The neck is the most common source of pain referred to the shoulder. Degenerative disease of the cervical spine, degenerative disc disease, and herniated nucleus pulposus can all refer pain to the shoulder. These symptoms may occur acutely or gradually. The pain is usually worse during daytime activities and better at night when activities cease. The patient with a C5-C6 herniated disk may present with pain very similar to that due to rotator cuff disease. Careful and thorough examination of the cervical spine and a complete neurovascular examination should be included in the evaluation of any patient with shoulder pain. On examination, range of motion in the neck may be restricted and may reproduce symptoms in the shoulder. Axial loading may especially cause referred pain. If a cervical condition is considered to be the source of pain, cervical radiographs including oblique views should be obtained. In the absence of neurologic findings, conservative measures may be inititiated. In the emergency department, the patient may be fitted with a soft cervical collar and provided with analgesics and anti-inflammatory agents as needed for comfort.
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