The Shoulder

Preliminary Examination

The active neck movements are positive.

A thorough clinical examination of the cervical spine must follow.

This consists of active, passive and resisted movements and a comprehensive neurological examination of the upper quadrant.

A cervical disco-dural conflict (the commonest cervical pathology) may cause pain in the 'shoulder-area'.
This may be the trapezius area, the deltoid, the clavi-pectoral area or the interscapular area.
The broad pain referrence (dural extrasegmental pain) results from the multisegmental innervation of the dura.

A disco-radicular conflict causes referrered pain in the respective dermatome in shoulder or arm (C4-C5-C6-C7-C8 and D1)

Preliminary Examination

Interpretation of the preliminary examination