A Simple Test for the Most Common Cause or Aggravating Factor of the Neck, Shoulder, or Upper Extremity Pain
Abstract
Background: Shoulder pain and neck pain affect respectively 25% and 43% of the population. The aim of this clinical study is to assess the proportion, correct diagnosis, and treatment of hypertension (HTN) in patients with pain in the neck, shoulder, and upper extremity.
Methods: 300 patients with complaints of neck, shoulder, or upper extremity pain without trauma or infection were studied from January 2015 to December 2017. After taking the history and examination, the blood pressure of these patients was recorded. Laboratory tests, x-ray, and magnetic resonance imaging (MRI) of the neck and affected shoulder joint were requested. Antihypertensive and symptomatic treatments were prescribed for patients with HTN. In the next visits, new history and examination, including the range of motion (ROM) of neck, shoulder, and upper extremity, blood pressure, and the results of laboratory tests, and images were checked. The final data were analyzed using chi-square test in SPSS software.
Results: The Prevalence of HTN in patients in the age groups of 20-30, 31-60, and above 60 years were 21%, 44%, and 56 %, respectively. Neck, shoulder, and upper extremity pain and motion improved significantly after antihypertensive and symptomatic treatment in patients with HTN.
Conclusion: HTN is the most common cause of neck, shoulder, and upper extremity pain in the adults and older patients referring to a physician. Thus, checking blood pressure by a physician or specialist is recommended for adults or older patients with neck, shoulder, or upper extremity pain. Antihypertensive and symptomatic treatments must be prescribed for nonsteroidal anti-inflammatory drugs (NSAIDs), and acetaminophen-codeine and corticosteroids should be prohibited for the patients with HTN.
1. Guez M, Hildingsson C, Nilsson M, Toolanen G. The prevalence of neck pain: A population-based study from northern Sweden. Acta Orthop Scand. 2002;73(4):455-9. doi: 10.1080/00016470216329. [PubMed: 12358121].
2. Hill CL, Gill TK, Shanahan EM, Taylor AW. Prevalence and correlates of shoulder pain and stiffness in a population-based study: The North West Adelaide Health Study. Int J Rheum Dis. 2010;13(3):215-22.doi: 10.1111/j.1756-185X.2010.01475.x. [PubMed: 20704617].
3. Garving C, Jakob S, Bauer I, Nadjar R, Brunner UH. Impingement syndrome of the shoulder. Dtsch Arztebl Int. 2017;114(45):765-76. doi: 10.3238/arztebl.2017.0765. [PubMed: 29202926]. [PubMed Central: PMC5729225].
4. Mills KT, Bundy JD, Kelly TN, Reed JE, Kearney PM, Reynolds K, et al. Global disparities of hypertension prevalence and control: A systematic analysis of population-based studies from 90 countries. Circulation. 2016;134(6):441-50. doi: 10.1161/CIRCULATIONAHA.115.018912. [PubMed: 27502908].
[PubMed Central: PMC4979614].
5. Victor RG. Systemic hypertension: Mechanisms and diagnosis.In: Mann D, Zipes D, Libby P, Bonow R, Editors. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. Philadelphia, PA: Elsevier Health Sciences; 2014.
6. Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL Jr, et al. The seventh report of the joint national committee on prevention, detection, evaluation, and treatment of high blood pressure: The JNC 7 report. JAMA. 2003;289(19):2560-72. doi: 10.1001/jama.289.19.2560. [PubMed: 12748199].
7. Miller RH 3rd, Azar FM, Throckmorton TW. Shoulder and elbow injuries. In: Canale ST, Azar FM, Beaty JH, Editors. Campbell's operative orthopaedics. Philadelphia, PA: Elsevier; 2017.
8. Shah KM, Clark BR, McGill JB, Mueller MJ. Upper extremity impairments, pain and disability in patients with diabetes
mellitus. Physiotherapy. 2015;101(2):147-54. doi: 10.1016/j.physio.2014.07.003. [PubMed: 25442298]. [PubMed Central: PMC4366332].
9. Waersted M, Hanvold TN, Veiersted KB. Computer work and musculoskeletal disorders of the neck and upper extremity: A systematic review. BMC Musculoskelet Disord. 2010;11:79. doi:
10.1186/1471-2474-11-79. [PubMed: 20429925]. [PubMed: PMC2874766].
