Just about everyone can relate to sore, tense and tight neck muscles or the occasional sharp pain through the shoulder when lifting overhead or reaching behind. Since there are many neuropathways between the shoulder and neck, distinguishing the symptoms can be a little confusing. Sometimes there is “referred” pain which is due to a large network of interconnecting sensory nerves that send signals to multiple areas. It can be a challenge to pin-point exactly where the pain is originating. The treatment approaches are completely different so it is critical to understand what your symptoms mean.
Based on symptoms alone, is there a way to determine a shoulder issue versus a cervical spine issue?
In many cases, these problems can overlap and be hard to distinguish for the patient. There are however, distinct symptoms to look for that specifically relate to cervical spine issues.
For example, you may have a cervical related issue if:
- Pain radiates down past the elbow and even into the hands.
- Pain radiates down the arm when you extend or twist the neck.
- Pain persists at rest.
- Pain feels sharp, stabbing or tingling.
- Hands feel numb and tingly.
If you feel any of these symptoms it is best to see a neurologist or orthopedic doctor to conduct a further evaluation.
An injury involving the shoulder will:
- Likely radiate upward and not past the elbow.
- Occur when lifting or raising arms above the head.
- Interrupt sleep and persist when laying on it at night.
- Feel better with the shoulder at rest.
Could you describe what is actually occurring when there is a problem with the cervical spine?
There are 8 pair of joints and 14 nerves in the neck that could easily become irritated and inflamed simply by our daily activities. The joints serve as a hinge responsible for looking up and down, left and right. When the support musculature around the spine is under-developed and weak, more duress is put on the joints and articulating (moving) surfaces. Eventually the inflammation around these joints can wear out cartilage, create bone spurs, and lead to a narrowing between the disc spaces. The use of cell phones and technology that requires looking down at a screen have detrimentally led to more and more neck related issues.
When the issue is related to the shoulder, does this mean there is a tear in the rotator cuff tendons?
Not necessarily. Rotator cuff tears can most certainly cause shoulder pain but there are other less traumatic culprits. Since the shoulder moves in more directions than any other joint in the body, it is highly susceptible to wear and tear. A common cause for pain in the shoulder is called bursitis. The purpose of the bursa is to decrease friction as the joint glides around. The bursa sac can become irritated with repetitive motion that could include postural habits, positioning during work and even the way we sleep. Arthritis or bone spurs can protrude into the underlying bursa sac and create a very common issue called, Impingement Syndrome. These things are all relatively easy to manage with the right treatment approach.
What are the best ways to prevent either of these injuries from occurring?
There are the unforeseen occurrences when a jarring injury takes place leading to problems in the shoulder and the neck. Those scenarios can obviously not be predicted or prevented. However, there is one very effective way to keep the degenerative, wear and tear process at bay and to ensure you keep these moving parts healthy and functional. In order to do this, it is critical to incorporate exercise into your daily routine. There is really no way around it.
When the muscles around our joints are strong, it takes the duress off of those articulating structures and tendinous attachments. The muscles are meant to take the brunt of the work and when they are weak, all of the stress goes onto the joints. A simple exercise routine using tension bands and light weights can make all the difference. Additionally, it is very important to keep in mind your postural habits when going about the day, especially using mobile devices. Our muscles will conform to whatever we ask of them. If the shoulders and neck are rounded forward all day long looking at a computer screen or cell phone, it’s not a matter of if the symptoms will occur, it’s just a matter of when.
I am a firm believer in correcting and rewiring poor anatomic habits which is why I have developed specific strength and rehabilitation protocols to aid in this process. I tell this to all of my patients; as advanced as modern medicine has become, there is a limit to just how much we can do to heal if there is a poor foundation. Give yourself the benefit of a daily exercise routine. It doesn’t have to be complex or overwhelming and can be done right from home. After 40 years as a physician specializing in painful nerve and spine conditions, the most sound advice I could impart would be; devote the time to keep your body strong and healthy, it’s the absolute best investment you could make.