The neck and shoulders are highly mobile areas of the body, and are at much higher risk of mechanical injury through everyday activities. Also, because they are intricately connected through a complex web of soft tissues, including muscles, tendons, ligaments, fascia and nerves, it can be difficult to distinguish the actual source of pain when an injury does occur. How are the neck and shoulders connected, what is “referred pain,” and how can you determine the true source of your shoulder or neck pain?
Referred Pain
While neck and shoulder pain affect millions of people annually, many are actually experiencing “referred pain,” or pain from source in a different part of the body. “People may come in with shoulder pain when they really have a neck problem,” says shoulder specialist Dr. Eric Ricchetti, MD, of the Cleveland Clinic’s Department of Orthopaedic Surgery. On the other hand, neck pain can also mask a shoulder issue. How are the neck and shoulders connected, and how does this contribute to referred pain?
Anatomy of the Shoulder Girdle
The shoulder girdle is the set of bones that connect the arms and shoulders to the trunk on each side, or our collarbones and shoulder blades. These structures are not even connected to the spine; the only true anatomical joint between the arms and shoulders and the trunk of the body is at the inner end of the collarbones and the sternum. That means that a web of muscles, nerves, tendons and ligaments are connecting everything to the spine from the neck down, and that problems in one area usually affect structures in the other. How can you determine the source of your pain?
When it’s the Neck
Shoulder pain can be caused by injury in the neck because the nerves and muscles that start in the neck make their way through the shoulder to get into the arm. Dr. E. Kano Mayer, MD, an interventional spine specialist in Cleveland Clinic’s Center for Spine Health, suggests having a medical evaluation for chronic problems. “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,” he says. How can you try to determine if shoulder pain is actually a neck issue?
- Pain radiates down the side of the neck, or to the shoulder blade
- Pins and needles sensation, or tingling, stabbing or burning
- Pain and sensations radiate past the elbow or into the hand
- Pain continues while resting, gets worse with neck movement
When it’s the Shoulder
Shoulder pain can come from anywhere in the shoulder joint itself, or any of the surrounding tissues. According to the Mayo Clinic, when the source of pain is in the joint, it will typically worsen with movement of the arm or shoulder, whereas referred pain from a neck issue won’t increase with arm movement. Signs include:
- Pain is in the shoulder joint itself, or on the outside of the upper arm, but not below the elbow
- The pain is dull and aching
- Overhead reaching, behind the back reaching, or lifting the arms makes it worse
- Pain improves when resting the arm
Not Sure of the Source of Your Neck and Shoulder Pain?
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