10. Yamamoto A, Takagishi K, Osawa T, Yanagawa T, Nakajima D, Shitara H, et al. Prevalence and risk factors of a rotator cuff tear in the general population. J Shoulder Elbow Surg. 2010;19(1):116-20. doi: 10.1016/j.jse.2009.04.006. [PubMed: 19540777].
11. Sher JS, Uribe JW, Posada A, Murphy BJ, Zlatkin MB. Abnormal findings on magnetic resonance images of asymptomatic shoulders. J Bone Joint Surg Am. 1995;77(1):10-5. doi: 10.2106/00004623-199501000-00002. [PubMed: 7822341].
12. Gumina S, Arceri V, Carbone S, Albino P, Passaretti D, Campagna V, et al. The association between arterial hypertension and rotator cuff tear: The influence on rotator cuff tear sizes. J Shoulder Elbow Surg. 2013;22(2):229-32. doi: 10.1016/j.jse.2012.05.023. [PubMed: 22748932].
13. Harvie P, Pollard TC, Carr AJ. Calcific tendinitis: Natural history and association with endocrine disorders. J Shoulder Elbow Surg. 2007;16(2):169-73. doi: 10.1016/j.jse.2006.06.007. [PubMed: 17188907].
14. Vogt MT, Simonsick EM, Harris TB, Nevitt MC, Kang JD, Rubin SM, et al. Neck and shoulder pain in 70- to 79-year-old men and women: Findings from the Health, Aging and Body Composition Study. Spine J. 2003;3(6):435-41. doi: 10.1016/s1529-9430(03)00150-5. [PubMed: 14609687].
15. McKee MD, Yoo DJ. The effect of surgery for rotator cuff disease on general health status. Results of a prospective trial. J Bone Joint Surg Am. 2000;82-A(7):970-9. doi: 10.2106/00004623-200007000-00009. [PubMed: 10901312].
16. Oliva F, Osti L, Padulo J, Maffulli N. Epidemiology of the rotator cuff tears: A new incidence related to thyroid disease. Muscles Ligaments Tendons J. 2014;4(3):309-14. [PubMed: 25489548]. [PubMed Central: PMC4241421].
17. Bae YH, Shin JS, Lee J, Kim MR, Park KB, Cho JH, et al. Association between hypertension and the prevalence of low back pain and osteoarthritis in Koreans: A cross-sectional study. PLoS One. 2015;10(9):e0138790. doi: 10.1371/journal.pone.0138790. [PubMed: 26393797]. [PubMed Central: PMC4578861].
18. Petersson CJ, Redlund-Johnell I. Joint space in normal gleno-humeral radiographs. Acta Orthop Scand. 1983;54(2):274-6. doi: 10.3109/17453678308996569. [PubMed: 6846006].
19. Kircher J, Morhard M, Magosch P, Ebinger N, Lichtenberg S, Habermeyer P. How much are radiological parameters related to clinical symptoms and function in osteoarthritis of the shoulder? Int Orthop. 2010;34(5):677-81. doi: 10.1007/s00264-009-0846-6. [PubMed: 19652970]. [PubMed Central: PMC2903182].
20. Kircher J, Kuerner K, Morhard M, Krauspe R, Habermeyer P. Age-related joint space narrowing independent of the development of osteoarthritis of the shoulder. Int J Shoulder Surg. 2014;8(4):95-100. doi: 10.4103/0973-6042.145213. [PubMed: 25538427]. [PubMed Central: PMC4262869].
21. Tran G, Hensor EM, Ray A, Kingsbury SR, O'Connor P, Conaghan PG. Ultrasound-detected pathologies cluster into groups with different clinical outcomes: Data from 3000 community referrals for shoulder pain. Arthritis Res Ther. 2017;19(1):30. doi: 10.1186/s13075-017-1235-y. [PubMed: 28183338]. [PubMed Central: PMC5304553].
22. Makela M, Heliovaara M, Sainio P, Knekt P, Impivaara O,
Aromaa A. Shoulder joint impairment among Finns aged 30 years or over: Pevalence, risk factors and co-morbidity.
Rheumatology (Oxford). 1999;38(7):656-62. doi:
10.1093/rheumatology/38.7.656. [PubMed: 10461481].
