Health Essentials from Cleveland Clinic

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

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 percent of 65-year-olds may only 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. Mayer. 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. 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 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.