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Bone, Muscle & Joint Health
shoulder

Shoulder Problems: A Pain in the Neck?

Experts diagnose & treat 'shneck pain'

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. 

Shneck pain

“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.

When the shoulder is the usual suspect

Great Pretenders Series

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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:

  • Develops in the shoulder itself or on the outside of your upper arm
  • Is dull and aching
  • Occurs when you reach overhead or behind your back, or when lifting
  • Radiates into the upper arm, but not past the elbow
  • Persists at night
  • Improves when you rest your arm

When the neck is the likely culprit

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:

  • Develops in your shoulder blade, or close to or on the side of your neck
  • Is sharp, stabbing, burning or tingling
  • Radiates down past your elbow or even into your hand
  • Persists at rest
  • Occurs when you extend your arms or twist them inward
  • Is relieved when you support your neck

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.

5 ways to relieve pain from a shoulder problem

  1. Resting from activities that aggravate pain
  2. Physical therapy exercises
  3. Icing the shoulder, especially at night
  4. Anti-inflammatory medications
  5. Cortisone injections to reduce inflammation in the shoulder

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.

4 ways to relieve pain from a neck problem

  1. Physical therapy, including posture therapy
  2. Anti-inflammatory medications and /or muscle relaxants
  3. Ice, heat and massage therapy
  4. Injection of cortisone to reduce inflammation or local anesthetics to relieve pain

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.

Tags: arthritis, Be Well e-News, Great Pretenders Series, joint pain, neck pain, pain relief, shoulder pain
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  • Jeffre

    Instead of painful injections, meds or unnecessary imaging, you could just go to a Physical Therapist and get better.

    • Lynn Ludam

      I like your response, and that ‘s what I will be doing again. I have a neck brace with magnets in it for magnet therapy seems to give some relief.

  • SWE

    In my 33 years of clinical experience, the majority of these shneck syndromes are multi-faceted and can best be handled by conservative care that includes grade 5 spinal closed joint reduction therapy which can only be done best by today’s Doctors of Chiropractic. S.W. Engen, DC, PAK, PES.

  • myomary

    Often, it is a soft tissue dysfunction due to myofascial trigger points: ;a common but often unrecognized source of pain that mimics other diagnoses and may be easily treated by a Board Certified Myofascial Trigger Point Therapist.

  • Marty

    Has anyone thought about the shoulder/neck pain may be “nerves”? Tension?

    • lola88

      Of course, many people carry stress in their shoulders. But that stress can cause a physiological problem. Do you find your shoulders are shrugged a lot? Is it cold where you live? People always scrunch up their shoulders when it’s cold out. Do you sleep with your arm under your head? There are many reasons to get shneck pain. You have to figure out which one your facilitating. “Nerves” is one of those reasons.

  • Alex Gometz, DPT

    Prehab is a great way to start, however, I agree with all the options above when they are customized by a good clinician with experience in rehabilitation.

  • http://www.facebook.com/people/Vincent-Regan/1329655471 Vincent Regan

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  • sherita coleman

    Will amphetamines cause a constant pain in upper arms and shoulders? Heart rate goes up pain intensifies. No relief no matter what I do.

    • Health Hub Team

      Sherita,

      We strongly urge you to seek care from a physician. It is very difficult for us to know without a physical examination and medical history, but in some cases amphetamines can cause unsafe changes to heart rate and rhythm, which in turn can cause referred pain to left arm and shoulders. If you do not currently have a primary care physician and would like to come to Cleveland Clinic, please call 800.444.CARE. If this is a medical emergency, please immediately call emergency personnel (911) to get prompt medical attention.
      Dr. Kano Mayer

  • Lynn Ludam

    Been having numbness/tingling in left arm cause is from neck. Seen doctor today @ another very good facility and were going to try physical therapy, besides a lot of the pain has subsided since I made the appointment to see doctor. Plus it is on going since childhood not from accident. This is new on the left side and finding out it is from my neck.

    • ian

      i got the same problems but its all on the left side of my body I get pain in my left arm and left leg

      • http://bloomberg.com/ Ginsengbull

        Me too. Knee, elbow, shoulder… I carry my cell phone on my left side.

        I wonder if that contributes.

        • kate

          yes wallets can be a big problem. i have heard of truck drivers with back issues . they dont realize how long they sit on wallet. it messes up your balance.

