Wednesday, September 26, 2018 7:35 AM–9:00 AM ePosters: P104. The operative treatment of shoulder pain: a comparison of shoulder and cervical spine surgical intervention

Abstract

BACKGROUND CONTEXT Complaints of shoulder pain are among one of the most common orthopaedic problems, impacting activities of daily living and in turn affecting quality of life in thousands of patients. Symptoms including pain, weakness, numbness, or tingling, may be due to shoulder or cervical spine pathology. As such, making a diagnosis and treatment plan may be complicated. When deciding how to operatively treat a patient who complains of shoulder pain with confirmed shoulder and cervical spine pathology, the literature does not offer clear recommendations to guide order of operative choices. PURPOSE This study provides incidence data of patients with both shoulder and cervical spine pathology who needed shoulder, cervical spine, or both surgeries while reporting their effectiveness in treating a patient's shoulder symptoms. STUDY DESIGN/SETTING Retrospective chart review including patients over a 9 year period who received diagnoses of shoulder and cervical spine pathology and underwent operative fixation for one or both etiologies. PATIENT SAMPLE A total of 154 patient charts were reviewed, most of whom were male (58.4%) and between the ages of 40 and 59years (61.7%). 59.1% underwent shoulder surgery, 9.7% underwent cervical spine surgery, and 31.2% underwent both operations. OUTCOME MEASURES Subjective report of operative success in relieving shoulder symptoms. METHODS Demographic information, diagnoses, operative details, and a subjective report of operative success in relieving shoulder symptoms were recorded. Patient who only received cervical spine surgeries were compared to those who only underwent shoulder surgeries. Patients who received spine surgery before shoulder surgery were compared to patients who underwent shoulder before spine surgery. Finally, patients who underwent both types of surgeries were compared to those who only underwent one type. RESULTS Of the 154 patient charts reviewed, most of our patients were male (n=90, 58.4%) and between the ages of 40 and 59years (n=95, 61.7%). Ninety-one (59.1%) underwent shoulder surgery, 15 (9.7%) underwent cervical spine surgery, and 48 (31.2%) underwent both operations. 71 patients (46.1%) overall noted complete cessation of original shoulder symptoms post-operatively. No statistical difference was seen when comparing the 34 of 91 patients (37.4%) who reported full treatment of shoulder symptoms after shoulder surgeries (single or multiple) only to the 6 of 15 patients (40.0%) after cervical spine surgeries (single or multiple) only (p=.85). Of the patients who only underwent shoulder repairs, patients with rotator cuff tears had the highest reported rate of symptom relief (n=29 of 60, 48.3%). Of the patients who only underwent spine surgeries, patients with herniated nucleus pulposus had the highest reported rate of symptom relief (n=1 of 2, 50.0%). The success rate in patients who underwent shoulder surgery before spine surgery (n=10 of 16, 62.5%) was identical to patients who underwent spine surgery before shoulder surgery (n=20 of 32, 62.5%) (p=1.00). Patients with bicep tendon tears or subluxation (n=9 of 10, 90.0%) and foraminal stenosis (n=14 of 20, 70.0%) reported the highest rate of symptom relief post-operatively in this cohort. Patients who underwent both shoulder and spine operations were significantly more likely to report cessation of shoulder complaints than those patients who only underwent one type of operation (p=.004). CONCLUSIONS Similar success rate were seen when comparing patients who underwent only shoulder surgeries verses only cervical spine surgeries and shoulder then spine surgery versus spine then shoulder surgery. Performing both types of surgeries also yields higher success rates than only one type of surgery.