Investigation of C5–C6 radiculopathy and shoulder rotator cuff lesions coexistence frequency

INTRODUCTION: The aim of this study was to evaluate the coexistence of C5 and/or C6 root compression with rotator cuff pathologies and its effect on pain and disability.
METHODS: A total of 65 patients with pain radiating from neck to shoulder were retrospectively evaluated on the basis of demographic data, duration of symptoms, overhead activities, and physical examination. The visual numerical scale (VNS), Quick DASH (Disabilities of the Arm, Shoulder, and Hand), and Shoulder Pain and Disability Index (SPADI) were also used. Cervical magnetic resonance imaging (MRI) was used to evaluate C5–C6 root compression, which was separated into two groups as patients with or without upper trunk root compression (UTRC). These groups were compared according to the MRI findings of patients with rotator cuff pathologies.
RESULTS: According to our results, C5 root compression (12.3%), C6 root compression (41.5%), UTRC (44.6%) were detected. There was no difference between the groups regarding the Hawkins and Neer tests. The Yergason and Jobe tests were statistically higher in patients without UTRC. In the shoulder MRIs, the rate of subscapular muscle tear was significantly higher in patients with UTRC. Other shoulder MRI findings were not different between the groups. VNS-neck and SPADI-pain scores were significantly higher in patients without UTRC. There was no difference between the groups in the scores of VNS-shoulder, Quick DASH, SPADI-disability, and SPADI-total.
DISCUSSION AND CONCLUSION: Radiating pain from neck to shoulder that is caused by C5–C6 root compression does not create a predisposition for clinical, radiologic, and functional pathologies in shoulder joint. It seems difficult to diagnose the exact origin of pain in patients who present with neck pain radiating to shoulder based on the findings of cervical or shoulder MRI alone.

C5-C6 Radikülopati ve Omuz Rotator Manþon Lezyonlarýnýn Birlikte Görülme Sýklýðýnýn Araþtýrýlmasý

GÝRÝÞ ve AMAÇ: Bu çalýþmada C5 ve/veya C6 sinir köklerinin basýsý ile omuz rotator manþon patolojilerinin birlikteliði ve bunun aðrý ile dizabilite üzerine etkisi deðerlendirildi.
YÖNTEM ve GEREÇLER: Boyundan omuza yayýlan aðrý þikâyeti ile baþvuran 65 hastanýn demografik verileri, boyun ve omuz aðrýsý süreleri, baþ üstü aktivite gerektiren iþlerde çalýþma durumu, fizik muayene verileri retrospektif olarak deðerlendirildi. Aðrý ve fonksiyonellik vizüel nümerik skala (VNS), Quick DASH (Disabilities of the Arm, Shoulder and Hand) ve Omuz Aðrý ve Özürlülük Ýndeksi (OAÖÝ) (Shoulder Pain and Disability Index, SPADI) verileriyle deðerlendirildi. Servikal manyetik rezonans görüntülemelerde (MRG) C5-C6 kök basýsý varlýðýna göre hastalar üst trunkus kök basýsý (ÜTKB) olanlar ve olmayanlar olmak üzere iki gruba ayrýldý. Gruplar MRG bulgularýna göre omuz patolojileri açýsýndan karþýlaþtýrýldý.
BULGULAR: Hastalarýn %12,3’ünde C5, %41,5’inde C6 kök basýsý, %44,6’sýnda ÜTKB saptandý. Hawkins ve Neer testleri açýsýndan gruplar arasýnda farklýlýk saptanmazken, Yergason ve Jobe testleri ÜTKB olmayanlarda istatistiksel olarak daha yüksek pozitifti. Omuz MRG’leri deðerlendirildiðinde ÜTKB olanlarda yalnýzca subskapularis kas yýrtýðý görülme sýklýðý anlamlý olarak daha yüksekti. Diðer omuz MRG bulgularý açýsýndan farklýlýk saptanmadý. VNS-boyun ve OAÖÝ-aðrý skorlarý ÜTKB olmayanlarda anlamlý olarak daha yüksekken, VNS-omuz, Quick DASH, OAÖÝ-dizabilite ve OAÖÝ-toplam skorlarý açýsýndan gruplar arasýnda anlamlý farklýlýk yoktu.
TARTIÞMA ve SONUÇ: Bu çalýþma servikal MRG’de saptanan ve boyundan omuza yayýlan aðrýya neden olan C5-C6 kök basýsýnýn omuzda klinik, radyolojik ve fonksiyonel bir patolojiye predispozisyon yaratmadýðýný desteklemektedir. Sadece servikal veya omuz MRG bulgularýna dayanarak aðrýnýn kaynaðýnýn söylenmesi de güç görünmektedir.