Mimori K, Muneta T, Komori H, Okawa A, Shinomiya K
Department of Orthopaedic Surgery, Tokyo Medical and Dental University, Japan.
J Shoulder Elbow Surg. 1999 Jul-Aug;8(4):303-6. doi: 10.1016/s1058-2746(99)90150-7.
It is well known that cervical radiculopathy sometimes causes shoulder pain. Hypothesizing that the cause of painful shoulder is related to the cervical spine in the absence of obvious radiculopathy, we measured the anteroposterior diameter of the spinal canal and the range of motion of the cervical spine in patients with painful shoulder on lateral cervical radiographs of the spine. Painful shoulder was diagnosed in 76 patients (24 men and 52 women; mean age 57.6 years). Patients who reported neck pain or numbness of the upper limbs and patients with neurologic abnormalities were excluded from this study. A control group of 54 asymptomatic volunteers (27 men and 27 women; mean age 55.5 years) was formed. The difference in age between the patient group and the control group was not significant. The anteroposterior diameter of the spinal canal at C5 and C6 in the painful-shoulder group (C5: 12.74 mm; C6: 12.76 mm) was significantly narrower than in the control group (C5: 13.60 mm; C6: 13.79 mm). The range of motion was greatest at C4-5 and smallest at C2-3 in both groups; and there was no significant difference in the range of motion between the painful-shoulder group and the control group. When women only or men only were assessed, the results were nearly the same between groups. The cervical spine without obvious radiculopathy appears to be involved in patients with a painful shoulder. We speculate that the shoulder is affected by irritation of a cervical nerve root or referred pain.
众所周知，神经根型颈椎病有时会引起肩部疼痛。鉴于在无明显神经根病的情况下，推测肩部疼痛的原因与颈椎有关，我们在颈椎侧位X线片上测量了肩部疼痛患者的椎管前后径和颈椎活动度。76例患者（24例男性，52例女性；平均年龄57.6岁）被诊断为肩部疼痛。本研究排除了报告颈部疼痛或上肢麻木的患者以及有神经功能异常的患者。形成了一个由54名无症状志愿者组成的对照组（27例男性，27例女性；平均年龄55.5岁）。患者组和对照组之间的年龄差异不显著。肩部疼痛组C5和C6水平的椎管前后径（C5：12.74mm；C6：12.76mm）明显窄于对照组（C5：13.60mm；C6：13.79mm）。两组中颈椎活动度在C4 - 5水平最大，在C2 - 3水平最小；肩部疼痛组和对照组之间的活动度没有显著差异。当仅评估女性或仅评估男性时，两组结果几乎相同。无明显神经根病的颈椎似乎与肩部疼痛患者有关。我们推测肩部受到颈神经根刺激或牵涉痛的影响。
