The neck and shoulder area is, to say the least, complex; it’s resplendent with many small but critical anatomical structures.
Often, neck pain and/or neck and arm pain is associated with some type of problem that is going on in the cervical spine. Examples include degenerative or herniated disc, spinal arthritis in the neck area, soft tissue damage following a whiplash incident, and in rare cases, things like infection, tumors, or cysts.
When shoulder pain is the complaint, possibilities that come to mind about the cause tend to be along the lines of bursitis, rotator cuff tear, impingement, or frozen shoulder.
But what happens when you have a combination of neck and shoulder pain? Does that mean two things are wrong? Or can any of the conditions mentioned above—those that tend to be attributed to just one area or the other—cause symptoms in both areas?
In a nutshell, when things go awry in either area, a number of body systems are involved, (although this is more true for neck problems.)
This means that either way, you can have pain in both neck and shoulders, based on which tissues are affected and how they respond. That said, there are some patterns at play. Let’s explore them.
○ Neck Problems That Cause Shoulder Pain
The cervical spine, which is the area of your spinal column that corresponds to your neck, is made up of seven fairly small, highly mobile bones, plus attaching ligaments, muscles, shock absorbing discs and more.
Because of the size and complexity of these interrelated moving pieces, the neck is vulnerable to wear and tear conditions such as arthritis, as well as to injury and postural mis-alignments.
One of the most common types of shoulder and arm pain caused by neck problems is called cervical radiculopathy.
Actually, while radiculopathy symptoms do include pain, the list doesn’t stop there. Radiculopathy symptoms may be created when something, whether it’s a herniated disc, a synovial cyst, a bone spur or other piece of tissue that doesn’t normally belong in the area, presses on, and therefore irritates a spinal nerve root.
The spinal nerve roots, which are located on either side of the spinal column, are clusters of nerves that have branched off the main spinal cord on their way out to all areas of the body. (These nerves branch off the spinal nerve root once they are fully outside the spinal column.)
The spinal nerve roots are located in spaces called the intervertebral foramen, which basically are holes on either side of the spinal column. Right and left pairs of intervertebral foramen can be found at every spinal level; they correspond to each of the 24 spinal bones (vertebrae) that comprise the column.
All this is to say that because radiculopathy comes about when the spinal nerve root is compressed and/or irritated by something, you’ll not only experience pain, but possibly numbness, weakness, pins and needles and/or electrical sensations as well.
And because the nerves branch out from the nerve root to all areas of the body, including the arms, symptoms that start with compression on the nerve root may radiate down the arm (and affect the shoulder as they go.) It’s this bit of knowledge that doctors rely on during the diagnostic process to pinpoint the exact place from which your radiculopathy symptoms may be arising.
So what are the most common conditions that lead to radiculopathy? Here’s the short list.
○ Cervical Spine Conditions That Cause Radiculopathy
Cervical spondylosis, aka neck arthritis, may involve the formation of bone spurs right where you don’t need them—in the intervertebral foramina we discussed above. This generally occurs in a later phase of the condition, which is discussed below and called spinal stenosis.
Spinal stenosis, which is a progressed form of spinal arthritis, occurs when the spaces in the spine, i.e. the spinal canal and the intervertebral foramen become narrowed. Because stenosis is arthritis-related, the narrowing is usually due to some type of extra bone growth in the area that encroaches on the space. This can result in contact between the new bone and the spinal nerve root, causing the radiculopathy we talked about earlier. Spinal stenosis can also cause neurogenic claudication, which is characterized by cramping, pain and weakness in one leg. In fact, neurogenic claudication is the hallmark symptom of spinal stenosis.
Degenerative disc disease, one of the first signs of degenerative changes in the spine (and therefore neck arthritis) to occur, is a wear and tear condition affecting the shock absorbing cushions located between spinal bones. In the case of DDD, as it’s often called for short, again, those tough outer fibers of the disc (the ones that protect and encase the soft inner substance) erode and fray. This can lead to either a bulging disc or a herniated disc.
