What To Do About Neck and Shoulder Pain

<p>Ridofranz / Getty Images</p>

Ridofranz / Getty Images

Medically reviewed by Forest Miller, OTR/LMedically reviewed by Forest Miller, OTR/L

Neck and shoulder pain frequently occur together. That's because the muscles, ligaments, and nerves in the neck and shoulders are interconnected, so a problem in the neck or shoulder can easily affect the other, leading to pain and discomfort in both areas.

Pain in your neck and shoulders can limit mobility, making simple activities like turning your head, reaching for an object, or maintaining proper posture difficult. Combined neck and shoulder pain often occurs from minor muscle strain, poor posture, or overuse injuries. Sometimes, pain in these areas is a sign of a more serious injury or medical condition that requires prompt medical attention and treatment.

How Neck and Shoulder Pain Presents

Neck and shoulder pain affects each person differently. Some people experience the pain suddenly, while others have a more gradual discomfort. The pain can also be constant or come and go, worsening during certain movements or activities. Depending on the cause of your pain and which structures are affected (e.g., bones, muscles, joints, ligaments, or tendons), neck and shoulder pain may feel:

  • Dull

  • Stiff

  • Sore or tender

  • Crampy

  • Sharp or shooting

  • Numb

  • Burning

  • Gnawing

  • Throbbing

Potential Causes of Neck and Shoulder Pain

Simultaneous neck and shoulder pain has many possible causes. Because the bones, muscles, nerves, ligaments, tendons, and blood vessels within the two body parts are interconnected, a problem originating in the neck can affect the shoulder and vice versa.

Soft Tissue Injury

Injury to the neck and shoulder's soft tissues—like the muscles, tendons, and ligaments—is a common cause of pain in these areas. A strain is an injury to a muscle or tendon, and a sprain is an injury to a ligament—a thick band of tissue that connects bones at a joint.

Sprains and strains can develop suddenly after an accident or fall when the soft tissues bend, twist, or stretch abnormally. They can also develop from poor posture or overuse and repetitive motions like heavy lifting or playing certain sports that overuse specific muscle groups. Over time, these can stress and fatigue the soft tissue, causing pain.

Symptoms of soft tissue injuries in the neck and shoulders include:

  • Aching pain

  • Muscle spasms

  • Muscle weakness

  • Stiffness

  • Limited range of motion

  • Pain that worsens with movement

  • Headache

  • Tingling, numbness, or weakness in the arms or hands

Cervical Radiculopathy

Cervical radiculopathy, or a “pinched nerve,” is the compression or irritation of a spinal nerve in the neck. The nerves branch away from the spinal cord in the neck and travel down the shoulders and arms. Compression of one of these nerves causes sharp, burning pain that starts in the neck and radiates to the shoulder and arm.

Symptoms of cervical radiculopathy include:

  • Worsening pain when moving your neck, such as looking up or turning your head

  • Pain or weakness in your shoulders, arms, or upper chest area

  • Tingling sensations, or a “pins and needles” feeling, in your arms, hands, and fingers 

Age-related spinal degeneration, or “wear and tear” on the spine, causes most cases of cervical radiculopathy. You might also develop this condition due to an injury that causes a herniated (slipped) intervertebral disc. In mild cases, lifting your arm over and behind your hand may relieve pain when you have cervical radiculopathy because this movement reduces pressure on the spinal nerve.

Rotator Cuff Injury

The rotator cuff is a group of muscles and tendons that stabilize the shoulder joint. Rotator cuff injuries typically develop from overuse or repetitive motions that cause the muscles and tendons to break down gradually, leading to rotator cuff injuries such as:

  • Bursitis: This condition causes inflammation of a bursa—a small, fluid-filled sac that acts as a cushion in the space between the rotator cuff and shoulder bones. You might develop bursitis when muscles and bones rub against the bursa.