23. Yang H, Hitchcock E, Haldeman S, Swanson N, Lu ML, Choi B, et al. Workplace psychosocial and organizational factors for neck pain in workers in the United States. Am J Ind Med. 2016;59(7):549-60. doi: 10.1002/ajim.22602. [PubMed: 27184340]. [PubMed Central: PMC4979741].
24. Son KM, Cho NH, Lim SH, Kim HA. Prevalence and risk factor of neck pain in elderly Korean community residents. J Korean Med Sci. 2013;28(5):680-6. doi: 10.3346/jkms.2013.28.5.680. [PubMed: 23678258]. [PubMed Central: PMC3653079].
25. Park SJ, Lee R, Yoon DM, Yoon KB, Kim K, Kim SH. Factors associated with increased risk for pain catastrophizing in patients with chronic neck pain: A retrospective cross-sectional study. Medicine (Baltimore). 2016;95(37):e4698. doi: 10.1097/MD.0000000000004698. [PubMed: 27631217. [PubMed Central: PMC5402560].
26. Peng B, Pang X, Li D, Yang H. Cervical spondylosis and hypertension: A clinical study of 2 cases. Medicine (Baltimore).
2015;94(10):e618.doi:10.1097/MD.0000000000000618.
[PubMed: 25761188]. [PubMed Central: PMC4602471].
27. Bruehl S, Chung OY, Jirjis JN, Biridepalli S. Prevalence of clinical hypertension in patients with chronic pain compared to nonpain general medical patients. Clin J Pain. 2005;21(2):147-53. doi: 10.1097/00002508-200503000-00006. [PubMed: 15722808].
28. Hosseini AA, Sobhani-Rad D, Ghandehari K, Benamer HT. Frequency and clinical patterns of stroke in Iran-Systematic and critical review. BMC Neurol. 2010;10:72. doi: 10.1186/1471-2377-10-72. [PubMed: 20731823]. [PubMed Central: PMC2936882].
29. Malekzadeh MM, Etemadi A, Kamangar F, Khademi H, Golozar A, Islami F, et al. Prevalence, awareness and risk factors of hypertension in a large cohort of Iranian adult population. J Hypertens. 2013;31(7):1364-71. doi: 10.1097/HJH.0b013e3283613053. [PubMed: 23673348]. [PubMed Central: PMC3766446].
30. Atroshi I, Gummesson C, Johnsson R, Ornstein E, Ranstam J, Rosen I. Prevalence of carpal tunnel syndrome in a general population. JAMA. 1999;282(2):153-8. doi: 10.1001/jama.282.2.153. [PubMed: 10411196].
31. Bland JD, Rudolfer SM. Clinical surveillance of carpal tunnel syndrome in two areas of the United Kingdom, 1991-2001. J Neurol Neurosurg Psychiatry. 2003;74(12):1674-9. doi:
10.1136/jnnp.74.12.1674. [PubMed: 14638888]. [PubMed: PMC1757436].
32. Emara MK, Saadah AM. The carpal tunnel syndrome in hypertensive patients treated with beta-blockers. Postgrad Med J. 1988;64(749):191-2. doi: 10.1136/pgmj.64.749.191. [PubMed: 3140228]. [PubMed Central: PMC2428835].
33. Guan W, Lao J, Gu Y, Zhao X, Rui J, Gao K. Case-control study on individual risk factors of carpal tunnel syndrome. Exp Ther Med. 2018;15(3):2761-6. doi: 10.3892/etm.2018.5817. [PubMed:29599825]. [PubMed Central: PMC5867472].
34. Titchener AG, White JJ, Hinchliffe SR, Tambe AA, Hubbard RB, Clark DI. Comorbidities in rotator cuff disease: A case-control study. J Shoulder Elbow Surg. 2014;23(9):1282-8. doi: 10.1016/j.jse.2013.12.019. [PubMed: 24618192].
35. Titchener AG, Fakis A, Tambe AA, Smith C, Hubbard RB, Clark DI. Risk factors in lateral epicondylitis (tennis elbow): A case-control study. J Hand Surg Eur Vol. 2013;38(2):159-64. doi: 10.1177/1753193412442464. [PubMed: 22490998].
36. Shiri R, Viikari-Juntura E, Varonen H, Heliovaara M. Prevalence and determinants of lateral and medial epicondylitis: A population study. Am J Epidemiol. 2006;164(11):1065-74. doi:10.1093/aje/kwj325. [PubMed: 16968862].
