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Case Report:

40 y/o female with 3 year history of left shoulder pain who had undergone left rotator cuff repair came to our office for evaluation. 

She had been involved in a  rear-end motor vehicle accident 3 1/2 years prior.  When the drunk driver struck her car, she was looking over her shoulder.

driving with neck turned

Her pain was localized in her left lower neck and shoulder, constant in duration, 6/10 in severity and burning in character.  Aggravating factors included lifting, extension and rotation .  A sport’s medicine evaluation obtained a MRI of the left shoulder which was significant for a tear in the rotator cuff.  Surgical repair was performed along with extensive rehabilitation.  Unfortunately for this patient, her pain did not resolve.

Referred pain is pain that is perceived at a site distant from the injury’s origin.  A classic example is during a heart attack when a patient may feel pain in the arm, jaw os back rather than in the chest which is the site of injury.

Facet joints are articular joints in the posterior aspect of the cervical, thoracic and lumbar spine. 

cervical facet 2

The cervical facets are a common site of injury following motor vehicle injury.  The C5/6 and C6/7 cervical facet joint are the most common levels injured.  Each facet level has a distinct referral pattern was demonstrated below:referral pattern of cervical facet

Injury to the C5/6 and C6/7 cervical facet typically results in pain in the lower neck and shoulder.  Diagnostic injection completely resolved this patient’ s pain.

Pain can arise from many different areas.  A thorough evaluation is essential which is the standard of care at the Centeno-Schultz Clinic.  Not all shoulder pain originates from the shoulder.

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