Shoulder impingement presenting as neck pain

Background: Chronic neck pain can be a difficult problem to evaluate and treat, as it can have several different causes. We studied a series of patients with neck pain near the superomedial aspect of the scapula that was referred pain from inflammation of the shoulder secondary to chronic impingement. We postulate that some patients with specific clinical findings and neck pain can benefit from treatment of shoulder impingement. Methods: We conducted a retrospective review of the charts of thirty-four patients with neck pain who met three criteria for the diagnosis of shoulder impingement syndrome: (1) a positive impingement sign with pain referred to the neck, (2) radiographic abnormalities, and (3) relief of neck pain after injection of lidocaine and cortisone into the subacromial space. Subjective pain scores were determined before and after the injection. Results: Thirty of the thirty-four patients obtained immediate relief of the neck pain following injection into the subacromial space, and the remaining four had substantial pain relief when they were evaluated three weeks following the injection. Avoidance of the shoulder impingement position (forward elevation of the arm above 900) subsequently minimized recurrences. Conclusions: In selected patients, chronic neck pain may be caused by shoulder impingement, which can be easily diagnosed with standard techniques. The difficulty in making this diagnosis is that the patient presents with neck pain rather than with the typical shoulder pain. The differential diagnosis of chronic lower neck pain should include shoulder impingement syndrome, which can be identified by classic physical and radiographic signs and can be treated with injection into the subacromial space and avoidance of the shoulder impingement position. Level of Evidence: Diagnostic study, Level IV-2 (poor reference standard). See Instructions to Authors for a complete description of levels of evidence.