    • Nina

      Read book by pete egoscue pain free its awesome. And check out the egoscue video on you tube

  • adhesive capsulitis treatment

    A 30 year old man presented with increasing deep seated shoulder pain
    for the past 1 year. It was attributed to a work accident where his left
    shoulder was forcefully pusshed backward while supporting against a
    heavy container. He did not feel as if his left shoulder was dislocated
    but started to have deep seated left shoulder pain when performing
    overhead activity.
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  • Scott Poynor

    Severe and persistent left shoulder pain was due to a splenic infarct, a potentially serious condition!

  • Joy Lisle

    what do you do for a reversed ‘c’ ?

  • ian

    hi I have a really bad neck pain for about four years now constant, I have also been having pain down the left side of my body and in my face aswell. I have been to the doctors and he sent me for an xray and the result come back and said that they was nothing wrong but I am still getting the pain

    • Rebecca

      Ask for a MRI I had severe pain in my shoulder and had several X-rays taken but they never showed a problem . I was sent to 5 specialists and finly got a MRI and on it showed my c7 vertebrae to be collapsing causing excruciating pain down to my fingers . Surgery was preformed and I’m 4 months post op now I have tremendous pain in my neck but shoulder ,arm and fingers are pain free . I would never have thought shoulder pain would result in neck surgery

    • marium

      MRI is very important for you

    • Debra MacCarthy

      me too Ian I had a mid back xray as the pain is so bad at times I can’t stand it! and the results came back with noting. I have not had a spine scan have you ?

  • imran

    Have severe right shoulder pain, seen doc 2 years ago and said I had a growth on my bone, needed operation. But couldnt do it at that time, went to a shoulder specialist today and there saying its my neck, so stressed out HELP

    • nina

      Buy book pain free by pete egoscue and do exercises has on you tube

  • Angela

    Neck pain for months. Doctor says its from shoulder. Does a tear in shoulder tendon actually cause neck pain?

  • beverb

    When is epigastric pain due to aortic dissection rather than stomach pain?

    • beverb

      Epigastric

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  • zenabsabu

    Hi . I am 41 years old. Last one week my neck pain start.and than slowly slowly this pain move to my shoulder.i feel somebody inject inside.i think my nervs is block.my pain is continue same .no improvment .pls help me

    • nina

      Look up Egoscue on you tube for neck or shoulder pain. It works wonders buy the book pain free from pete egoscue

  • dave

    I am 28 and have for the past 12 years had a dull non bothering shoulder pain that didn’t hurt much till about 5 months ago. I really started to notice pain back in May and it would go crazy if I had half of a 12 ounce bottle of beer. Not sure if that is related or how but very long story made short on September 16th I started to have back spasms and a week later the emergancy room told me I had shoulder birsitis. Two weeks go by and I notice I couldn’t lift the shoulder at all unless I manually picked ny arm up with my right hand. I was told it is rotator cuff tendonitis and told to see a orthopedic surgeon. About three days ago I notice an increase in pain and now neck and some back pain and when I move my head a certain way I get a tingly feeling that last for about 5 to 10 minutes. Can someone tell me what’s going on? All left side btw

  • Henry Mark

    Neck and shoulder pain can be due to many reasons.Sometimes our modern lifestyle itself can be a cause.Activities like sitting hours in-front of desk can really fasten the process.You can know more how to treat with this here:http://www.asseenontv.com/light-relief/detail.php?p=296343

  • judy

    Once, after an accident, I had neck stiffness with some pain down to half way on shoulder and my arm, deltoid area, felt like it had a rubberband pulling it in. A hospital P.A. asked if my rib was broken on that side. Sure enough x-ray revealed fx rib.

  • Aurea

    My shoulder pain is slowly getting better.
    The pain is a achy and dull.. just like what you described. Have dr.app. today.
    Thx!

  • Carebearz

    I get pain randomly on my left side but it’s lower shoulder pain (sharp like I dislocated it then after awhile it will just go away, if i feel it coming on I try to stretch my arm up and over the back of my shoulder)… Hard to pinpoint the exact spot because it’s almost level collar bone but radiates all over…

  • Hilary@shoulder pain treatment

    I am 35 years old and I am a housewife. From last two year I have facing serious shoulder pain. It was begins after giving birth of my 2nd kids. Is that shoulder pain have any relation with pregnancy ? Please explain me and also suggest me how can I get relief from this misery.

    http://breakthroughchiropractic.com/

    • Melissa

      I’ve been facing chronic right sided shoulder and neck pain. I had a baby in 2012, so it started when she was 9 months old. Doctor said it was because of carrying a little one around and sent me for physical therapy which doesn’t help. A nurse friend says to demand a MRI.

