Session Time: 12:30pm-2:00pm
Location: Research Hub - Kiosk 3
Disclosures: Eric J. Wagner, DO, MA: Nothing to disclose
Case Description: We present growing numbers of cases of patients (now > 10) with radiating arm pain in the absence of cervical pathology.
Setting: In every identified patient, neurologic examination of the upper limb was normal. For example, we present a 63-year-old female patient with pain traveling from her neck down her lateral arm, forearm and lateral hand (C5-C6 dermatomes). Cervical spine ROM did not reproduce symptoms of radiating pain. Cervical spine MRI was also unremarkable for a source of right-sided nerve root compression. Symptoms were instead reproduced by directly palpating over the acromioclavicular (AC) joint. Right shoulder radiograph showed degenerative changes of the AC joint. Diagnostic ultrasound showed considerable degenerative changes and tenderness over the AC joint. Ultrasound-guided injection of the right AC joint was performed with Triamcinolone/Lidocaine, which resulted in immediate resolution of right upper-limb radiating pain. Follow-up visits showed retained, complete resolution of this pain.
Assessment/Results: Both immediate and chronic resolution of radiating arm pain without any cervical spine intervention suggests that the primary source of radiating pain was the AC joint, not the spine.
Discussion: A typical presentation of pain that starts in the neck/shoulder and radiates down the arm is highly suggestive of cervical radiculopathy or myofascial pain. However, in multiple cases, direct palpation over the AC joint caused the same referral pattern. Moreover, diagnostic injection into the AC joint resolved the patient’s symptoms completely. This could possibly be explained by a referred pain pattern originating from the suprascapular nerve (C5-C6), which provides sensory afferents to the AC joint. C5-C6 dermatomes cover the lateral arm, forearm and lateral hand.
Conclusion: Our growing, international case series across multiple hospital systems suggests that AC joint pathology might be a highly underdiagnosed source of radiating upper-limb pain. We now regularly evaluate patients for AC joint arthralgia prior to more extensive and expensive workup.
Level of Evidence: Level IV
To cite this abstract in AMA style:Wagner EJ, Sanchez A, Sambasivan A, Galloza-Otero J. Not All Radiating Arm Pain Originates from the Neck: An International Case Series on Acromioclavicular Arthralgia [abstract]. PM R. 2019; 11(S2)(suppl 2). https://pmrjabstracts.org/abstract/not-all-radiating-arm-pain-originates-from-the-neck-an-international-case-series-on-acromioclavicular-arthralgia/. Accessed September 24, 2023.
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