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Cervical spine magnetic resonance imaging in primary care consulters with shoulder pain: A case control study
  1. Anindita Paul (anindita.paul{at}bolton.nhs.uk)
  1. Keele University, United Kingdom
    1. Martyn Lewis (a.m.lewis{at}cphc.keele.ac.uk)
    1. Keele University, United Kingdom
      1. Jackie Saklatvala (pra27{at}keele.ac.uk)
      1. Staffordshire Rheumatology Centre, United Kingdom
        1. Iain McCall (pra05{at}cphc.keele.ac.uk)
        1. Robert Jones and Agnes Hunt Hospital, United Kingdom
          1. Mike Shadforth (pra19{at}cphc.keele.ac.uk)
          1. Staffordshire Rheumatology Centre, United Kingdom
            1. Peter Croft (p.r.croft{at}cphc.keele.ac.uk)
            1. Keele University, United Kingdom
              1. Elaine Hay (e.m.hay{at}cphc.keele.ac.uk)
              1. Keele University, United Kingdom

                Abstract

                Objectives: To investigate the association between shoulder region pain presenting in primary care and cervical spine magnetic resonance imaging (MRI) abnormalities.

                Methods: A matched case-control study of 48 pairs of participants. Cases had presented to primary care with a new episode of shoulder pain. Controls had no history of shoulder region pain and were individually matched with cases by age, gender and referring clinician. All participants underwent a structured clinical assessment and cervical spine MRI. Scans were scored by experienced musculoskeletal radiologists blind to case-control status.

                Results: Median age of participants was 51 years (range 19-79) and 21 (44%) were female. 'Neck pain in the past week' was reported by 25 (52%) cases and 7(15%) controls (OR 10.0; 95% CI 2.4, 88.2). Cervical spine MRI from C3/4 to C6/7 revealed: 18 (38%) of both cases and controls had disc height loss ³50% at any level; 10 (21%) cases and 8 (17%) controls had disc disease with neural compromise; 11 (23%) cases and 16 (33%) controls had foraminal stenosis; 9 (19%) of both cases and controls had canal narrowing. At least one of the above findings was present in 24 (50%) cases and 23 (48%) controls (OR 1.1; 95% CI 0.4, 3.4).

                Conclusions: Cervical spine MRI abnormalities were similar in both cases and controls, despite significantly more self-reported neck pain in cases with shoulder pain. Other possible mechanisms, such as muscular strain or postural problems, may explain the observed clinical association between shoulder region pain and neck associated symptoms.

                • MRI scans
                • matched case-control study
                • neck
                • shoulder pain

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