Determination of Referred Scapula Pain from C6 or C7cervical Spinal Stenosis

Abstract

Objective: The purpose of this study was to see if there was any referred medial scapula pain from C6 or C7 cervical spinal stenosis. Scapula pain of neurologic origin is currently thought to be primarily mediated by C5 via the dorsal scapular nerve. Dorsal root ganglion neurons with dichotomising axons are present in several species and are considered to play a role in referred pain. An interventional spine clinic observed a number of patients with medial scapula pain who did not have C5 stenosis, but many of these patients had C6 or C7 stenosis.

Methods: The charts of 278 patients seen in an interventional spine clinic over an 11 year period from 2008 to 2018 who were diagnosed with cervical radiculopathy based on location of pain were reviewed. 135 of these had cervical MRI imaging. Data was collected to evaluate for a correlation of the level of cervical stenosis with the location of pain at the medial border of the scapula.

Results: Patients with ipsilateral medial scapula pain had 0.0% incidence of stenosis at C4, 29.5% at C5, 64.6% at C6, 49.2% at C7, 0.0% at C8, and 80% with either C6 or C7 stenosis.

Conclusion: This is the first report of referred pain to the medial scapula from cervical stenosis at the C6 or C7 levels. The mechanism of referred pain is reviewed and a plausible and testable neurologic explanation for these observed findings is presented.