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Symptoms referred to the shoulder girdle

Pain originating from the cervical spine or from the upper thoracic spine is frequently felt at the shoulder girdle, for example at the base of the neck, in the trapezius muscle or in the scapular area. It may also radiate towards the subclavicular, pectoral or axillary regions or into the upper limb. This overlaps with possible symptoms from shoulder girdle disorders.

Shoulder girdle movements are therefore included in both the cervical (see Chapter 6) and thoracic (see Chapter 25) examinations. This preliminary screening may arouse suspicion about the shoulder girdle.

Symptoms referred from the shoulder girdle

Pain that originates from a disorder in the shoulder girdle is usually experienced at the base of the neck, in the pectoroclavicular area or in the trapezius muscle. It rarely spreads down the arm and thus arm pain may implicate either the spine or the shoulder.

Paraesthesia in the arm may result from a condition affecting the brachial plexus in the shoulder girdle.

History

Symptoms from a disorder in the shoulder girdle are not typical. They mimic those of neck, upper thorax or shoulder.

History-taking will therefore start in the same way as for the examination of the cervical (see Chapter 6) or thoracic spine (see Chapter 25) or of the shoulder (see Chapter 12). The examiner will notice elements that may lay blame on the spinal joints (e.g. pain shifting from the centre to one side) or features that point towards a lesion of the shoulder girdle (e.g. increase of symptoms following scapular movements).

Inspection

On inspection, special attention must be given to swelling (i.e. in the supraclavicular fossa), changes in the colour of the skin, muscular atrophy, difference in height of the shoulders and winging of the scapula.

Functional examination

The functional examination of the shoulder girdle is never done as primary testing but follows evaluation of one of the other regions, which may provide elements that implicate the shoulder girdle.

If the patient has described symptoms that could originate from the spine or from the shoulder, the cervical, thoracic or shoulder examination is performed. When, in this examination, signs are found that point towards the shoulder girdle (e.g. positive scapular tests), these will be examined thoroughly.

When the history is unspecific a preliminary examination (quick survey) of the upper quadrant is done (see p. 212). This includes tests for: