Neck and Shoulder Pain

The neck and shoulder region is highly susceptible to pain due to its range of motion and the stress it endures daily. Pain in this area can strike suddenly or develop gradually, significantly impacting one’s quality of life. Simple activities such as turning your head, lifting objects, or even sitting at a desk can become challenging and uncomfortable.

This discomfort often leads to difficulty concentrating, irritability, and sometimes even headaches. Understanding the causes and appropriate treatments for neck and shoulder pain is crucial in managing symptoms and regaining normal function.

Where in the Neck and Shoulder Does It Hurt?

Neck and shoulder pain can occur in various areas with different levels of severity, and the pain can significantly disrupt your daily activities. To help address your discomfort effectively, it’s important to pinpoint exactly where you feel the pain. Is it a sharp sting at the base of your neck, a constant ache over your shoulders, or a deep throb near your shoulder blade?

Identifying the specific location of the pain is important as it can help us understand the potential causes of the pain and recommend the best treatments.

The specific areas where neck and shoulder pain can occur include:

• Upper neck: This area includes the region near the base of the skull. Pain here is often associated with headaches, suboccipital pain, or stiffness that can affect the cervical (neck) range of motion.
• Middle neck: This corresponds to the mid-cervical vertebrae. Issues here can lead to pain that might feel like a deep ache or sharp twinges during certain movements.
• Lower neck: Located towards the base of the cervical spine, this area transitions into the thoracic spine, aka the mid back. Pain in the lower neck can radiate downwards into the scapula (shoulder blade) and is often linked with shoulder and upper back discomfort.
  
  Additionally, neck pain can manifest in both the posterior (back) and anterior (front) parts of the neck.
• Posterior neck pain: This often involves irritation of the facet joints, cervical discs, exiting nerves, and muscles.

• Anterior shoulder: This is often associated with persistent muscle tension due to cervical instability, ligament injuries, and AC and SC joint injuries.

Specific areas where shoulder pain can occur include:

• Anterior shoulder: Pain in the front part of the shoulder often involves the biceps tendon, supraspinatus, or subscapularis tendons, and may be related to tendonitis.
• Posterior shoulder: Common causes of pain in the back part of the shoulder include issues with the rotator cuff or referred pain from the neck.
• Lateral shoulder: Pain in the side of the shoulder is commonly associated with rotator cuff problems, deltoid muscle injury, or bursitis.
• Superior shoulder: Pain in the top part of the shoulder often involves the acromioclavicular joint and sternoclavicular joint and can result from arthritis, joint separation, or other injuries.
• Under the shoulder blade: Pain under or around the shoulder blade can be caused by many structures, including muscle, ligament, and tendon injuries, rotator cuff tendinosis, thoracic facet injuries, and referred pain from a cervical disc or facet:

The different areas of the neck and shoulder identified above are for ease of identifying the location of pain or dysfunction. In reality, patients can have pain in one or more areas or pain that originates in one area that extends into another. This is simply a guide.

Types of Pain in Shoulder and Neck

There are many different types of pains in the neck and shoulder. The most common include:

• Stinging: This type of pain feels sharp and intense, akin to a burn or a quick jab. It often occurs suddenly in the neck or shoulder area
• Shooting: Characterized by sudden, sharp pains that travel or “shoot” along the nerves from the neck down to the shoulder and possibly further along the arm. This pain is typically nerve-related and can be caused by a compressed or irritated nerve in the neck. 
• Stiffness: This refers to a reduction in the joint’s ability to move freely, often accompanied by discomfort and soreness. Stiffness in the neck and shoulders can result from prolonged inactivity, muscle tension, or underlying conditions such as arthritis.
• Numbness: This sensation involves a lack of feeling in the neck, shoulder, or arm area, which might feel as though it has “fallen asleep.” Numbness is often associated with nerve irritation or compression. 
• Soreness: Soreness typically manifests as a deep, aching pain in the muscles surrounding the neck and shoulders. It often results from overuse, muscle strain, or holding tension in these areas. Soreness can also be exacerbated by stress or poor posture.

Common Causes of Pain in Shoulder and Neck

Neck and shoulder pain are common complaints that can arise from a number of different sources. 

Lifestyle factors related to pain in the cervical spine include:

Muscle Strain

Muscle strain, also known as a pulled muscle, occurs when fibers within a muscle or the tendon are stretched beyond their capacity and tear. This injury often results from overexertion, improper use, or overstretching during physical activities, but it can also happen from sudden movements or accidents.

This type of injury leads to inflammation and soreness in the affected muscles, pain, swelling, bruising, and reduced range of motion. The severity of a strain can vary; mild strains may cause minimal discomfort, while severe strains can result in significant pain and disability.

Poor Posture

Poor posture can lead to pain in the neck and shoulders due to the unnatural alignment and strain it places on the spine. When you slouch or maintain a forward-head posture, for example, it increases the stress on the cervical spine. 

This misalignment forces the muscles, tendons, and ligaments in the neck and shoulders to work harder to keep the head upright. Eventually, muscle tension and fatigue occur resulting in discomfort and pain in the neck and shoulder. 

Neck injuries and conditions that can cause pain in the neck and shoulder include:

 Cervical Instability

Cervical stability refers to the neck’s ability to maintain its alignment and functional integrity under normal conditions and physical stress. Stability is maintained by muscles and ligaments. Ligaments are thick pieces of connective tissue that connect bone to bone. 

Muscle weakness and/or ligament injuries can cause cervical instability. This instability can lead to abnormal movement or alignment of the vertebrae, causing pain, discomfort, and potentially nerve irritation in the neck and shoulder areas.

Frozen Shoulder

Frozen shoulder, also known as adhesive capsulitis, is a condition where the shoulder joint becomes stiff and painful and has a limited range of motion. It occurs when the connective tissue around the shoulder joint thickens and tightens, restricting movement. 

Neck and shoulder pain are common in patients with frozen shoulders, due to the thickened connective tissue, muscle imbalance, and compensatory muscle movements.

Cervical Osteoarthritis

Cervical osteoarthritis, commonly known as neck arthritis, is a degenerative condition that affects the joints and discs in the cervical spine. It is characterized by the breakdown of cartilage, which leads to pain, stiffness, and reduced mobility in the neck. Osteoarthritis in the lower cervical spine is a common cause of neck and shoulder pain.

Cervical Facet Injuries

A cervical facet is a small, paired joint on the back side of the neck that allows for smooth movement and flexibility of the neck. Cervical facet injuries involve damage to the facet joints located in the cervical spine, which can occur through trauma such as whiplash from a car accident or through chronic degenerative processes like arthritis. 

When facet joints are damaged, they can cause significant pain and stiffness in the neck, which may radiate into the shoulders. The pain is typically worsened by movements that extend or rotate the neck. 

Cervical Disc Injuries

The cervical spine is composed of seven bony building blocks that stack one upon another. Sandwiched between each is a soft, cushion-like structure called a disc. Their primary role is to absorb shock and maintain spinal flexibility, allowing for a wide range of neck movements. 

The discs are susceptible to both injury and degeneration. Common injuries include disc protrusions, bulges, herniations, and extrusions. Injuries to cervical discs, particularly in the lower cervical spine, can cause pain in the neck and shoulder.

Cervical Radiculopathy

Cervical radiculopathy is a painful medical condition resulting from the compression or irritation of nerves as they exit the cervical spine. This compression can occur due to various reasons, such as herniated discs, bone spurs, or spinal stenosis, leading to inflammation or damage to the nerve root. 

The condition typically causes pain that radiates from the neck into the shoulder and down the arm, accompanied by symptoms such as numbness, tingling, or weakness in the affected areas. 

Cervical Stenosis

Cervical stenosis is a medical condition where the spinal canal narrows, potentially compressing the nerves that travel through the spine. The stenosis can occur in the central canal or in the neural foramen which is where the nerves exit the spine. 

This narrowing can be due to arthritis, facet overgrowth, disc injuries, ligament thickening, instability, and bone spurs. When the spinal nerves are compressed, it can lead to pain in the neck and shoulders, numbness, and weakness or tingling in the arms, hands, and fingers. 

Specific conditions related to the shoulder include:

Shoulder Osteoarthritis

Shoulder arthritis is a medical condition where the cartilage in the shoulder joints wears down, causing pain, stiffness, and reduced range of motion. There are two principal joints in the shoulder. 

• Glenohumeral joint: The large ball socket joint formed by the upper arm bone (humerus) and the shoulder socket (glenoid)
• Acromioclavicular joint: The joint formed by the collar bone (clavicle) and the acromion

Both of these joints are susceptible to injury, degeneration, and osteoarthritis, which can lead to pain in the lower neck and shoulder.

Rotator Cuff Tears

The rotator cuff (RC) is a group of four muscles and their tendons in the shoulder that stabilize the shoulder joint and allow for a wide range of arm movements. These muscles are the: 

• supraspinatus
• infraspinatus
• teres minor 
• subscapularis

They work together to keep the head of the upper arm bone firmly within the shallow socket of the shoulder blade. The most common rotator cuff injury is a tear, which can be partial or full thickness. RC tears typically lead to pain, weakness, and reduced range of motion. The pain can be localized in the shoulder but can also radiate to the neck and upper back.

Rotator Cuff Tendinosis

Rotator cuff tendinosis is a chronic condition characterized by the degeneration of the rotator cuff tendons, typically due to overuse, aging, or repetitive stress. Unlike tendonitis, which involves inflammation, tendinosis is marked by the breakdown of collagen in the tendons. Both tendinosis and tendonitis can lead to neck and shoulder pain.

Shoulder Bursitis

Shoulder bursitis is the inflammation of the bursa, a small fluid-filled sac that cushions and reduces friction between tissues such as bone, muscles, and tendons in the shoulder joint. The subacromial bursa, located beneath the acromion and above the rotator cuff tendons, is the most commonly affected in shoulder bursitis. The inflamed bursa and swelling in the shoulder can limit the shoulder’s range of motion and create significant pain in the neck and shoulder. 

Shoulder Dislocation

Shoulder dislocation occurs when the upper arm bone (humerus) pops out of the shoulder socket (glenoid). The major causes of shoulder dislocation are trauma, overuse, and ligament laxity. In a dislocated shoulder, the joint becomes unstable, causing neck and shoulder pain in addition to a restricted range of motion.

Fractures

A shoulder fracture is a break in one of the bones in the shoulder, most commonly involving the clavicle (collarbone), the proximal humerus (the upper part of the arm bone), or the scapula (shoulder blade). Shoulder fractures can cause immediate neck and shoulder pain, inflammation, swelling, and potential impingement or irritation of nearby nerves.

Other Serious Conditions

Besides the neck and shoulder conditions mentioned, other serious conditions can also cause pain in these areas. Some conditions require prompt evaluation by a doctor.

• Gallstones
  
  Gallstone disease involves the formation of hard particles, or stones, in the gallbladder. These stones can block the bile ducts leading to intense pain known as biliary colic. While the primary symptom of gallstone disease is pain in the abdomen, particularly the right upper quadrant, this pain can sometimes radiate or refer to other areas, including the neck and shoulder.
• Heart attack
  
  A heart attack, or myocardial infarction, occurs when the flow of blood to a part of the heart is blocked for a long enough time to cause damage or death to the heart muscle. This blockage is most commonly caused by a buildup of fat or cholesterol, which can form a plaque in the coronary arteries. 
  
  The pain from a heart attack is not limited to the chest; it can also radiate to other areas of the body, including the neck, shoulders, arms, and back.
• Stroke
  
  A stroke occurs when the blood supply to part of the brain is interrupted or reduced, preventing brain tissue from getting oxygen and nutrients, which leads to the death of brain cells. Strokes can be caused by a blockage (ischemic stroke) or the bursting of a blood vessel (hemorrhagic stroke). 
  
