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SHOULDER PAIN which radiates down the arm is likely to be of indirect origin. The primary lesion may be overlooked if the examining physician concentrates on the shoulder. Pain in the shoulder radiating down the arm to the elbow or into the hand and fingers is nearly always due to a cervical lesion, since primary lesions of the shoulder usually do not produce radiating pain beyond the elbow. Furthermore, if the shoulder is normal to physical examination and by roentgen study, the primary lesion responsible for the painful shoulder is probably in the neck.
Osteoarthritis of the cervical spine, degenerated or extruded intervertebral discs, a cervical rib, or a neoplasm involving some part of the cervical spine, are some of the common causes of pain in the shoulder and arm. Pain in the neck may be trivial or nonexistent. The muscles of the neck, including the anterior scalenus muscle, may
Edward L. Compere. The Painful Shoulder. JAMA. 1964;189(11):845–846. doi:10.1001/jama.1964.03070110047011