By the way, the inner liquid is what gives the disc its shock absorbing capacity. When it dries out or escapes as is the case in many cases of disc problems, your flexibility may decrease and your pain may increase. Discs that have fully dried out lead to bone on bone articulation, which can not only be painful but also lead to bone spurs.
Herniated intervertebral disc occurs when the tough outer fibers of the shock absorbing cushions located between spinal bones are disrupted to the point where the liquid-y substance inside can escape. Theoretically, this is not painful, but many times, herniated disc material lands on a spinal nerve root, causing radiculopathy symptoms.
○ Shoulder Problems That May Cause Neck Pain
Unlike shoulder pain that is referred from the neck, neck pain due to shoulder problems are mainly related to soft tissue damage following an injury or condition. That said, the shoulder is often the site of pain referred from other areas of the body, or from system medical conditions. Issues involving your heart, lungs, abdominal organs and/or your spinal cord can all be the originators of shoulder, and sometimes neck, pain. For this reason, it's important to take them seriously and speak with your medical provider as soon as you can after experiencing neck or shoulder pain.
Here’s a short list of shoulder problems that may, along with giving you shoulder pain, refer pain to your neck.
Have you ever broken your collarbone? This injury is pretty common in serious cyclists and the risk is higher when you speed. Neck pain related to a broken collarbone will likely be soft-tissue related.
Shoulder bursitis can causes swelling, stiffness and pain, especially after an injury to the area. As stated above, symptoms such as these—especially in terms of affected soft tissue - don’t discriminate between the shoulder area and the neck area.
Broken shoulder blade: An injury to the shoulder blade usually is associated with relatively forceful trauma.
Rotator cuff injuries is a tearing of the muscles that surround the shoulder joint (acronym: sits muscles.) It may be due to a sudden sports injury or repetitive wear and tear over time. You may feel pain in your shoulder when you try to move it, but the soft tissue in your neck may also be affected.
Related to rotator cuff injuries, shoulder impingement syndrome refers to the compression of the tendons of the shoulder against the acromium, which is the end of a piece of bone on the shoulder blade that forms part of a “shelf” under which the arm bone connects. The muscles (and tendons of the rotator cuff are located in this “sub-acromial” area as well. The compression occurs with repeated overhead movements (do you participate in throwing sports or swimming, for example?) It may also occur as a result of an injury or fall, weakness in the shoulder muscles and other things.
○ Soft Tissue and Posture
The conditions and injuries listed above focused mainly on hard tissue and structures in the joints. But let’s not forget about soft tissue. Soft tissue can have a big effect on your pain and functionality levels.
By soft tissue, I mean muscles, ligaments, fascia (which is a covering around muscles responsible for our upright integrity) tendons and more. These more naturally pliable structures can even be the entire cause of some types of spine and shoulder pain. As an example, if you’ve ever been involved in a minor car accident, the pain that later ensued—whether it was a headache, some neck pain or shoulder pain—may have been entirely due to soft tissue damage. Such is the case for many simple car crashes.
Recall from above that when you injure your neck or shoulders, more than one body system may be affected. When you have neck pain, you may find that the muscles of your shoulders lose their strength. This in turn can lead to painful shoulder impingement and/or problems in your shoulder blade (a structure called the scapula).
Conversely, if you have pain in the acromioclavicular joint of your shoulder (which is located just above the top-most part of your arm) you may experience radiating pain in your neck.
And don’t forget whiplash! Along with other types of trauma or injury to the neck, whiplash may lead to ligament sprain or muscle strain. This type of injury doesn’t discern between areas. Neck? Shoulder? It’s all the same to whiplash and other common injuries. So you’re likely to feel pain and restriction in both areas.
Finally, habitual shoulder posture can play a role in the health of your neck. People who sit at desks all day may be prone to shoulders that round in and upper back kyphosis. This in turn can lead to a condition known as forward head posture. In this way, your shoulder and your neck may collude to create muscle tension and weakness, poor posture and pain.