Clinical Differentiation: Cervical Spine vs. Shoulder Pathology

The Cervicobrachial Diagnostic Challenge

• Patients commonly present with overlapping neck, periscapular, and shoulder pain.

• Accurate clinical localization is the essential first step before imaging or intervention.

• The primary goal is distinguishing cervical radiculopathy from intrinsic glenohumeral or subacromial pathology.

Provocative & Relieving Physical Examination Tests

• Shoulder Abduction Relief Sign (Bakody Test):

  • The patient actively abducts the symptomatic arm and rests the hand on top of the head.

  • Symptom relief during this maneuver confirms pain of cervical spine origin (cervical radiculopathy).

  • Elevation of the arm decreases mechanical tension across the compressed lower cervical nerve roots.

• Shoulder Movement Provocation:

  • Pain exacerbated by direct shoulder motion (active elevation, internal rotation, or external rotation) indicates intrinsic shoulder pathology (rotator cuff disease, impingement, or adhesive capsulitis).

  • Direct glenohumeral manipulation typically spares cervical radicular pathways.