37. Wojcik G, Sokolowska B, Piskorz J. Epidemiology and pathogenesis of thoracic outlet syndrome. Curr Issues Pharm Med Sci. 2015;28(1):24-7.
38. Franklin SS, Wilkinson IB, McEniery CM. Unusual hypertensive phenotypes: What is their significance? Hypertension. 2012;59(2):173-8. doi: 10.1161/HYPERTENSIONAHA.111.182956. [PubMed: 22184330].
39. Mitchell RN, Schoen FJ. Blood vessels. In: Kumar V, Abbas AK, Fausto N, Aster JC, Editors. Robbins & Cotran pathologic basis of disease e-book. Philadelphia, PA: Elsevier Health Sciences; 2009. p. 495.
2. Hill CL, Gill TK, Shanahan EM, Taylor AW. Prevalence and correlates of shoulder pain and stiffness in a population-based study: The North West Adelaide Health Study. Int J Rheum Dis. 2010;13(3):215-22.doi: 10.1111/j.1756-185X.2010.01475.x. [PubMed: 20704617].
3. Garving C, Jakob S, Bauer I, Nadjar R, Brunner UH. Impingement syndrome of the shoulder. Dtsch Arztebl Int. 2017;114(45):765-76. doi: 10.3238/arztebl.2017.0765. [PubMed: 29202926]. [PubMed Central: PMC5729225].
4. Mills KT, Bundy JD, Kelly TN, Reed JE, Kearney PM, Reynolds K, et al. Global disparities of hypertension prevalence and control: A systematic analysis of population-based studies from 90 countries. Circulation. 2016;134(6):441-50. doi: 10.1161/CIRCULATIONAHA.115.018912. [PubMed: 27502908].
[PubMed Central: PMC4979614].
5. Victor RG. Systemic hypertension: Mechanisms and diagnosis.In: Mann D, Zipes D, Libby P, Bonow R, Editors. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. Philadelphia, PA: Elsevier Health Sciences; 2014.
6. Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL Jr, et al. The seventh report of the joint national committee on prevention, detection, evaluation, and treatment of high blood pressure: The JNC 7 report. JAMA. 2003;289(19):2560-72. doi: 10.1001/jama.289.19.2560. [PubMed: 12748199].
7. Miller RH 3rd, Azar FM, Throckmorton TW. Shoulder and elbow injuries. In: Canale ST, Azar FM, Beaty JH, Editors. Campbell's operative orthopaedics. Philadelphia, PA: Elsevier; 2017.
8. Shah KM, Clark BR, McGill JB, Mueller MJ. Upper extremity impairments, pain and disability in patients with diabetes
mellitus. Physiotherapy. 2015;101(2):147-54. doi: 10.1016/j.physio.2014.07.003. [PubMed: 25442298]. [PubMed Central: PMC4366332].
9. Waersted M, Hanvold TN, Veiersted KB. Computer work and musculoskeletal disorders of the neck and upper extremity: A systematic review. BMC Musculoskelet Disord. 2010;11:79. doi:
10.1186/1471-2474-11-79. [PubMed: 20429925]. [PubMed: PMC2874766].
10. Yamamoto A, Takagishi K, Osawa T, Yanagawa T, Nakajima D, Shitara H, et al. Prevalence and risk factors of a rotator cuff tear in the general population. J Shoulder Elbow Surg. 2010;19(1):116-20. doi: 10.1016/j.jse.2009.04.006. [PubMed: 19540777].
11. Sher JS, Uribe JW, Posada A, Murphy BJ, Zlatkin MB. Abnormal findings on magnetic resonance images of asymptomatic shoulders. J Bone Joint Surg Am. 1995;77(1):10-5. doi: 10.2106/00004623-199501000-00002. [PubMed: 7822341].
12. Gumina S, Arceri V, Carbone S, Albino P, Passaretti D, Campagna V, et al. The association between arterial hypertension and rotator cuff tear: The influence on rotator cuff tear sizes. J Shoulder Elbow Surg. 2013;22(2):229-32. doi: 10.1016/j.jse.2012.05.023. [PubMed: 22748932].
13. Harvie P, Pollard TC, Carr AJ. Calcific tendinitis: Natural history and association with endocrine disorders. J Shoulder Elbow Surg. 2007;16(2):169-73. doi: 10.1016/j.jse.2006.06.007. [PubMed: 17188907].
