An aching shoulder may not signal a shoulder problem. And a sore neck may not indicate a neck problem.
“People may come in with shoulder pain when they really have a neck problem,” says Eric Ricchetti, MD, a shoulder specialist in Cleveland Clinic’s Department of Orthopaedic Surgery. Conversely, neck pain can mask a shoulder problem.
“The way the body reports pain is somewhat unreliable," explains E. Kano Mayer, MD, an interventional spine specialist in Cleveland Clinic’s Center for Spine Health. "Neck and shoulder pain so commonly overlap that some refer to it as ‘shneck’ pain.”
Why? Because the neck and shoulder are intimately connected by multiple nerve pathways. When injury occurs, the brain can’t always trace pain pathways back to their source, and what we feel may not be what is really going on. "This is known as 'referred pain,'" says Dr. Mayer.
Shoulder pain is most often caused by an injury to the rotator cuff, a group of tendons and muscles that stabilize the joint. The rotator cuff develops wear and tear with age, and can be easily injured. When this happens, we compensate by using different muscles to pick things up or reach for them. “This may cause both shoulder and neck pain,” says Dr. Ricchetti. You may have a rotator cuff injury or other shoulder problem if pain:
Inflammation of any of the 14 nerves or eight pairs of joints in the neck can cause neck pain. The joints — or vertebrae — serve as a “hinge” that lets us nod or shake our heads during conversation (no wonder they wear out). In fact, 65 percent of 65-year-olds have arthritis in one or more neck joints.
“Because pain in one area can so often be confused with another, a thorough exam must be done, including range of motion, strength testing and provocative neck and shoulder maneuvers,” says Dr. Mayer. You may have arthritis or nerve-related neck pain if pain:
It’s important to see a specialist to get a thorough physical examination of your neck and shoulder. To help with diagnosis, they may inject lidocaine (a local anesthetic) into the shoulder, or the joints or nerves of the neck. “This diagnostic test helps guide treatment — if it relieves pain, it demonstrates where the problems are,” explains Dr. Mayer. Whether the problem lies in your neck or your shoulder, he and Dr. Ricchetti note that conservative measures are usually tried first.
If these measures fail to bring relief, you may need an MRI of your shoulder. If that shows a torn rotator cuff, then shoulder surgery may be necessary, says Dr. Ricchetti. If the physical exam and imaging indicate arthritis or a nerve-related pain in your neck, he recommends referral to a spine specialist. Spine specialists will conduct a thorough neurological examination, and do imaging and other tests. They will also begin with conservative care.
Whether you have chronic pain in your shoulder, your neck or both, don’t wait to see an expert. “Having a neck or shoulder specialist evaluate your complaints will determine where the main problem is and will get you started on the correct treatment,” says Dr. Ricchetti.
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