  • Tendonitis: This condition causes inflammation of the tendons in the rotator cuff—the tissue bands that connect the muscles to the shoulder bones. Repetitive shoulder movements can irritate or pinch the tendons, leading to tendonitis.

  • Rotator cuff tear: A partial or complete tear of a tendon in the rotator cuff can happen suddenly from a fall or heavy lifting or develop over time from wear-and-tear of the tendon.

If you develop a rotator cuff injury, you may experience the following symptoms:

  • Shoulder pain when resting or at night when lying on the affected shoulder

  • Pain during certain movements, such as lifting or lowering your arm or reaching behind your back

  • Weakness in the arm

  • A clicking or popping sound when moving your arm

  • Radiating pain from the shoulder to the base of the neck

Over two million people experience rotator cuff injuries in the United States each year. The risk of a rotator cuff injury is higher in people over age 40, athletes who play sports that involve repetitive shoulder movements, and people whose jobs require heavy lifting or reaching overhead.

Cervical Spondylosis (Neck Osteoarthritis)

Cervical spondylosis, or neck osteoarthritis, is a degenerative joint disease that affects the joints and discs in the neck, causing pain and stiffness. Age-related wear and tear on the spine causes the discs between the spinal vertebrae (bones) and cartilage to wear away.

This condition may cause pain and stiffness in the neck that improves with rest. Other symptoms include:

  • Pain that worsens when holding your neck in the same position for a prolonged period (e.g., driving)

  • Muscle spasms in the neck and shoulders

  • Headaches

  • Popping or grinding sounds when moving your neck

  • Weakness or numbness in the arms, hands, and fingers

Frozen Shoulder

Frozen shoulder, or adhesive capsulitis, is a condition that causes pain and stiffness in the shoulder joint. The condition develops when the shoulder capsule, which surrounds the shoulder joint and tendons, thickens and tightens, restricting movement in your shoulder. Neck pain is common with a frozen shoulder because you begin to use your neck muscles to compensate for the loss of motion and function of your shoulder.

If you develop a frozen shoulder, the condition typically progresses through three stages:

  • Freezing: In this stage, pain gradually worsens, and the shoulder loses range of motion. Freezing lasts between six weeks and nine months.

  • Frozen: Pain may improve during the frozen stage, but your shoulder will remain stiff and feel challenging to move, which is when neck pain may develop or worsen. The frozen stage lasts between four and six months.

  • Thawing: The motion and function of your shoulder gradually return during the thawing stage, which can last between six months and two years.

People with certain conditions, such as diabetes, thyroid disease, heart disease, and Parkinson’s disease, have a higher risk of experiencing a frozen shoulder. If you live with any of these conditions, it may help to ask your healthcare provider if you can do anything to lower your risk of developing this injury.

Pericarditis

Pericarditis is the inflammation of the pericardium—a thin, fluid-filled sac surrounding the heart. This condition typically develops in response to viral, fungal, or bacterial infections but can also occur in people with a recent heart attack or heart surgery.

Inflammation causes the two layers of the pericardium to rub together, leading to sharp, stabbing chest pain that begins on the left side of the chest. This pain can then radiate from the chest to the left side of your neck and shoulder. Other symptoms of pericarditis include:

  • Worsening pain when coughing, taking a deep breath, or lying down

  • Difficulty breathing

  • Fatigue

  • Weakness

  • Heart palpitations

  • Anxiety

  • Abdominal or leg swelling

Anyone can develop pericarditis, but it is most common in people assigned male at birth between the ages of 16 and 65.

