Sore Shoulder, Check Your Spine

Research Paper Title

Shoulder Pain of Spinal Source in the Military: A Case Series.

Background

Musculoskeletal injury (MSI) presents the greatest threat to military mission readiness. Atraumatic shoulder pain is a common military MSI that often results in persistent functional limitations. Shoulder orthopaedic evaluation presents many diagnostic challenges, due in part to the possibility of a spinal source of symptoms.

Methods

This case series outlines the use of mechanical diagnosis and therapy to screen the cervical and thoracic spine in active duty (AD) service members (SMs) with a chief complaint of unchanging or worsening shoulder pain.

Results

All three SMs previously received shoulder-specific diagnoses from experienced clinicians, yet repeated movements revealed a possible spinal nociceptive driver that guided targeted intervention. Treatment directed only at the cervical spine resulted in a clinically important improvement within an average of 10 days from the initial evaluation, return to duty (RTD) within an average of 32 days, and continued resolution at 3 months.

Conclusions

SMs can independently complete the screening process with guidance from healthcare providers, ultimately shaping the treatment strategy and possibly facilitating self-management of future recurrence. This case series demonstrates that identification of shoulder pain of spinal source in the military population may be an important step in facilitating timely RTD. These cases also highlight the use of a standardised, systematic method to screen the cervical and thoracic spine that concurrently reveals the indicated treatment. Further research to determine the prevalence of shoulder pain of spinal source in the AD population and its impact on RTD rates has the potential to reduce the substantial burden of MSI in the military.

Reference

Hathcock, J.A., Boyer, C.W. & Morris, J.B. (2021) Shoulder Pain of Spinal Source in the Military: A Case Series. Military Medicine. doi: 10.1093/milmed/usab059. Online ahead of print.

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