What Is Neck and Shoulder Pain? Symptoms, Causes, Diagnosis, Treatment, and Prevention

“Given their shared anatomy, it is very common to see both neck and shoulder pain complaints happen at the same time,” says Farah Hameed, MD, associate chair of the department of rehabilitation and regenerative medicine and medical director of women’s health rehabilitation at Columbia University Irving Medical Center in New York City. This is because of their proximity on the body and the fact that the neck and shoulder share multiple nerve pathways.

This is even more true when people have been living with low-level pain for a long time, Dr. Hameed adds. “They may learn compensatory movement patterns and positions that can add strain to the neck or shoulder, and so one isolated condition can become two connected conditions.”

The key to know is that people develop pain for different reasons, and the treatment options are unique to the underlying cause.

• Dull aches in the neck, shoulder, or both
• Limited range of motion and pain when reaching overhead or behind your back
• Discomfort at night
• Stabbing, burning, or tingling sensations
• Pain that travels to your shoulder or down your arm

While neck and shoulder pain often overlap, there are some clues to distinguish whether the pain stems from the neck or shoulder.

“Pain that radiates to the top of the shoulder and into the neck can be associated with a neck problem, particularly if it is associated with burning or electric sensations as well as numbness and tingling that can extend down the arm,” says Gregory Gasbarro, MD, an orthopedic surgeon at The Shoulder, Elbow, Wrist, and Hand Center at Mercy in Baltimore.

Meanwhile, shoulder-specific issues are often felt on the side of the affected shoulder, with pain worsening with movement, Dr. Gasbarro notes.

Your neck and shoulders are made up of several structures, including:

• Vertebrae
• Spinal cord
• Intervertebral discs (sponge-like pads between vertebrae)
• Muscles
• Joints
• Bones
• Ligaments (tissues that connect bones, joints, and cartilage)
• Tendons (tissues connecting muscles to bones)

Mechanical or structural issues in any of these areas often create pain.

• Sprains and strains in the muscles or ligaments
• Irritation and inflammation of tendons
• Partial or full tears of tendons
• Shoulder bursitis (swelling and inflammation of fluid-filled sacs called bursae)
• Trauma or injury
• Adhesive capsulitis (known as “frozen shoulder”)
• Arthritis
• Poor posture (known as “tech neck”)
• Pinching of a nerve root
• Herniated or ruptured discs
• Spondylolisthesis (when a vertebra slips out of place)
• Degenerative disc disease from aging
• Fractured vertebrae
• Spinal stenosis

You’ll likely feel it when you experience neck and shoulder pain. If the pain worsens or doesn’t improve over time, start with your primary care physician. They will most likely refer you to an orthopedic surgeon for an evaluation, says Ravi Vaswani, MD, a physician who specializes in orthopedic surgery and sports medicine at Northwell Health Orthopaedic Institute in Long Island, New York.

During the physical exam, your doctor will attempt to find the source of the pain. “We do a lot of provocative physical exam maneuvers, in addition to imaging, to figure out if it's shoulder or neck pain,” says Joshua Pan, MD, assistant professor of anesthesia and critical care with the University of Chicago. The goal is to recreate the source of the pain and observe (via imaging tests) where it’s coming from.

• X-Ray This imaging test uses radiation to identify broken bones, arthritis, or dislocation.

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• Magnetic Resonance Imaging (MRI) An MRI uses a magnetic field and radio waves to take detailed pictures of bones, tendons, muscles, and blood vessels.

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• Computerized Tomography (CT) A CT scan uses X-rays to create detailed pictures and can identify dislocation, injury, fractures, or soft tissue problems.

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• Electromyography (EMG) or Other Electrophysiological Tests These tests involve inserting small needles (electrodes) into muscle to measure electrical activity. They are used to explore nerve or muscle disorders.

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• Arthrogram If an X-ray isn’t detailed enough, this imaging test may be used. It involves putting contrast dye into a joint before taking more X-rays. An arthrogram may also use fluoroscopy (an imaging procedure that uses X-ray beams to create video images), CT, or MRI instead of X-rays to get better images of the joint.

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• Arthroscopy During this procedure, a surgeon makes a small incision before inserting a camera to view the inside of your joint. Arthroscopy is used when X-rays and other imaging tests aren’t enough to diagnose a joint condition. Surgeons can also repair some types of joint damage during arthroscopy, using thin surgical instruments inserted through small incisions.

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Duration of Neck and Shoulder Pain

Neck and shoulder pain can be short-term, lasting a few days to a few weeks. Meanwhile, “Neck and shoulder pain can last for a few weeks, or if more chronic it can last months to years,” Hameed says. It’s important to see a healthcare professional if you’re experiencing chronic or severe symptoms so you can avoid long-term complications, she says.

Treatment of the pain depends on what’s causing it in the first place. If it’s a serious health issue such as a heart attack, emergency medical care is needed.

“We have the ability to offer conservative options before moving forward with surgery,” Dr. Pan says. “So we’ll start with conservative treatment like over-the-counter anti-inflammatories and physical therapy, and for people who are not responding, we’ll talk through more options.”

Gasbarro suggests trying conservative approaches to treatment for two to three weeks and then seeking more help if the pain persists.

Lifestyle and Behavioral Changes That Can Help

Try these strategies yourself to help the pain go away:

• Rest the painful area. Avoid movements that worsen the pain, though you don’t need to avoid activity completely.