Other Causes

Sometimes, neck and shoulder pain can occur due to other, less common causes. The following conditions may also contribute to pain:

  • FibromyalgiaA chronic condition that causes widespread body pain and tenderness, including in the neck and shoulders

  • Thoracic outlet syndrome: Compression of the nerves or blood vessels in the lower neck and chest area, which can cause pain, numbness, and weakness in the neck and shoulders

  • Pancoast tumors: A rare form of lung cancer that causes neck and shoulder pain, numbness, and a chronic cough

When To Contact a Healthcare Provider

Sometimes, neck and shoulder pain resolves on its own with time and self-care measures, but certain symptoms and situations warrant medical attention. See a healthcare if your neck and shoulder pain:

  • Lasts longer than one week

  • Is severe and limits your ability to carry out daily activities or interferes with sleep

  • Does not improve with over-the-counter pain medications

  • Occurs with other symptoms, such as weakness or numbness in your arm or hand

  • Develops after an accident, fall, or injury

Seek emergency medical care if you have neck and shoulder pain that occurs alongside any of the following symptoms:

Diagnosis

If you're experiencing painful or persistent neck and shoulder discomfort, seeing a healthcare provider for a diagnosis is a good first step. During your appointment, your primary care provider will conduct a physical exam to check for symptoms and ask about your medical history. In some cases, they may enlist the help of an orthopedic surgeon (a doctor specializing in conditions that affect the musculoskeletal system) if your condition is more serious.

When taking your medical history, your provider may ask the following questions:

  • Where do you feel the pain?

  • What does the pain feel like?

  • Are there any activities that worsen or relieve the pain?

  • Do you have any underlying muscle, joint, or bone-related conditions?

  • Have you recently had an injury or accident?

  • Which other symptoms are you experiencing?

Depending on what they observe during the physical exam, your healthcare provider may also order other tests to confirm a diagnosis. These tests may include:

  • X-rays: To identify bone spurs, fractures, or signs of arthritis

  • Ultrasound: To check for bursitis or rotator cuff injuries

  • Computed tomography (CT scan): To diagnose soft tissue injuries

  • Magnetic resonance imaging (MRI): To detect problems like herniated discs, nerve compression, or rotator cuff injuries

  • Electromyography (EMG) and nerve conduction studies: To assess nerve damage and measure the speed and function of your body’s electrical signals moving along the nerves

  • Blood tests: To measure blood cell counts and help identify markers of infection and inflammation

Treatment

If you receive a diagnosis for a condition contributing to your neck and shoulder pain, getting started on treatment is essential. Your exact treatment plan will depend on the cause of your pain, but healthcare providers will generally recommend a combination of home remedies and medical treatments.

Home Remedies

At-home treatments can help relieve neck and shoulder pain, especially if your injury or condition is minor or temporary. Consider the following self-care measures:

  • Getting rest

  • Trying ice and heat therapy

  • Taking over-the-counter pain relievers such as Advil (ibuprofen), Aleve (naproxen), or Tylenol (acetaminophen)

  • Practicing gentle stretches, such as shoulder rolls or moving your head from side to side

  • Modifying your workstation or daily habits to reduce strain on your neck and shoulders

Medical Treatments

If home remedies are ineffective or if you have a more serious injury or condition, your healthcare provider may recommend medical treatments. These include:

  • Prescription medications: Stronger nonsteroidal anti-inflammatory drugs (NSAIDs), oral corticosteroids, or muscle relaxants can reduce inflammation and muscle spasms to relieve moderate to severe neck and shoulder pain

  • Corticosteroid injections: Injecting corticosteroids directly into the affected area can reduce inflammation and relieve pain

  • Physical therapyA physical therapist can design a personalized treatment program that includes stretching and strengthening exercises to improve flexibility and posture and reduce pain

  • Surgery: When conservative treatments are ineffective, surgery may be necessary to address injuries involving significant structural damage or when neck and shoulder pain progressively worsens despite treatment

A Quick Review

Many underlying health concerns can cause neck and shoulder pain—including poor posture, muscle injuries, nerve compression, and arthritis. While living with pain in these areas can be debilitating and significantly limit your ability to carry out daily activities, there are home remedies and medical treatments that can help improve pain. Keep in mind: early treatment is the best way to feel relief, so if you have symptoms, it's a good idea to see a healthcare provider for a proper diagnosis

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