  While strokes themselves do not directly cause pain, they can lead to secondary effects that might involve pain in the neck and shoulders. 
• Stable angina
  
  Stable angina is a condition characterized by chest pain or discomfort that typically occurs with exertion or stress. It is caused by reduced blood flow to the heart muscle due to coronary artery disease. The pain from stable angina, which is often described as a pressure or tightness in the chest, can radiate to other areas, including the neck, shoulders, arms, and back.
• Osteoporosis
  
  Osteoporosis is a bone disease characterized by a decrease in bone density and strength, leading to bones that are fragile and more susceptible to fractures. It can cause neck and shoulder pain through fractures or microfractures in the vertebrae. 
• Thoracic outlet syndrome (TOS)
  
  Thoracic outlet syndrome (TOS) is a medical condition characterized by compression of the blood vessels or nerves in the space between your collarbone and your first rib. This compression can lead to pain, numbness, and tingling in the neck, shoulder, and arm. The symptoms typically get worse with activities that involve lifting the arms or repetitive movements. 
• Brachial neuritis
  
  Brachial neuritis, or neuralgic amyotrophy, is a neurological condition characterized by sudden, severe pain in the shoulder and arm, followed by muscle weakness or atrophy. This condition stems from inflammation or damage to the brachial plexus, a network of nerves that extends from the spinal cord, through the neck, and into the arm. 
• Cancer
  
  Cancer is a disease characterized by the uncontrolled growth and spread of abnormal cells in the body. It can develop in virtually any organ or tissue, such as the lung, breast, skin, or bone. When cancer affects the neck and shoulder areas directly it can cause pain. 
  
  Additionally, cancer can lead to neck and shoulder pain indirectly through metastasis, where cancer cells break away from the original tumor and spread to bones or lymph nodes in these regions, causing pain and discomfort. 

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Treating Shoulder and Neck Pain at Home

Most individuals manage their mild to moderate neck and shoulder pain at home with non-invasive, conservative treatments. The most common include: 

• Ice pack: Reduces inflammation and swelling
• Hot compress: Increases blood flow to the site of injury thereby increasing oxygen to tissue and aiding in the healing process. 
• Nonsteroidal anti-inflammatory drugs (NSAID): Common examples include Advil, Motrin, Aleve, and aspirin. These are powerful anti-inflammatory agents that can reduce inflammation and pain. These medications have significant adverse side effects and therefore should be avoided. 
• Topical creams: Topical creams for pain relief are medications applied directly to the skin over painful areas, such as the neck and shoulders. These creams can contain a variety of active ingredients, including:
  • Capsaicin: Derived from chili peppers, capsaicin creams deplete a neurotransmitter called substance P, which is essential for transmitting pain signals to the brain, thereby reducing pain sensations.
  • Lidocaine: A local anesthetic, lidocaine numbs the treated area, reducing pain by blocking nerve signals.

When to Seek Medical Attention

As discussed above, there are many causes of neck and shoulder pain. Seeking medical attention for neck and shoulder pain is important when:

• Pain is severe or persistent: If the pain is intense, does not improve with home treatment after a few days, or continuously recurs, it’s essential to consult your physician. 
• Accompanying symptoms: If neck or shoulder pain is accompanied by symptoms such as numbness, tingling, or weakness in the arms or hands, or if you experience trouble with balance or coordination, these could be signs of a more serious condition requiring medical evaluation.
• Impact on daily activities: If the pain significantly affects your ability to perform daily activities such as turning your head, lifting objects, or even sleeping, you should seek medical attention. 
• Associated symptoms: If you experience symptoms like fever, weight loss, or severe headaches with neck or shoulder pain, these could indicate an underlying medical condition that needs immediate attention.

Traditional Diagnostic Procedures

The evaluation of neck and shoulder pain starts with a thorough medical history and physical examination. Additional diagnostic studies are often requested. The most common include: 

• X-ray
  
  An X-ray study is a diagnostic imaging technique that uses small amounts of radiation to produce images of bones and joints within the body. X-rays are important in demonstrating fractures, dislocations, bone spurs, and overall health of joints.
• CT scan
  
  A CT scan, or computed tomography scan, is an advanced imaging technique that combines multiple X-ray measurements taken from different angles to produce detailed 3-D images of the body. It provides detailed images of bone and joints and can identify small fractures and subtle bone abnormalities that might not be visible on traditional X-rays.
• MRI
  
  Magnetic resonance imaging (MRI) is a diagnostic imaging technique that uses strong magnetic fields and radio waves to generate detailed images of the organs and tissues within the body. Unlike X-rays and CT scans, an MRI does not use ionizing radiation, making it a safer option for repeated use. 
  
