January 6, 2021

Is Your Shoulder Pain Actually a Neck Problem?

How to tell the difference

elderly man with shoulder pain

An aching shoulder may not signal a shoulder problem. And a sore neck may not indicate a neck problem.

Advertisement

Cleveland Clinic is a non-profit academic medical center. Advertising on our site helps support our mission. We do not endorse non-Cleveland Clinic products or services. Policy

“People may come in with shoulder pain when they really have a neck problem,” says orthopaedic surgeon Eric Ricchetti, MD. Conversely, neck pain can mask a shoulder problem.

Here’s how to tell the difference and possible treatment options for a sore neck or a painful shoulder.

“Shneck pain”

“The way the body reports pain is somewhat unreliable,” explains Dr. Ricchetti. “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. Ricchetti.

Advertisement

When the shoulder is the suspect

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, up to 70% of 65-year-olds may have symptomatic 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. Ricchetti. You may have arthritis or nerve-related neck pain if pain:

  • Radiates to your shoulder blade, or close to or on the side of your neck.
  • Electric-like, stabbing, burning or tingling.
  • Radiates down past your elbow or even into your hand.
  • Persists at rest.
  • Radiates down your arm when you extend or twist your neck.
  • 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. Ricchetti. Whether the problem lies in your neck or your shoulder, conservative measures are usually tried first.

Advertisement

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 or yoga to increase range of motion and strength.
  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.

Related Articles

woman looking down at smartphone
October 19, 2020
Is Your Smartphone Causing Your Neck Pain?

Improve text neck by improving your posture

Illustration of Reversed shoulder replacement
April 1, 2019
Facing Shoulder Surgery? Is Joint Replacement or Fusion Best for You?

An orthopaedic surgeon outlines the alternatives

Female embracing young child.
November 12, 2018
What You Can Do to Help Relieve Your Baby’s Torticollis

Tips for easing the tight neck muscle that tilts the head

Notes taped to window of possible new year's resolutions with hand in foreground holding marker.
December 1, 2023
How To Keep Your New Year’s Resolutions

Pick specific, measurable goals, but also be open to changing them if need be

person holding a thermometer with stress thought bubbles above head
December 1, 2023
Yes, There Is Such a Thing as Stress Sickness

From nausea, weight gain and eczema, stress can affect your immune system in many ways

bowl of soy-based cubes with hand
November 30, 2023
Can Soy Cause Breast Cancer?

Research consistently shows that soy-based foods do not increase cancer risk

person scratching neck that has eczema
November 29, 2023
How Lifestyle Changes and Self-Care Can Improve Your Atopic Dermatitis

Changing your wardrobe or environment won’t eliminate eczema, but it can help reduce flares

person stressing, with clock and books
November 29, 2023
6 Ways To Feel Less Anxious in the Mornings

Breathwork, sleep mediatation and avoiding screens can help fight back morning anxiety

Trending Topics

group of hands holding different beverages
November 14, 2023
10 Myths About Drinking Alcohol You Should Stop Repeating

Coffee won’t cure a hangover and you definitely shouldn’t mix your cocktail with an energy drink

Person applies moisturizer as part of their skin care routine after a shower.
November 10, 2023
Korean Skin Care Routines: What You Need To Know

Focus on the philosophy — replenishing and respecting your skin — not necessarily the steps

glass of cherry juice with cherries on table
November 8, 2023
Sleepy Girl Mocktail: What’s in It and Does It Really Make You Sleep Better?

This social media sleep hack with tart cherry juice and magnesium could be worth a try

Ad