Pain in the neck and shoulder can be interconnected and problems in the neck usually causes pain that travels down your shoulder. It sometimes causes a lot of confusion among shoulder and spine surgeons because the exact cause for the shoulder and neck pain in some cases may be difficult to identify. But there is one important difference. If there is a problem in the neck there is usually an associated pain, pins and needles and numbness beyond the shoulder radiating to the arm and fingers.
What are the causes of pain in the neck and shoulder?
1) CERVICAL DISC PROLAPSE: this is a condition where the note that this coming out of the cervical spine in your neck is pinched by a possible disc prolapse. This usually causes pain in the neck that radiates down to the shoulder and past the elbow into the fingers. There is associated pain, pins and needles and numbness. The movements of the shoulder are usually pain-free.
2) CERVICAL SPONDYLOSIS (CERVICAL OSTEOARTHRITIS): This is usually due to wear and tear changes of the cervical spine in your neck. The joints of the cervical spine in the neck are inflamed leading to cervical osteoarthritis. Bony spurs that occur around these joints pinch the nerve that comes out of the cervical spine and causes neck pain and shoulder pain.
3) ROTATOR CUFF INJURIES: The rotator cuff is a group of muscles that hold your arm in the socket of the shoulder. Rotator cuff tear can be by an injury due to single fall or by repeated stress injury over time. This causes pain over your shoulder and is increased on moving your shoulder. But there is no associated pain in the needles and numbness in the arm or the fingers
4) OTHER SOFT TISSUE INJURIES OF THE NECK AND SHOULDER: This can be due to whiplash injury to the neck that tears the muscles, ligaments and tendons. This causes pain and stiffness in the neck that can travel down to your shoulder. Also, soft tissue injury to the shoulder from the fall can also cause pain around the shoulder.
What does the spine surgeon do to differentiate between neck and shoulder pain?
The spine surgeon in his clinic performs a careful assessment of the movements of your neck. Any increase in pain that travels down the shoulder and the arm is a sign of problem in your neck. The movements of your shoulder in this case will be pain-free. If the pain worsens on moving the shoulder, then there may be an associated problem in the shoulder. In this situation, the spine surgeon would arrange an MRI scan to confirm the diagnosis.
How does an MRI scan help in the diagnosis of a shoulder and a neck problem?
MRI scans are very sensitive to soft issues changes due to injury and inflammation. It can reliably differentiate between a disc prolapse in the cervical spine of your neck and soft tissue injury like a rotator cuff tear in the shoulder. This guides the spine surgeon to direct appropriate treatment to either the neck or the shoulder
What is the best initial treatment for neck and shoulder pain?
REST: Usually a period of rest for 2 to 3 days for the soft tissues of the neck and shoulder is very helpful in managing the pain. A break from sports or other activities will allow the soft tissues to settle.
WARM/COLD PACKS: A warm or cold compress helps to reduce the swelling and spasm of the muscles around the neck and shoulder.
EXERCISES: Gentle stretches to improve the movements of the neck and shoulder will break the spasm and tightness in the muscles. These stretches are available in the Blog – ‘Simple stretches for your stiff neck’
MEDICATIONS: Simple over-the-counter medications like paracetamol and neurofen can be used on a daily basis for comfort and pain relief.
What is the next step in the management of neck and shoulder pain?
If your pain does not settle with simple home remedies, then you are likely to need steroid injections either into a neck or shoulder to reduce the swelling and inflammation around the soft tissues. Surgery may be needed if there is a large disc prolapse in the neck or a rotator cuff tear that needs repair.