Persistent dull pain and deep drilling discomfort in the shoulder or scapular region

Introduction One of the symptoms caused by cervical spondylosis is persistent dull pain in the shoulder or shoulder area and deep discomfort. Cervical spondylosis, also known as cervical vertebra syndrome, is a general term for cervical osteoarthritis, proliferative cervical spondylitis, cervical nerve root syndrome, and cervical disc herniation. It is a disease based on degenerative pathological changes. Mainly due to long-term cervical vertebrae strain, bone hyperplasia, or disc herniation, ligament thickening, resulting in cervical spinal cord, nerve root or vertebral artery compression, a series of clinical syndromes of dysfunction. The manifestations of cervical disc degeneration and its secondary pathological changes, such as vertebral instability, loosening; nucleus protruding or prolapse, spur formation, ligament hypertrophy and secondary spinal stenosis, etc., stimulated or oppressed Adjacent nerve roots, spinal cord, vertebral artery, and cervical sympathetic nerves, and cause a variety of symptoms and signs of the syndrome.

Cause

The basic pathological change of cervical spondylosis is the degeneration of the intervertebral disc. The cervical vertebra is located between the skull and the thorax. The cervical disc has frequent activities under load-bearing conditions and is susceptible to excessive micro-injury and strain.

The main pathological changes are: early cervical disc degeneration, decreased water content of the nucleus pulposus and fibrous swelling and thickening of the annulus fibrosis, followed by glassy degeneration and even rupture. After cervical disc degeneration, the pressure resistance and tensile strength are reduced. When subjected to the gravity of the skull and the pulling force of the muscles of the head and chest, the degenerated disc can undergo localized or extensive bulging to the periphery, narrowing the intervertebral disc space, overlapping the articular processes, dislocation, and the longitudinal diameter of the intervertebral foramen. Become smaller. As the traction resistance of the intervertebral disc becomes weaker, when the cervical vertebra moves, the stability between adjacent vertebrae decreases and the intervertebral instability occurs, the mobility between the vertebral bodies increases and the vertebral body has a slight slippage, which then appears Bone hyperplasia of the posterior facet joint, hook joint and lamina, degeneration of the ligamentum flavum and ligament, cartilage and ossification.

Because the cervical disc bulges around, the surrounding tissues (such as the anterior and posterior longitudinal ligaments) and the vertebral periosteum can be picked up, and a gap is formed between the vertebral body and the protruding intervertebral disc and the ligament tissue that is picked up. The gap ", in which the accumulation of tissue fluid, coupled with the bleeding caused by the micro-damage, makes this bloody fluid mechanized and then calcified, ossified, thus forming the epiphysis. The relaxation of the anterior and posterior ligaments of the vertebral body makes the cervical spine unstable, which increases the chance of trauma and gradually increases the callus.

The epiphysis together with the bulging annulus fibrosus, the posterior longitudinal ligament and the edema or fibrous scar tissue caused by the traumatic reaction, forming a mixture in the spinal canal at the site corresponding to the intervertebral disc, may exert an oppressive effect on the spinal nerve or the spinal cord. The epiphysis of the hook joint can protrude from the anterior to the posterior to the intervertebral foramen to compress the nerve root and the vertebral artery. The epiphysis of the anterior border of the vertebral body generally does not cause symptoms, but there are reports of such anterior epiphysis affecting swallowing or hoarseness in the literature. After the spinal cord and nerve roots are compressed, they are only functional changes at the beginning. If the pressure is not relieved in time, it will gradually produce irreversible changes. Therefore, if non-surgical treatment is ineffective, surgery should be performed promptly.

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The symptoms of cervical spondylosis are very rich, diverse and complex. Most patients begin to have milder symptoms, which gradually worsen later, and some of them have more severe symptoms. This is related to the type of cervical spondylosis, but often the type is simple, with one type as the main cum and one to several types mixed together, called mixed cervical spondylosis, so the symptoms are very rich and diverse. complicated. Diagnosis and treatment can be based on their main symptoms.

Differential diagnosis

Pain in the shoulder: due to visceral disease, causing shoulder pain, or hyperalgesia, known as suffering. Symptoms appear to be slow, dull, or uncomfortable. They do not completely conform to the nerve direction, the area is blurred, and the pain is blurred.

Persistent severe shoulder pain: persistent severe shoulder pain, often caused by dislocation of the shoulder joint. There is a clear history of trauma.

Intercostal shoulder strap pain: Disc herniation can squeeze the spinal nerve roots at the exit of the root canal nerve causing pain in the intercostal shoulder strap. Intercostal scapular pain is a clinical manifestation of thoracic disc herniation.

Scapular radioactive pain: Radiation pain: the pain is radioactive, and conductive pain will be released from the proximal end of the limb (near the heart side) to the telecentric end, just like a string of inductance. This means that the lesion does not occur in the limb itself, but in the spinal cord of the neck, chest, or lumbar or at a large nerve center or nerve trunk. Radiation pain in the upper extremities indicates a lesion in the neck or shoulder of the nerve plexus.

Dull pain and radiation pain in the periorbital area: dull pain and radiation pain in the periorbital area are clinical manifestations of suprascapular nerve compression. Scapular nerve compression is one of the most common causes of shoulder pain. Some scholars abroad believe that this sign accounts for 1% to 2% of all patients with shoulder pain.

The material in this site is intended to be of general informational use and is not intended to constitute medical advice, probable diagnosis, or recommended treatments.