Common Causes of Neck and Shoulder Pain

The neck and shoulders are resplendent with many small, but critical anatomical structures. To say the least, this is one complex area we're talking about. And with such complexity comes the risk for pain, injury, degenerative conditions, and restricted movement.

Man stretching back and shoulders with physical therapist
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Types of Neck and Shoulder Problems

Often, a lesion in the cervical spine is what lurks beneath your upper body pain. A degenerative or herniated disc, spinal arthritis, soft tissue damage following a whiplash incident, poor posture from sitting or standing at a computer, or rare conditions such as infection, tumors, or cysts are all known to cause pain and dysfunction.

If you have shoulder pain without neck pain, you may be dealing with bursitis, rotator cuff tear, impingement, or frozen shoulder.

But what happens when you experience a combination of neck and shoulder pain? Does that mean you have two, or even more, problems to deal with? Or might any of the conditions mentioned above, those that tend to be attributed to just one specific area, cause symptoms in both neck and shoulders?

With a neck and shoulder pain combination, it's likely that several body systems are involved, particularly if the symptoms arise from something going on in your neck. That said, there may be some patterns at play. Let’s explore them.

Neck Causes of 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 misalignments.

One of the most common types of shoulder and arm pain caused by neck problems is called cervical radiculopathy. 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 comes into contact with 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 foramina, 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 do.

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.

Cervical Spine Causes of Radiculopathy

Several common conditions leading to radiculopathy. Here’s the shortlist.

Cervical spondylosis (neck arthritis) may involve the formation of bone spurs right where you don’t need them, which is in the intervertebral foramina discussed above. This generally occurs in a later phase of the condition, and at that point is known as spinal stenosis.

Spinal stenosis, 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 discussed earlier.

Spinal stenosis may also cause neurogenic claudication, a hallmark symptom of this condition characterized by cramping, pain, and weakness in one leg. 

Degenerative disc disease (DDD), one of the first signs of degenerative changes in the spine, and therefore neck arthritis, to occur, is a wear and tear condition; it affects those shock-absorbing cushions located between spinal bones. 

In the case of DDD, the tough outer fibers of the disc, which are designed to protect and encase the soft inner substance responsible for the shock-absorbing functions, erode and fray. When this occurs, you may get a bulging or herniated disc.

By the way, when the inner liquid in the disc dries out or escapes, either may be the case in cases of disc problems, your flexibility may decrease while your pain increases. Discs that have fully dried out may lead to bone-on-bone articulation at the joint, which may not only be painful but it may also lead to 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 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 Causes of Neck Pain

Shoulder pain you experience may actually be referred from your neck to other areas, based on what's going on in your body systems. Issues involving your heart, lungs, abdominal organs and/or your spinal cord can all be the originators of shoulder pain, and sometimes neck pain.

For this reason, it's important to take symptoms seriously and speak with your medical provider as soon as you can after experiencing neck or shoulder pain. When neck pain is related or due to shoulder problems, this tends to occur after an injury, or because of some type of soft tissue damage.

Here’s a shortlist of shoulder problems that may cause pain at the site of the problem or refer it into your neck:

  • A broken collarbone is common among hardcore, competitive athletes, and, of course, the risk is likely higher when you speed. Neck pain related to a broken collarbone is generally soft-tissue related.
  • Shoulder bursitis can cause swelling, stiffness, and pain, especially if you injure the area. Like many other injuries and conditions, bursitis doesn't discriminate between neck and shoulders, which means pain may occur in either area.
  • An injury to the shoulder blade, including fracture of this bone, usually is associated with forceful trauma.
  • Rotator cuff injury is a tearing of the muscles and tendons that surround the shoulder joint. It may be caused by a sports injury or with time by repetitive wear and tear. The pain you may feel in your shoulder when you try to move is not the only symptom; 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 acromion, 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. For example, do you participate in throwing sports or swimming, for example? Shoulder impingement may also occur as a result of an injury or fall, weakness in the shoulder muscles, or other things.

Soft Tissue and Posture

The conditions and injuries listed above focused mainly on bone-hard tissue and structures in the joints. But let’s not forget about soft tissue. The condition of your soft tissue can have a big effect on your pain and functionality levels.

Soft tissue includes muscles, ligaments, fascia, 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. For example, if you’ve ever been in a minor car accident, the pain that later ensued, whether it was a headache, neck pain, or shoulder pain, may have been entirely due to soft tissue damage.

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 (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.

Along with other types of trauma or injury to the neck, whiplash may lead to a ligament sprain or muscle strain. This is another type of injury that doesn’t discern between areas. Neck? Shoulder? It’s all the same to whiplash, and you’re likely to feel pain and restriction in both areas after a car accident.

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 kyphosis and shoulders that round inward. 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.

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