  It provides detailed images of soft tissue including muscles, ligaments, tendons, and nerves. It is useful in identifying inflammation, nerve irritation or compression, and abnormalities in the bone marrow. 
• Electromyography
  
  Electromyography (EMG) is a diagnostic procedure that assesses the health of muscles and the nerve cells that control them. They are used along with nerve conduction tests to identify nerve and muscle dysfunction. 

Traditional Medical Treatments

Traditional medical treatments for neck and shoulder pain generally include a range of interventions aimed at alleviating discomfort and improving function. The most common include: 

Physical Therapy

Physical therapy plays a crucial role in the treatment of neck and shoulder pain by focusing on restoring movement, improving function, and reducing pain. 

Medication

Medications can be a part of the treatment plan for neck and shoulder pain, providing relief from pain and inflammation. Common medications utilized include NSAIDs, Acetaminophen, muscle relaxants, topical analgesics, and steroids. 

Surgery

When conservative care fails to provide significant or sustained benefits, some patients are referred for surgery. The specific surgery is dependent upon the underlying injury and its severity. Surgery may help by decompressing areas of compression, removing bone spurs, and providing stability. 

Unfortunately, there are significant risks, which include bleeding, infection, and failure. There is no guarantee that the pain and dysfunction will improve. Unfortunately, after surgery, the functional anatomy has forever changed, often with a host of new problems.

Why Traditional Medical Treatments Sometimes Fail

Traditional medical treatments for neck and shoulder pain sometimes fail to provide adequate relief for various reasons:

• Incorrect diagnosis: Misdiagnosis or an incomplete understanding of the underlying cause of pain can lead to ineffective treatment and clinical results.
• Reliance on MRI findings: Physical examination is essential to correlate findings on MRI. All too often the diagnosis is made only by review of MRI, which cannot evaluate range of motion, stability, and other clinically important factors.
• Medical specialization: Medical specialization often results in a narrow focus during training, with many doctors completing fellowships in specific subspecialties. This can lead to compartmentalized care: a shoulder specialist rarely evaluates the cervical spine, and a neck surgeon is unlikely to perform a shoulder ultrasound. 
  
  However, the neck and shoulder are interconnected and often require simultaneous evaluation due to significant overlap in function and pathology.

State-of-the-Art Treatments for Pain in Shoulder and Neck

At the CSC, the evaluation of pain in the neck and shoulder starts with a thorough review of past and current medical and surgical history, followed by a comprehensive physical examination. In-office ultrasound is used to assess the integrity of the shoulder joint, tendons, ligaments, and muscles. Current images are reviewed in detail.

All this is completed to secure an accurate diagnosis. An accurate diagnosis is key as it will determine treatment options. Common treatment options for neck and shoulder pain due to neck and shoulder injuries include prolotherapy, platelet-rich plasma (PRP), and bone marrow concentrate that contains stem cells.

Not all regenerative clinics are the same. At the CSC we have a state-of-the-art cell laboratory with cell biologists that can customize the PRP and stem cell dosage that is right for you.

All injections are performed by board-certified, fellowship-trained physicians who are experts in the field. All injections are performed under X-ray or ultrasound guidance to ensure the PRP and/or stem cells are accurately delivered to the site of injury. 

Neck and Shoulder Pain Can Be Treatable

Neck and shoulder pain are common yet complex conditions that require careful and accurate diagnosis to ensure effective treatment. While traditional medical treatments including physical therapy, medication, and surgery can offer relief, they are not always successful in addressing the root cause of the pain. 

State-of-the-art treatments such as prolotherapy, (PRP), and bone marrow concentrate with stem cells offer a more comprehensive approach that targets the underlying issues and promotes healing from within. With accurate diagnosis and individualized treatment plans, neck and shoulder pain can be treated effectively, improving overall joint health and function. 

Don’t let neck and shoulder pain hold you back – seek out effective intervention plans to regain your mobility and quality of life. Remember, there is always hope for improvement when it comes to managing neck and shoulder pain!

Your neck and shoulder pain deserve professional treatment. Make an appointment today!

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