Using X-ray to diagnose unilateral chronic neck and/or shoulder pain from decades of computer work

Question

I understand that unilateral chronic neck and/or shoulder pain from decades of computer work, in an otherwise healthy person, is likely to occur due to one of these conditions (and maybe also some others)¹:

• Mouse shoulder due to inappropriate arm position during working with a computer mouse (CCOHS, Acta Inform Med)
• Myofascial pain syndrome: muscle pain associated with a forced posture, repeated movements and stress (Mayo Clinic, Indian J Anesth)
• Pinched nerve in the neck (cervical radiculopathy): compression of the nerve that goes from the cervical spinal cord to an arm and may or may not be associated with the pain and tingling in the other parts of the arm and neck (AAFP)

• Frozen shoulder (adhesive capsulitis): an inflammation of the capsule of the shoulder joint; risk factors include shoulder immobilization, diabetes, thyroid disease, etc. (BMJ, OrthoInfo)

• (I don't know if Degenerative Spine disease might also cause that, as "degeneracy" can be genetic or due to "accidents").

My question

From learning on the above conditions (with maybe the exception of the last one), I understand that Ultrasound, MRI and Orthopedic tests (such as Spruling's test for Cervical radicolupathy), are often used to suggest diagnosis.

But, usually, will physicians also use X-ray to diagnose unilateral chronic neck and/or shoulder pain from decades of computer work, in an otherwise healthy person?

Notes

_{1. credit for user:Jan for his great answer here}

Answer 1

Yes, many physicians will be very prone to use X-ray or MRI to diagnose one-sided shoulder pain in an otherwise healthy person, but not necessary as the first thing. There is a variety of physical examination tests, like Spurling's test, other "provocation tests," tests to evaluate the strength of the individual muscles, the range of motion (ROM) in the shoulder, etc. that a doctor can use before going into further investigations. If a primary doctor can't do it, an orthopedician can do it, but if a doctor is not willing to do any manual tests before going to X-ray, you have a legitimate right to be suspicious.

A physician will first ask about the symptoms: the character and exact location of pain, triggers and relievers, eventual associated symptoms, such as pain in the neck or tingling in the arm, etc., which can make him think that the symptoms may be just from the overuse rather than from "structural" problems (actual tendon/bone damage...) that would require "machine" investigations. A doctor can then suggest to make a break from the work, changing the body position at the desk, before going into further diagnostics or treatment.

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From another perspective: In a man who is otherwise healthy, meaning having no symptoms or history of arthritis or any other disease, excessive mouse use will not likely result in a damage of the shoulder that would need imaging investigations. "Mouse shoulder" and "myofascial pain syndrome" are not associated with structural damage visible by X-ray or MRI. But, imaging can reveal a herniated disc in the neck, which is not related to mouse use but can be related to long-term forced neck position in a predisposed person.

So, it depends on the case.