E76 The American Journal of Orthopedics ® September 2013 www.amjorthopedics.com An Original Study Neck–Shoulder Crossover: How Often Do Neck and Shoulder Pathology Masquerade as Each Other? Jonathan N. Sembrano, MD, Sharon C. Yson, MD, Okezika C. Kanu, MD, Jonathan P. Braman, MD, Edward Rainier G. Santos, MD, Alicia K. Harrison, MD, and David W. Polly Jr, MD N eck and shoulder pain are common presentations in the ambulatory care setting. 1-4 Identiicat ion of the correct pain generator is a prerequisite to effective treatment in patients with neck and/or shoulder problems. However, distinguishing cervical spine pathology from pri- mary shoulder disease can be dif icult. Neck and shoulder symptoms may overlap and coexist because of their proximity in anatomical locations, common innervations, and overlying musculature. 5,6 In addition, there are similar demographics for the patients with these 2 types of pathology. 7,8 It is not uncommon to diagnose and treat a case of cervical spine pa- thology that initially presented as a shoulder complaint, and vice versa. 9-11 A recent best evidence synthesis placed the 12-month inci- dence of neck pain between 30% and 50%. 3 Another systematic review placed the 12-month incidence of shoulder pain be- tween 5% and 47%. 12 The relative frequencies of how often one type of pain is mistaken for the other are not well established. We conducted a study to determine the frequency of symptomatic neck pathology among patients seen at a shoul- Abstract Authors’ Disclosure Statement: Dr. Sembrano has ongoing research supported by NuVasive Inc. Dr. Santos has ongoing research supported by SI-Bone Inc. Dr. Polly was a consultant for Medtronic Inc and has received research support from Medtronic Inc and grants from the US Depart- ment of Defense, the Scoliosis Research Society, and The Pediatric Orthopaedic Society of North America. Drs. Yson, Kanu, Braman, and Harrison report no actual or potential conlict of interest in relation to this article. Cases of consecutive new patients seen at ortho- pedic spine and shoulder clinics were reviewed. Four percent of spine patients had signiicant shoulder pathology, and 3.6% of shoulder patients had signiicant spine pathology. Identiication of the correct pain generator is a prerequisite for effective treatment in patients with neck and/or shoulder problems. However, distin- guishing between the two can be dif icult. Relative frequencies of how often one is mistaken for the other have not been well established. Six hundred ninety-four new patients were seen at the orthopedic shoulder clinic (n = 452) or spine clinic (n = 242) at an academic institution during a 2-year period. One hundred seven patients had previous shoulder surgery, and 39 had previous neck surgery. The 548 patients (shoulder clinic, 345; spine clinic, 203) who had no previous surgery were reviewed with respect to workup performed, inal diagnosis, subsequent operative procedures, and incidence of referral from the shoulder clinic to the spine clinic and vice versa. Among the patients seen at the shoulder clinic, 325 (94.2%) had shoulder pathology, 6 (1.7%) had neck but no shoulder pathology, 6 (1.7%) had shoulder and neck pathology, and 8 (2.3%) had an unidentiiable cause of pain. Of the 12 patients with neck pathology, none underwent neck surgery. Among the patients seen at the spine clinic, 182 (89.7%) had neck pathology, 5 (2.5%) had shoul- der but no neck pathology, 3 (1.5%) had neck and shoulder pathology, and 13 (6.4%) had an unidenti- iable cause of pain. Of the 8 patients with shoulder pathology, 1 (12.5%) underwent shoulder surgery. Our analysis suggests that for patients who present to a shoulder surgeon’s clinic for shoulder pain, 3.6% will turn out to have neck pathology. For patients who present to a spine surgeon’s clinic for neck pain, 4% may turn out to have shoulder pathology. Thus, approximately 1 in 25 patients seen at a surgeon’s clinic for a presumed shoulder or neck problem may exhibit neck–shoulder cross- over, in which pathology in one may be mistaken for or coexist with the other. AJO DO NOT COPY