Neck and shoulder pain has a variety of causes. Some people experience only shoulder or neck pain, while others experience pain in both areas. Depending on the activity and cause, neck and shoulder pain may alternate in intensity.
What are the Symptoms of Shoulder and Neck Pain
Neck and shoulder pain symptoms depend on the cause and can range from mild to severe. Common symptoms include pain deep in the shoulder joint that worsens with certain movements, reduced movement in the neck and shoulder, headaches, pins and needles, and weakness of the shoulder joint.
Causes of Shoulder and Neck Pain
There are many different causes of neck and shoulder pain. In younger people, pain is likely due to an injury or trauma. Natural degeneration occurs in the neck and shoulder joints with age, which may become persistently painful over time. See below for more details.
1. Soft tissue injuries
Soft tissue injuries include any injury to the muscles, ligaments, tendons, and cartilage of the neck and shoulder joint:
Ligaments are bands of tissue that connect bone to bone. They provide stability in both the shoulder and neck joints. Ligaments may become damaged during an accident, resulting in whiplash of the neck or shoulder dislocation. Ligament pain is usually short-term pain.
Tendons connect your muscles to your bones, allowing you to move. Tendons in the shoulder often become injured with overuse injuries, common in activities such as swimming.
Cartilage injuries: Cartilage lines the joint, facilitating the smooth gliding of the bones past one another. Cartilage injuries are often caused by trauma but can also result from wear and tear or degeneration.
Muscle injuries: Muscle injuries can result from overuse or trauma. For example, tears of the rotator cuff muscles or tendons may occur due to an injury or fall.
Osteoarthritis can occur both in the neck and shoulder joints. Cervical spondylosis is the name given to arthritis of the neck. With age, the joints of the neck undergo wear and tear, exposing the underlying bone, and causing stiffness, pain, and sometimes headaches. This degeneration may also cause the development of bone spurs which may impinge on the nerves that exit the neck, a condition known as spinal stenosis.
Shoulder osteoarthritis often results from an injury or trauma such as a dislocation or fracture, termed post-traumatic arthritis. Shoulder osteoarthritis also results in the development of bone spurs, which results in pain, stiffness, and sometimes clicking with any movement of the shoulder.
3. Pinched Nerve (Cervical radiculopathy)
A pinched nerve, known as cervical radiculopathy, occurs when the nerves that exit the neck at the spine are compressed, a condition related to spinal stenosis. Spinal stenosis is caused by osteoarthritis, bone spurs, and disc herniations. It results in inflammation and pain that radiates into the upper back or down the arm. Other symptoms of cervical radiculopathy include numbness, weakness of the arm, shoulder, hands, or fingers, pins and needles, and pain that radiates down into the arm and hand.
4. Bulging Discs
Discs are the cushions that act as shock absorbers between each vertebra. A bulging disc is when the disc becomes damaged and bulges into the spaces where the nerves exit the spine. Discs can become injured because of degenerative disc diseases such as osteoarthritis or traumatic injuries to the neck. The symptoms of a herniated disc are similar to a pinched nerve and include:
Whiplash is an injury of the neck that is often caused by a traumatic event such as a car crash, sports injury, or physical abuse. Whiplash occurs with the forceful, rapid back and forth or side-to-side movement of the head, resulting in neck joint sprains or a tear in the neck muscles. The symptoms of whiplash include:
6. Rotator Cuff Tears
The rotator cuff is the group of muscles and tendons that surround the shoulder joint, providing the shoulder with stability. Rotator cuff tears often occur with a traumatic injury such as a fall or with overuse, such as in sports requiring repeated overhead movements. People over 50 are also more likely to develop rotator cuff injuries due to bone spurs (from osteoarthritis). The symptoms of rotator cuff injuries include:
7. Frozen Shoulder
Frozen shoulder is a condition that often affects older people. It is characterised by excessive stiffness and pain that prevents shoulder movement. There is no known cause of frozen shoulder, although it is thought to develop in people who have had previous shoulder injuries. The symptoms of shoulder pain include:
Constant dull ache in the shoulder.
Reduced movement in the shoulder, including not being able to put the arm behind the back.
8. Shoulder Bursitis
Bursae are the fluid-filled cushions that prevent the tendons of your shoulder from rubbing on the bone. Damage to any of the tendons and muscles in the rotator cuff may lead to inflammation and thickening of the bursae, which is termed shoulder bursitis. Symptoms of shoulder bursitis include:
A bulge or lump in the shoulder joint
Pain with shoulder movement
Redness or swelling of the shoulder joint.
Fractures often occur because of a traumatic injury such as a sporting incident or motor vehicle collision. Fractures can occur in the spine, the collar bone, and the scapula. Fractures, and especially those of the spine, are a medical emergency.
10. Organ Pain
Some organ pain refers to the neck, shoulder and arms. For example, sudden pain or numbness in the neck, jaws, or shoulders can signify a heart attack, while gallstones can cause pain that starts in the upper back that radiates into the arms. Note that a heart attack is a medical emergency. Symptoms of a heart attack include:
How to Diagnose Shoulder and Neck Pain
To diagnose what may be causing your neck and shoulder pain, your physician or physiotherapist will ask you questions about your symptoms and medical history. They will also perform a detailed physical examination to assess any structural issues and rule out any problems with your neck or spine.
The physical examination involves inspecting the neck and shoulder for swelling and inflammation and assessing your posture. You will be asked to move in different directions to ascertain which movements increase the pain and assess the range of motion of your neck and shoulders. The examiner may also perform special clinical tests to try and exacerbate the symptoms.
Often other imaging tests are necessary to understand what is causing the pain. These include X-rays, MRI scans, CT scans, electromyography (EMG), lumbar punctures (to check for infection) and arthroscopy.
Treating Neck and Shoulder Pain
There are various treatment options for neck and shoulder pain, depending on the underlying cause. Serious conditions such as fractures and heart attacks require emergency care.
Fractures and complete ligament or muscle tears of the shoulder may require surgery and must be kept in a sling for up to 4 – 6 weeks. Osteoarthritis of the shoulder and neck may be treated with corticosteroid injections and prescription medications such as strong pain killers and oral corticosteroids.
If your pain is caused by compression of the nerves in your neck (cervical radiculopathy), your doctor will determine the degree of damage and recommend conservative treatment such as medications and physiotherapy or more invasive treatment such as surgery.
Mild to moderate neck and shoulder pain may be treated with medications such as ibuprofen, aspirin, or Tylenol. Your doctor may also recommend trying physiotherapy. The goal of physiotherapy is to reduce neck and shoulder pain and restore strength and mobility.
Many different conditions can cause shoulder and neck pain. Mild to moderate pain will usually resolve within a matter of weeks, while more severe pain may need more serious intervention.