14. Vogt MT, Simonsick EM, Harris TB, Nevitt MC, Kang JD, Rubin SM, et al. Neck and shoulder pain in 70- to 79-year-old men and women: Findings from the Health, Aging and Body Composition Study. Spine J. 2003;3(6):435-41. doi: 10.1016/s1529-9430(03)00150-5. [PubMed: 14609687].
15. McKee MD, Yoo DJ. The effect of surgery for rotator cuff disease on general health status. Results of a prospective trial. J Bone Joint Surg Am. 2000;82-A(7):970-9. doi: 10.2106/00004623-200007000-00009. [PubMed: 10901312].
16. Oliva F, Osti L, Padulo J, Maffulli N. Epidemiology of the rotator cuff tears: A new incidence related to thyroid disease. Muscles Ligaments Tendons J. 2014;4(3):309-14. [PubMed: 25489548]. [PubMed Central: PMC4241421].
17. Bae YH, Shin JS, Lee J, Kim MR, Park KB, Cho JH, et al. Association between hypertension and the prevalence of low back pain and osteoarthritis in Koreans: A cross-sectional study. PLoS One. 2015;10(9):e0138790. doi: 10.1371/journal.pone.0138790. [PubMed: 26393797]. [PubMed Central: PMC4578861].
18. Petersson CJ, Redlund-Johnell I. Joint space in normal gleno-humeral radiographs. Acta Orthop Scand. 1983;54(2):274-6. doi: 10.3109/17453678308996569. [PubMed: 6846006].
19. Kircher J, Morhard M, Magosch P, Ebinger N, Lichtenberg S, Habermeyer P. How much are radiological parameters related to clinical symptoms and function in osteoarthritis of the shoulder? Int Orthop. 2010;34(5):677-81. doi: 10.1007/s00264-009-0846-6. [PubMed: 19652970]. [PubMed Central: PMC2903182].
20. Kircher J, Kuerner K, Morhard M, Krauspe R, Habermeyer P. Age-related joint space narrowing independent of the development of osteoarthritis of the shoulder. Int J Shoulder Surg. 2014;8(4):95-100. doi: 10.4103/0973-6042.145213. [PubMed: 25538427]. [PubMed Central: PMC4262869].
21. Tran G, Hensor EM, Ray A, Kingsbury SR, O'Connor P, Conaghan PG. Ultrasound-detected pathologies cluster into groups with different clinical outcomes: Data from 3000 community referrals for shoulder pain. Arthritis Res Ther. 2017;19(1):30. doi: 10.1186/s13075-017-1235-y. [PubMed: 28183338]. [PubMed Central: PMC5304553].
22. Makela M, Heliovaara M, Sainio P, Knekt P, Impivaara O,
Aromaa A. Shoulder joint impairment among Finns aged 30 years or over: Pevalence, risk factors and co-morbidity.
Rheumatology (Oxford). 1999;38(7):656-62. doi:
10.1093/rheumatology/38.7.656. [PubMed: 10461481].
23. Yang H, Hitchcock E, Haldeman S, Swanson N, Lu ML, Choi B, et al. Workplace psychosocial and organizational factors for neck pain in workers in the United States. Am J Ind Med. 2016;59(7):549-60. doi: 10.1002/ajim.22602. [PubMed: 27184340]. [PubMed Central: PMC4979741].
24. Son KM, Cho NH, Lim SH, Kim HA. Prevalence and risk factor of neck pain in elderly Korean community residents. J Korean Med Sci. 2013;28(5):680-6. doi: 10.3346/jkms.2013.28.5.680. [PubMed: 23678258]. [PubMed Central: PMC3653079].
25. Park SJ, Lee R, Yoon DM, Yoon KB, Kim K, Kim SH. Factors associated with increased risk for pain catastrophizing in patients with chronic neck pain: A retrospective cross-sectional study. Medicine (Baltimore). 2016;95(37):e4698. doi: 10.1097/MD.0000000000004698. [PubMed: 27631217. [PubMed Central: PMC5402560].
26. Peng B, Pang X, Li D, Yang H. Cervical spondylosis and hypertension: A clinical study of 2 cases. Medicine (Baltimore).
2015;94(10):e618.doi:10.1097/MD.0000000000000618.
[PubMed: 25761188]. [PubMed Central: PMC4602471].
