Can Your Neck Cause Your Shoulder Pain?
You notice an ache on top of your shoulder or along your shoulder blade. It makes sense to think the problem is in your shoulder. Sometimes it is. But sometimes the pain is actually coming from your neck.
This post explains how that can happen, what clues to look for, what care usually looks like, and when you should get help right away.
Your neck and shoulder share nerves
Your neck and shoulder are close neighbors, and they share many of the same nerves. Because of this, a sore disc, a sore joint, or an irritated nerve in your neck can cause pain that you feel somewhere else. This is called referred pain.
Pain that starts in the neck can show up in:
The top of your shoulder
On or around your shoulder blade
Between your shoulder blades
Sometimes down into your arm
Research supports this. In studies by Slipman and colleagues (2005) and Fukui and colleagues (1996), gently stimulating discs and small joints in the neck brought on the same shoulder and shoulder blade pain that patients already had. Pain like this often feels deep and achy, and it can be hard to point to one exact spot.
Where it hurts is a clue, not the whole answer
Many of us learned that nerve pain follows a neat "map" down the arm. Real life is messier. A 2009 study by Murphy and colleagues found that pain from an irritated nerve in the neck often does not follow those textbook maps.
The shoulder blade can be a helpful clue, though. A 2006 study by Tanaka and colleagues looked at people with an irritated nerve in the neck. Shoulder blade pain often came from that nerve, and it often showed up before any arm symptoms did.
Clues your shoulder pain may be coming from your neck
None of these clues proves where pain is coming from, but each one can point toward the neck:
Pain on or between your shoulder blades
Neck pain on the same side as your shoulder pain
Pain that changes when you move your neck or hold your head in certain positions
Tingling, numbness, or pain spreading down your arm
Relief when you rest your hand on top of your head. Some people with an irritated nerve in the neck notice this (Fast and colleagues, 1989).
Why checking both the neck and shoulder matters
Neck problems and shoulder problems can look a lot alike, and many people have both at the same time. It also works the other way around. A 2003 study by Gorski and Schwartz described people whose "neck pain" was actually coming from a shoulder problem.
Scans are only one piece of the picture, too. A 2015 study by Nakashima and colleagues found that disc bulges show up on MRI in most adults who have no pain at all. So a finding on a scan does not always explain your symptoms.
The best way to sort this out is a careful look at both areas: how your neck and shoulder move, your strength, feeling, and reflexes, and how your pain responds to gentle movement and testing.
What care usually looks like
There is good news here. A 2014 review by Wong and colleagues found that most people with an irritated nerve in the neck get much better within several months.
Care is usually active, not passive. Neck pain guidelines (Blanpied and colleagues, 2017) support combining approaches such as:
Exercise to rebuild strength and movement in your neck, upper back, and shoulder
Hands on care, such as chiropractic adjustments or gentle mobilization of the neck and upper back
Gentle nerve gliding exercises to help calm an irritated nerve
Traction, a gentle and steady pull on the neck, for some people whose arm symptoms last
Every person is different, so the right mix depends on what your evaluation shows and how your body responds.
Simple things you can do at home
Keep moving gently. Neck pain guidelines encourage staying active within your comfort level.
Find your relief position. If resting your hand on your head eases arm pain, it is fine to use that position for short breaks.
Ease off what flares it. For a while, cut back on positions or lifts that send pain down your arm, then return to them slowly.
Keep track of changes. Notice what makes your pain better or worse, and share it with your provider.
How we help at Pacheco Spine and Sport
When you come to us with shoulder pain, we check your neck too, and when you come in with neck pain, we check your shoulder. Our goal is to understand where your pain is really coming from before we start treatment.
From there, care may include chiropractic adjustments, rehab exercise to build strength and movement, and other approaches that fit your situation. If your evaluation shows you need imaging, we can write the order and refer you to a trusted imaging center. If another type of care would help, we will refer you there too.
When to get medical care right away
Most shoulder and neck pain is not dangerous. But some signs need prompt medical attention. Get care right away if you notice:
Weakness in your arm or hand that is getting worse
Clumsy hands, such as trouble with buttons or writing, or trouble with balance or walking
New changes in bladder or bowel control
Fever, or weight loss you cannot explain
Pain that started after a fall, crash, or other injury
Shoulder or arm pain that will not go away if you have a history of cancer or have smoked
The bottom line
Your neck can cause shoulder and shoulder blade pain. Because the two areas overlap so much, the most helpful first step is an evaluation that looks at both. The outlook is usually good, and active care helps most people get back to what they enjoy.
This post is for general education and is not a substitute for personal medical advice. Talk with your provider about your symptoms.
Pacheco Spine and Sport
Dr. Anthony Pacheco and Dr. Amber Pacheco
1067 Gilmer Street, Suite C, Sulphur Springs, TX 75482
903-629-5126
Sources
Slipman CW, Plastaras C, Patel R, et al. Provocative cervical discography symptom mapping. Spine J. 2005;5(4):381-8. doi:10.1016/j.spinee.2004.11.012
Fukui S, Ohseto K, Shiotani M, et al. Referred pain distribution of the cervical zygapophyseal joints and cervical dorsal rami. Pain. 1996;68(1):79-83. doi:10.1016/S0304-3959(96)03173-9. https://pubmed.ncbi.nlm.nih.gov/9252002/
Murphy DR, Hurwitz EL, Gerrard JK, Clary R. Pain patterns and descriptions in patients with radicular pain: does the pain necessarily follow a specific dermatome? Chiropr Osteopat. 2009;17:9. doi:10.1186/1746-1340-17-9
Tanaka Y, Kokubun S, Sato T, Ozawa H. Cervical roots as origin of pain in the neck or scapular regions. Spine. 2006;31(17):E568-73. doi:10.1097/01.brs.0000229261.02816.48
Fast A, Parikh S, Marin EL. The shoulder abduction relief sign in cervical radiculopathy. Arch Phys Med Rehabil. 1989;70(5):402-3. https://pubmed.ncbi.nlm.nih.gov/2719545/
Gorski JM, Schwartz LH. Shoulder impingement presenting as neck pain. J Bone Joint Surg Am. 2003;85(4):635-8. doi:10.2106/00004623-200304000-00008. https://pubmed.ncbi.nlm.nih.gov/12672838/
Nakashima H, Yukawa Y, Suda K, Yamagata M, Ueta T, Kato F. Abnormal findings on magnetic resonance images of the cervical spines in 1211 asymptomatic subjects. Spine (Phila Pa 1976). 2015;40(6):392-8. doi:10.1097/BRS.0000000000000775. https://pubmed.ncbi.nlm.nih.gov/25584950/
Wong JJ, Côté P, Quesnele JJ, Stern PJ, Mior SA. The course and prognostic factors of symptomatic cervical disc herniation with radiculopathy: a systematic review of the literature. Spine J. 2014;14(8):1781-9. doi:10.1016/j.spinee.2014.02.032
Blanpied PR, Gross AR, Elliott JM, et al. Neck Pain: Revision 2017. J Orthop Sports Phys Ther. 2017;47(7):A1-A83. doi:10.2519/jospt.2017.0302
