Jeremy Tran, n/a: No financial relationships to disclose
Introduction: Shoulder pain is one of the most common musculoskeletal conditions, with possible etiologies to include glenohumeral arthritis, biceps tendinopathy, and rotator cuff pathology. However, central nerve compression within the cervical spine can often present as shoulder pain as well. The overlapping and sometimes concurrent clinical manifestations of these entities can make determining the exact etiology of shoulder pain challenging and may complicate treatment. Without knowing for certain which is the source of their symptoms, patients can be subject to costly, and sometimes unnecessary, surgeries. However, if surgeons fail to recognize when their patient’s pain is due to multiple contributing factors, they may be inadequately treated.
Objectives: To determine the incidence of patients who undergo both cervical spine decompression surgery (CSD) and shoulder surgery, as well as investigate temporal patterns and timing between the two surgical groups.
Methods: The Military Health System Data Repository, consisting of medical treatment data of all active duty servicemembers, dependents, and retired beneficiaries, was queried for common procedural terminology (CPT) codes for CSD and shoulder surgeries (to include arthroscopic debridement, rotator cuff repair, biceps tenodesis, and arthroplasty) between January 2015 and December 2021. Patients were sorted based on sequence of surgical intervention: 1) CSD before shoulder surgery and 2) shoulder surgery before CSD. The percentage of patients in each category was calculated, as well as the time between surgeries. Medical records were also reviewed to determine the patient’s chief complaint at the time of their index procedure.
Results: Within the military healthcare system between 2015 and 2021, a total of 3,319 patients underwent CSD, of which 58 patients (1.75%) required a subsequent shoulder surgery, with a mean time of 765.1 ± 101.3 days between procedures. Over that same time period, 45,425 patients underwent shoulder surgery, with 48 subsequently undergoing CSD (0.11%), and mean time of 832.5 ± 90.1 days between surgeries. Of those that underwent both types of procedures (n=106), 98 patients (92.4%) had a chief complaint of “shoulder pain” at their index procedure. Of the shoulder surgeries performed, 38 included biceps tenodesis (35.8%), 23 arthroscopic debridements (21.7%), 21 rotator cuff repairs (19.8%), 17 subacromial decompressions (16.0%), 8 labral repairs (7.5%), and 3 shoulder arthroplasties (2.8%). The most common cervical levels involved in surgical decompression in this group were C5-C6 (67.9%) and C6-C7 (60.4%).
Conclusions: Patients who underwent both CSD and shoulder surgery were more likely to have cervical spine decompression performed first, with the most common level of decompression being C5-C6. The most common shoulder surgery performed within this cohort of patients was a biceps tenodesis.