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   Use your common sense and if the area feels strained, avoid that movement.

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• Use hot or cold therapy. Use heat (like a heating pad or hot shower) to tame pain caused by chronic conditions like arthritis. Cold therapy is ideal for acute pain, muscle spasms, or nerve pain. Apply an ice pack to the painful area for 15 to 20 minutes a few times daily.

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• Do physical therapy. Work with a physical therapist to improve strength and flexibility and reduce your chances of further or future injury.

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   A physical therapist can recommend exercise and stretch routines you can do at home to correct the issue and improve pain, Pan says. He suggests giving it about four to six weeks to see some signs of improvement, and if there are none, discuss other options with your doctor.

Medication and Other Prescription Treatment Options

If you can’t perform exercises during physical therapy without feeling pain, OTC or prescription medication may be necessary, says John Stamatos, MD, a board-certified anesthesiologist and pain management specialist with Orlin and Cohen Orthopedic Group in Syosset, New York.

• Prescription NSAIDs or analgesics
• Muscle relaxants (such as diazepam)
• Injections of numbing medications or steroids
• Hyaluronic acid injections
• Peripheral nerve stimulation
• Radiofrequency ablation

When it comes to some of these stronger prescription medications, particularly injections, the goal is most often to help the patient find relief and begin to move and exercise again in ways that will help reduce the risk of pain recurrence, Dr. Stamatos says.

“These really are a jump-start to get people comfortable enough by reducing inflammation to be able to do the exercises necessary to maintain the relief and not be dependent on the procedures,” he explains.

Hyaluronic acid injections in the shoulder are another option. These act as a natural lubricant for the shoulder, Pan says.

Peripheral nerve stimulation is a newer treatment option that Pan says is used more and more frequently. It involves placing a small electrical device near the nerves to lessen pain signals and strengthen surrounding muscles. The device typically stays in for 60 days. “It allows patients to participate better in physical therapy and work on their range of motion,” Pan says.

Another treatment option is radiofrequency ablation. “We create a small burn and break out the nerve with radio waves,” Pan says. This prevents pain signals from being sent to the brain.

Alternative and Complementary Therapies

Alternative and complementary therapies can be used in combination with physical therapy and medications to relieve pain. Popular alternative and complementary therapies for pain relief include:

• Massage Therapy Soft-tissue massage can help relax tense muscles and improve circulation, Hameed says. This may lower inflammation and stop pain messages traveling to and from the brain.

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• Chiropractic Care Chiropractors can perform adjustments and muscular rehabilitation to help with pain, says Sherry McAllister, a doctor of chiropractic and the president of the Foundation for Chiropractic Progress (F4CP), based in San Jose, California. “[Chiropractors] often work on the area of pain while also focusing on the surrounding region, as in many cases the area around the injury has taken on increased stress and strain,” she adds.
• Acupuncture Acupuncture involves inserting thin needles into specific points (known as acupoints) on the body. This practice is thought to stimulate the nervous system, releasing chemicals that stimulate the body’s natural healing abilities.

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• Transcutaneous Electrical Nerve Stimulation (TENS) TENS therapy uses a battery-powered device to deliver electrical impulses through your skin at or near areas of pain. The electrical current relaxes muscles and nerves that may be overworked, overstressed, or sprained, Pan says. TENS can be done with a healthcare provider or using an OTC unit at home.

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Neck and shoulder pain can’t always be prevented. Still, there are steps you can take to minimize your risk:

• Stretch to maintain flexibility and range of motion. “Performing gentle stretches throughout the day, focusing on your neck, shoulders, and upper back, can help to prevent tightness of these muscles, which can lead to pain,” Hameed says.
• Build shoulder strength. “Shoulder exercises performed with high reps and low weight can enhance joint stability in the shoulder,” Dr. McAllister says.
• Don't overdoing it. Be smart about what your body can handle and avoid putting it in stressful situations. Pay attention to signs of discomfort and address minor aches before they get worse, Hameed says.

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• Practice good posture. Poor posture can strain the discs and joints in the neck and create tight, uncomfortable shoulders over time. To prevent issues, check in with your posture throughout the day. “Sit tall with your shoulders back and relaxed, ears in line with your shoulders,” Hameed says.
• Adopt an ergonomic-friendly work setup. Make it easier to maintain good posture with a work setup that encourages proper alignment. “If you work at a desk, ensure your monitor is at eye level, and your chair provides lower back support,” Hameed says. And don’t forget to take breaks to move around every 30 minutes. “Take short walks, do some stretches, or simply change positions to avoid prolonged sitting in one position, which can lead to pain,” Hameed says.
• Make sleep tweaks. Side sleeping places pressure on the shoulder beneath you, which can cause neck and shoulder pain. The best sleep position for these areas is on your back, and you should use a supportive pillow and mattress to align your neck and spine.

Most pain will resolve over time or through the treatment options listed above. However, if a patient does not seek treatment, they may experience long-term pain and dysfunction, Dr. Vaswani says.

Pan says that it’s important to address neck and shoulder pain in order to keep your range of motion before it becomes a larger problem. “What happens when patients lose their range of motion is they get something called frozen shoulder, a dreaded complication of prolonged shoulder pain that can last a few months to a few years,” he says.