27. Bruehl S, Chung OY, Jirjis JN, Biridepalli S. Prevalence of clinical hypertension in patients with chronic pain compared to nonpain general medical patients. Clin J Pain. 2005;21(2):147-53. doi: 10.1097/00002508-200503000-00006. [PubMed: 15722808].
28. Hosseini AA, Sobhani-Rad D, Ghandehari K, Benamer HT. Frequency and clinical patterns of stroke in Iran-Systematic and critical review. BMC Neurol. 2010;10:72. doi: 10.1186/1471-2377-10-72. [PubMed: 20731823]. [PubMed Central: PMC2936882].
29. Malekzadeh MM, Etemadi A, Kamangar F, Khademi H, Golozar A, Islami F, et al. Prevalence, awareness and risk factors of hypertension in a large cohort of Iranian adult population. J Hypertens. 2013;31(7):1364-71. doi: 10.1097/HJH.0b013e3283613053. [PubMed: 23673348]. [PubMed Central: PMC3766446].
30. Atroshi I, Gummesson C, Johnsson R, Ornstein E, Ranstam J, Rosen I. Prevalence of carpal tunnel syndrome in a general population. JAMA. 1999;282(2):153-8. doi: 10.1001/jama.282.2.153. [PubMed: 10411196].
31. Bland JD, Rudolfer SM. Clinical surveillance of carpal tunnel syndrome in two areas of the United Kingdom, 1991-2001. J Neurol Neurosurg Psychiatry. 2003;74(12):1674-9. doi:
10.1136/jnnp.74.12.1674. [PubMed: 14638888]. [PubMed: PMC1757436].
32. Emara MK, Saadah AM. The carpal tunnel syndrome in hypertensive patients treated with beta-blockers. Postgrad Med J. 1988;64(749):191-2. doi: 10.1136/pgmj.64.749.191. [PubMed: 3140228]. [PubMed Central: PMC2428835].
33. Guan W, Lao J, Gu Y, Zhao X, Rui J, Gao K. Case-control study on individual risk factors of carpal tunnel syndrome. Exp Ther Med. 2018;15(3):2761-6. doi: 10.3892/etm.2018.5817. [PubMed:29599825]. [PubMed Central: PMC5867472].
34. Titchener AG, White JJ, Hinchliffe SR, Tambe AA, Hubbard RB, Clark DI. Comorbidities in rotator cuff disease: A case-control study. J Shoulder Elbow Surg. 2014;23(9):1282-8. doi: 10.1016/j.jse.2013.12.019. [PubMed: 24618192].
35. Titchener AG, Fakis A, Tambe AA, Smith C, Hubbard RB, Clark DI. Risk factors in lateral epicondylitis (tennis elbow): A case-control study. J Hand Surg Eur Vol. 2013;38(2):159-64. doi: 10.1177/1753193412442464. [PubMed: 22490998].
36. Shiri R, Viikari-Juntura E, Varonen H, Heliovaara M. Prevalence and determinants of lateral and medial epicondylitis: A population study. Am J Epidemiol. 2006;164(11):1065-74. doi:10.1093/aje/kwj325. [PubMed: 16968862].
37. Wojcik G, Sokolowska B, Piskorz J. Epidemiology and pathogenesis of thoracic outlet syndrome. Curr Issues Pharm Med Sci. 2015;28(1):24-7.
38. Franklin SS, Wilkinson IB, McEniery CM. Unusual hypertensive phenotypes: What is their significance? Hypertension. 2012;59(2):173-8. doi: 10.1161/HYPERTENSIONAHA.111.182956. [PubMed: 22184330].
39. Mitchell RN, Schoen FJ. Blood vessels. In: Kumar V, Abbas AK, Fausto N, Aster JC, Editors. Robbins & Cotran pathologic basis of disease e-book. Philadelphia, PA: Elsevier Health Sciences; 2009. p. 495.
| Files | ||
| Issue | Vol 5, No 4 (2019) | |
| Section | Research Articles | |
| DOI | https://doi.org/10.18502/jost.v5i4.4377 | |
| Keywords | ||
| Hypertension Neck Shoulder Upper extremity | ||
| Rights and permissions | |
|
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
How to Cite
1.
khajeh R, Fallah Y. A Simple Test for the Most Common Cause or Aggravating Factor of the Neck, Shoulder, or Upper Extremity Pain. J Orthop Spine Trauma. 2020;5(4):86-91.
