Cross-talk between shoulder and neck pain: an imaging study of association between rotator cuff tendon tears and cervical foraminal stenosis

Rotator cuff tendon tears are prevalent in patients with shoulder pain, the third most common musculoskeletal complaint. As shoulders are largely innervated by cervical nerves, it seems possible that rotator cuff pathology could have an association with cervical spine disorders, although few studies have investigated this possibility. This study aimed to explore the association between rotator cuff tendon tears and cervical radiculopathy (at C5 and C6 levels) in the shoulder pain population. We conducted a retrospective review of a clinical registry of shoulder ultrasound (US) examinations and cervical spine radiographs, recruiting a total of 126 patients with cervical spine radiographs taken within 1 year of US examinations. Foraminal stenosis was grouped into 4 categories: C4/5 intervertebral foramen only, C5/6 intervertebral foramen only, both C4/5 and C5/6 intervertebral foramina, and neither C4/5 nor C5/6 intervertebral foramen. The groups with and without rotator cuff tendon tears were compared for various factors, using the Mann-Whitney U test for continuous variables and the χ(2) test for categorical variables. A multivariate analysis was conducted using a logistic regression model to investigate the association between rotator cuff tendon tears and cervical foraminal stenosis. Patients with rotator cuff tendon tears tended to be older and had more night-time pain. No significant association was identified between rotator cuff tendon tears and cervical foraminal stenosis at C5 and C6 levels. The only factor significantly predicting rotator cuff tendon tears was old age (odds ratio, 1.04; 95% confidence interval: 1.00–1.09). In patients with shoulder or neck pain, no significant association existed between rotator cuff tendon tears and cervical foraminal stenosis (at the C5 and C6 levels). When patients present with undifferentiated shoulder and neck pain, physicians should take a detailed history, perform physical examinations and imaging studies of both the neck and shoulder regions.