The association between cervical spine pathology and rotator cuff dysfunction.

STUDY DESIGN

Retrospective cohort study.

OBJECTIVE

To investigate the relationship between cervical spine (C-spine) and rotator cuff (RTC) pathology.

SUMMARY OF BACKGROUND DATA

Cervical spine and RTC pathology cause significant shoulder pain in isolation and in tandem, but there is limited information about the relationship between these 2 entities.

METHODS

Patients with a diagnosis of C-spine and/or RTC pathology between 2005 and 2011 were identified using a large national database composed of private payer as well as Medicare patient records. Patients with concomitant C-spine and RTC diagnoses were then stratified by age group and sex. Patients with lumbar spine (L-spine) and RTC pathology were used as a comparative group, and multivariate logistic regression was used for statistical analysis.

RESULTS

Concomitant C-spine and RTC diagnoses were identified in 86,928 patients representing 13% of 679,112 patients with a RTC diagnosis and 16% of 531,177 patients with a C-spine diagnosis. The association between C-spine and RTC pathology increased significantly with age as RTC diagnoses were present in 13% of patients with C-spine pathology younger than 60 years old but increased to 25% in C-spine patients older than 60 years (P<0.0001). For patients over 60 years old who developed a new C-spine diagnosis, 11% would develop a new RTC diagnosis or undergo an operation for a RTC disorder within 5 years. Lumbar diagnosis codes (2,297,480 patients) were over 4 times more common than C-spine codes but RTC pathology had a significantly higher correlation with C-spine pathology than L-spine pathology (odds ratio, 2.32) and patients with C-spine pathology were more likely to develop new rotator cuff pathology (odds ratio, 1.53).

CONCLUSIONS

The association between cervical spine and RTC pathology is significantly greater than that between L-spine and RTC pathology and increases substantially with patient age. Further studies are needed to elucidate the cause of this relationship.