      • Alice Jackson

        It could be your shoulder but it could be referred pain from your gall bladder. After having a baby a lot of women develop gall stones and other problems with the gall bladder. Watch after eatting for pain. Try and avoid greasey fried, fatty foods and see if that helps. See a Dr. Also for the pain!

  • Chris Prosperie Molaison

    I have been diagnosed with Arachnoiditis in both hips. It was recommended by my neurosurgeon to seek relief at one of four clinics including The Cleveland Clinic. Any info would be appreciated

  • SMB

    Since the ’70′s, I have had severe pain in my shoulder and neck, which would ‘come and go’. So severe I could not function on my job, and put me into depression. Then in 2003, my husband and I were in Cleveland, Ohio. He suggested we go to the Cleveland Clinic to see if they could help with the pain. There, i met Dr. Steven Samples, who gave me 21 shots of Botox. The pain started subsiding in 30 minutes. Since that day, I have had shots of Botox every 3 months, and this is the ONLY thing I have found that completely stopped the pain. They found I have a malady called Spasmotic Torticollis, and only—–3 people in 10,000 are struck by this severely painful illness.
    Botox is extremely expensive, like $6,000, so you would need good insurance.

  • Starfish Karen

    I have severe neck, shoulder and arm pain down to my fingers. It’s been going on for over three months. i was in the hospital for a upper GI bleed and they did an xray on my shoulder and found nothing. I do have a herniated disc in my neck I found out 10-12 years ago about it when I had a MRI. Do you thiink the neck is causing all this problem and pain? I can’t lift my arm hardly at all. been using moist heat and trying to do range of motion but just makes it worse. What should I do. i am 68.

    • Kim Ronkainen

      I had bad shoulder pain in 2006 and could hardly lift my arm as well. I had an MRI and it turned out I had a torn rotator cuff. You might want to ask for a MRI of the shoulder if you haven’t had one done yet. X-rays won’t show a tear. My surgeon told me range of motion exercises won’t help if it’s a tear.

      • Starfish Karen

        Kim, did you have surgery on your shoulder? And if so, how bad was it after surgery on the healing process?

        • Kim Ronkainen

          I ended up having rotator cuff surgery on both shoulders. With my experience, my arm was in a special sling that had a cushion piece placed between the arm and the body. The sling had to be worn for a month and I wasn’t allowed to use the arm for that first month. Physical therapy is a bit painful to get the range of motion back, but is worth it. Both shoulders are good now. Hope you find out what’s wrong and wishing you a speedy recovery.

          • Starfish Karen

            Thank you kim.:)

          • Kim Ronkainen

            You’re welcome. :)

  • Cindy

    was a firefighter (paid on call) in 2004, I fell off a parked fire truck and broke my left wrist. After 3 years of going doc to doc per workmen’s comp., found out I had 3 torn ligaments in my left hand and 1 in the right (corrected by surgery on ’07), CT scan of my neck showed C4, C5 & T1 have budging disc (still do – hard to move my head to look up – stiff). An Othro MRI showed that the Infra tendon cuff has a partial tear. Had a couple of rounds of PT for the shoulder that worked, Chiropractic care for the neck. Ice/heat as needed,Tylenol (pain) Advil (swelling) when necessary steroid shots. 2013, (now 57) I tore my left shoulder Supra tendon cuff 100%. Ortho Surgeon states that I will be off work for a year due to the type of work I do (as an independent contractor – if I don’t do my job today I do not have it tomorrow. I drive 100 + miles 5 days a week delivering a local paper). I pay for my own health insurance and can not afford the deductible, plus there will be NO income after surgery. If I can wait 5 more years, I will recieve my husbands disability and will be able to have the surgery. My question is, how long is it safe to do the steroid shots or take the medicine before it harms/side affects my system? Thank You..

  • Teresa Skelton

    I have left shoulder and left side of my neck that hurts.If I hold something in my left hand for a few minute it gos numb and the it start tingling.I’ve notice my sciatica starts in on my right side and gos down my leg and sometimes it feels like I have fire in my right foot on the bottom coming out.My right shoulder is also hurting and burning now.About 7yrs.ago I had a big TV fall on my right shoulder at work.I had 3 different times of therapy.It got to where it was making it worse.Even hurt in my chest.They disabled me 3%.I’m almost 56yrs.old and it’s getting to where I can’t work anymore. Any suggestions?

