# Shoulder pain that is not shoulder pathology – a shoulder surgeon's guide to concomitant cervical spine and rotator cuff disease

## TL;DR

This paper helps shoulder surgeons recognize and manage cases where shoulder pain is actually caused by neck issues rather than shoulder problems.

## Contribution

The paper introduces an algorithmic approach to diagnose and manage coexisting shoulder and cervical spine conditions.

## Key findings

- Rotator cuff and cervical spine diseases often coexist and complicate treatment decisions.
- A structured diagnostic approach can help distinguish between shoulder and cervical spine pathology.
- Shoulder surgeons should prioritize identifying cervical spine issues that may require surgery before addressing the shoulder.

## Abstract

Rotator cuff and cervical spine disease are complex and nuanced conditions that commonly coexist, creating a challenging treatment paradigm.

An algorithmic approach to diagnosis and management is developed in this study and illustrated through clinical vignettes.

The diagnostic and therapeutic challenges of concomitant shoulder and neck conditions may be simplified by this approach.

Shoulder surgeons should seek cervical disease with a high index of suspicion and understand cervical conditions that may take surgical precedence to rotator cuff repair.