How do I know if the pain I’m feeling is coming from my neck or shoulder?

The cervical spine is made up of 7 vertebral bodies, joints, nerves, muscles, ligaments and soft tissue.  Any of these structures may have injury, inflammation, overuse, or degenerative changes.  Pathology in the cervical spine can produce referred pain (pain that is felt in a different location).  It is not uncommon for cervical disc protrusions, which cause nerve impingement to produce pain that is felt in the shoulder, thoracic region, scapula, arm, or hand.  Cervical radiculopathy or a compressed nerve in the cervical spine may produce pain described as burning, tingling, or an electric type sensation radiating to the upper extremity.  Nerve type pain originating from the neck is frequently worse at night.  Arthritic pain coming from the cervical facet joints is described as stiffness in the neck or pain with turning, rotating the head, or driving.  A frequent cause of neck pain is a forward head posture secondary to prolonged cell phone or computer use.  The head weighs 10 lbs and prolonged positioning of the head in front of the body leads to fatigue and spasm in the muscles that support the head. The cervical paraspinals, trapezius, and rhomboid muscles become overworked.  If a patient feels pain radiating to the arm with movement of the neck or head then it is most likely the cervical spine causing the pain.

The shoulder joint is a ball and socket type joint with extensive mobility.  Because of the large range of motion of the shoulder, injury may be common.  The rotator cuff is a group of tendons and muscles that surround the shoulder joint, keeping the head of the humerus within the shoulder socket. Over time or as we age, we develop degenerative changes in the acromioclavicular (AC joint), the glenohumeral joint, or rotator cuff.   Rotator cuff tendonitis or biceps tendonitis is secondary to acute or chronic inflammation of the tendons.  Bursitis is inflammation of the fluid filled sacs between the tendons and the bones of the shoulder. Adhesive capsulitis or frozen shoulder is also a common cause of shoulder pain. Shoulder pathology may be felt with overhead activities, lifting, reaching behind the back or across the chest.  The pain may be felt in the front, top, posterior aspect of shoulder or in the upper arm. The patient may describe a click or creaking sensation when the shoulder is moved. They may either describe stiffness or a sensation of instability of the shoulder. It is frequently painful to lie on the side during sleeping when shoulder pathology is present.   It would be unusual to complain of tingling or numbness of the arm or hand if the issue is coming from the shoulder.  Shoulder disorders rarely refer pain to the hand or below the elbow. With a complete tear of the rotator cuff, the patient would have weakness in the shoulder/arm with certain movements.  Shoulder impingement is frequently caused by an overuse injury or arthritis of the AC joint. A narrowed space or inflamed tendons prohibits a smooth gliding motion as the rotator cuff tendons slide under the AC joint.

Neck and shoulder pain are the 2^nd and 3^rd most common musculoskeletal complaints that bring patients in to see a physician.

For a physician to determine whether the structure causing the pain is coming from the cervical spine or shoulder, it requires a obtaining a history and comprehensive physical examination.  X-ray imaging will be performed as necessary and if needed an ultrasound of the shoulder or an MRI of the cervical spine or shoulder will be ordered.  Physical therapy to improve body mechanics, strengthen the supporting muscles, decrease overuse, and provide the patient with the tools needed to manage their condition is often part of the treatment plan.  The physician will determine if medications such as nonsteroidal anti-inflammatory medications, corticosteroids, topical preparations, and/or injections are appropriate in the management of the patient’s condition.