  • jodiblond13

    Lot’s of pain starting at the base of my neck, middle of my back just above my bra. Follows my scapula, down the back of my arm and numbness with tingling in my hand and fibgers. Work como Dr said it was muscle stain and didn’t even do xrays.

    • Alice Jackson

      Work comp drs are the worse. They’re paid not to find something wrong that is work related. See another Dr. Could be a pinched nerve.

  • Terry Hendrix

    I was working on my truck today and when I went to loosen a bolt I pulled hard and something popped loud in my right shoulder and now my arm and my back pain is so severe I can’t walk straight or lay back I’m in a lot of pain what do I do I’ve never had back problems

  • Gary Bridger

    I have suffered shoulder and neck pain frin the 80s after a tractor went into the back of my car, and yeas of ju jitsu on too. Im ok when working, most of the time. Its when I stop and rest. The ache starts, then pain moves up the neck and into my head., making head ache and eyes , if I sneeze, this also gives 3 to 4 days of sickening pain. I have been to consultants, waste of money, all say the same, pain killers or op, 50 percent work or worse. I hear of a new op that inplants a micro mesh, this pulls all the nerves and things togethers, very succesfull, in th uk, I could do with this, as this effects my enjoymentbof life, makes me irritable, im a diver, photographer, so lifting and carrying bags is a way of life. Any help.?

  • Dee

    I started with an eye twitch that lasted a week and a half. Then the “tightness” started moving down the right side of my face. Then, it started pain in my neck behind my ear into my shoulder and sending shooting pains down iron my fingers. I went the the Dr. They said pinched nerve but didn’t do any testing. Now it’s going into my lower back and down my right leg. Has anyone had this?

  • 4realvideos Ike

    I have constant slight pain above right shoulder blade what should I do. Help please.

    • HealthHubTeam1

      I would recommend being evaluated by your primary care
      physician to determine the cause of your pain. Then, if a referral is
      necessary, they would be able to recommend a specialist.

      -Eric Ricchetti, MD

  • Carine Weisbrot Nadel

    rt. shoulder was already compromised when I was nearly killed in a car accident. since then I’ve endured countless injections in both shoulder/neck. pain radiates from shoulder down to hand and the opposite way to shoulder blade and up neck. I have RA, degenerative discs (C3-5, L3-5, S1-2). have gone through 3 muscle relaxers, gabapentin, the epidurals, PT (which made all this WORSE) and I can’t take pain meds-make me sick to my stomach. Plus-I have severe osteoporosis and levo scoliosis

    • hankf68

      I feel ya, although my accident was on heavy equipment (I rolled a dozer down a mountain side, a track broke and caused it), was in hospital 10 days, I have had 4 back (lumbar completely fused) 4 knee (3left, 1right), 3 shoulder (1left w/pins and screws, 2right, 3rd surgery just 3weeks ago) and 3 other minor ones, now I have (been hurting over a year and is very bad now) a pinched nerve in my neck and my surgeon said we would deal with it after my shoulder surgery heals and I too cannot take their narcotic meds, so it sucks indeed, good luck to you and remember, you aren’t alone in your suffering. :)

      • Carine Weisbrot Nadel

        thank you! I know a support group/cyber pal is a good thing to have. I have one RA buddy who, while we’ve never met, is wonderful for the both of us to have-it’s a commiseration team that no one but us understands. Our husbands are more than fantastic, but only we know what the other is going through

        • hankf68

          You are welcome, it is always great to have support from those who understand and who have walked in your footsteps. I haven’t ever been in a support group and no one in my family really understands, so sometimes I comment on sites such as this and sometimes people reply, that help some when I am real down, so thank you. I hope you find some relief and comfort and wish you the best. I will check out the support group if want to give me the name of it.

  • zennit

    i m 21 i feel same back neck pain and i hardly move it start when i return from gym plz help me

  • CottonCandyKiss

    I have pain between my left shoulder blade when I slept on my side. It did this on my right side first, but after that pain stopped the left one started to hurt. It was so painful that I could not turn my head and had to take pain killers. I went to see my doctor and she told me to do some therapy exercises. It’s been five years and the pain has not gone away. Does anyone know what it is? I am thinking I’m going to see my doctor again and ask for an MRI because some days it is hard to turn my head or lift my left arm without it hurting.