients identified the location of pain during single-finger palpation by one examiner.

Pertinent Results:

  • the neck or scapular pain and the arm/finger symptoms occurred on the same day in only 30% of the patients
  • pain preceded arm/finger symptoms in the remaining 70% (35 patients)
  • in these 35 patients - 33 described the interval between the pain and arm/finger symptoms - <1 week (15 pts) or 1 month or longer (7 pts) [other patients somewhere between]
  • within one month of surgery, 92% of patients were not experiencing pain in the original location
  • when painful site was suprascapular, C5-6 radiculopathy was frequent (p<0.01)
  • when the painful site was interscapular, C7 or C8 radiculopathy was frequent (p<0.001)
  • when the painful site was scapular (directly over the scapula), C8 radiculopathy was frequent (p<0.01)

Conclusions & Practical Application:

This study raises a couple of relevant points for consideration:
  1. pain in the scapular region is a common precursor to radicular symptoms in the arm/fingers
  2. the location of pain in the scapular region can be helpful in determining the involved nerve root level
If patients are not responding to conservative care of scapular region pain, a closer investigation for possible cervical radiculopathy is warranted. The associations delineated in this study between nerve root levels and pain locations in the scapular region could prove useful in this process.