Neck and Shoulder Pain
Neck and shoulder pain can occur for a number of reasons and may be short-lived or a chronic annoyance, discomfort, and disability. The neck is an extremely complex area in terms of the nervous system and circulation with numerous blood vessels and cervical nerves passing through it. The innervation to the upper body, including the shoulders and the neck, supplied by these cervical nerves may be disrupted by acute or chronic damage such as whiplash or a degenerative demyelinating nerve condition. Ischaemia in the muscles of the shoulder may also occur if a blood vessel becomes compressed or damaged, leading to muscle cramps and pain initially and followed by muscle atrophy (wasting) if the problem persists.
In some cases neck and shoulder pain may be a result of poor posture, sitting in a draught for a long time, sleeping at a funny angle, or carrying a heavy load in an uncomfortable way. Similarly, using a shoulder bag day in and day out can cause chronic neck and shoulder pain even if the bag is not obviously heavy, simply by applying a consistent strain to one side of the upper body. Opting for a backpack may be a good way of avoiding neck and shoulder pain if this is the likely culprit.
For those who sit at a desk for a large portion of their working day it is important to try to incorporate some neck exercises into the routine, some of which are easily done whilst at the desk, although getting up to stretch and walk around every half hour or so is preferable. Checking the angle of the computer screen, the position of the keyboard, and chair height is also likely to reveal small stresses on the body which can effect pain in the neck and shoulders over time. An ergonomic assessment should help reduce the incidence of neck and shoulder pain throughout the work environment and is often cost-effective for an employer due to less sick days taken by staff.
Neck and Shoulder Pain Causes
Where neck and shoulder pain exist as part of an increasing systemic pain profile, with sleep disruption, altered mood or cognition, and fatigue it is possible that they are symptoms of fibromyalgia syndrome. This condition, the cause of which remains largely unknown, often occurs with acute and chronic stress and is difficult to treat without addressing this underlying stress. Over time, those with fibromyalgia have been found to develop fatty tissue in the shoulders where muscle should be and this can reduce strength and mobility as well as increase pain signals through the adipose tissue. Fibromyalgia sufferers have a number of trigger points which cause extreme pain when pressed, often even when lightly touched, and these can help a doctor identify the disease. Neck and shoulder pain may simply be due to a strain or acute stress causing tension in the muscles in the neck and upper back, but where it becomes chronic it requires further investigation.
Neck and Shoulder Anatomy
The area of the neck and shoulder is called the brachial plexus and this can be damaged at birth if a baby becomes stuck during delivery and is forcibly pulled from the birth canal. Congenital defects in the brachial plexus may also lead to neck and shoulder pain, as can chronic microtrauma in childhood leading to inflammation in the area. Signs of brachial plexopathy include a visible disparity between the size of one arm and the other, a cold hand on one side only, and radicular pain in the arm, amongst other things. These symptoms are particularly pronounced when the sufferer tries to raise their arm above shoulder height and some people may not be able to perform this seemingly simple act due to a compressed brachial plexus. Problems may also occur with drainage of the lymph in the axilla, neck, and chest with infections possible.
Neck and Shoulder Pain from Pinched Nerve and Injuries
Neck and shoulder pain can occur, therefore, with compression of the nerves and blood vessels due to disc herniation, spinal curvature, the presence of a cervical rib, acute trauma, and repetitive microtrauma in the shoulder or chest. Brachial plexus injuries are also common in those taking part in sports such as football, and rugby, where the neck may be forced up during a tackle as the chest is pushed downward, thus stretching the brachial plexus. This type of injury is called a burner or a stinger and may actually wrench the nerves out of the cervical spine or sever them somewhere in the shoulder, leading to excruciating neck and shoulder pain followed by numbness, weakness, and possible paralysis of areas of the upper body.
Neck and Shoulder Pain Diagnosis
Muscle cramps and inflammation, calcification of the ligaments, bone deformation or hypertrophy, and oedema can all exert compression on the nerves in the neck and shoulder, therefore it is one of the first things physicians tend to look for when performing neck and shoulder pain diagnosis. The majority of shoulder and neck pain is due to a pinched nerve at C6 or C7 in the neck itself however, which may cause the muscles to cramp and spasm and could then lead to further nerve compression in the brachial plexus. The cervical nerves are also responsible for innervating the thyroid gland, teeth, tonsils, the outer ear, the nose, the vocal cords, and for regulating the pharynx and the epiglottis to stop the accidental aspiration of food. Where neck and shoulder pain exist alongside other problems with swallowing, breathing, or a seemingly unrelated condition concerning the neck or head it may be that the root cause is a common one. Such nerve trauma may occur due to spinal stenosis which should be recognizable on an X-Ray or MRI scan, as is disc herniation, and fracture which may also cause nerve compression.
Neck and Shoulder Pain from Whiplash
Those who have suffered whiplash do not always develop symptoms straight away and may not connect the sudden onset of neck and shoulder pain with the accident. Whiplash can however compromise the connective tissue in the neck and lead to hypermobility after initial swelling has reduced, making degenerative conditions such as cervical arthritis more likely to develop. In the majority of cases a pinched nerve in the neck happens at C6 or C7, and your physician will isolate the problem by assessing your symptoms and then, most often, sending you for an X-Ray, MRI or CT scan. If the nerve at C5 is pinched, however, you are likely to develop shoulder pain, numbness, and weakness in the deltoids and bicep muscles. Pain can be both sharp and acute, or a dull aching pain in the neck or shoulder. Some patients may experience a widespread pain, whereas for others it is isolated to a smaller spot and can produce a burning sensation. Numbness, and a feeling of pins and needles in the shoulder can indicate a trapped nerve and lead to muscle weakness and, over time, muscle atrophy (wasting).
Neck and Shoulder Pain from Fibromyalgia
Where there is a suspicion of fibromyalgia the doctor may test the trigger points in different areas of the body to see if these elicit a pain response in the patient. If pain is generally worsened after alcohol consumption, relieved by exercise, and exacerbated when stress levels are high, then fibromyalgia is a likely diagnosis. A test to detect high levels of substance P in the spinal fluid may confirm the diagnosis, as can high levels of N-methyl-D-aspartate (NMDA), both of which increase a person’s sensitivity to pain. A spinal tap may reveal high levels of inflammatory substances (specific cytokines) and any neurological deficits such as developing weakness or numbness in the neck and shoulder may instead lead a physician to suspect a demyelinating disorder such as multiple sclerosis, amyotrophic lateral sclerosis, or spinal cord injury. Further tests would need to be carried out to detect any lesions in the spinal cord or brain and the presence of antibodies to myelin in the blood. These conditions are considerably less likely to be the cause of neck and shoulder pain but may be suspected if other symptoms are also present, in any case they should not be overlooked during neck and shoulder pain diagnosis.
Neck and Shoulder Pain Treatment
When determining neck and shoulder pain treatment, where an acute brachial plexus injury has occurred and nerves have been cut the severed nerves may be stitched back together in some cases, or a nerve graft may be applied to help healing. Damage at the spinal cord itself is likely to cause a permanent disability. If pain from the injury is less acute then applying ice is advisable as this can reduce the swelling in the area and lower compression, which helps to relieve neck and shoulder pain. It is not recommended to apply heat in such an injury as this could increase the inflammation in the area and actually worsen the effects of the trauma causing more nerve and blood vessel damage. Avoiding the risk of further trauma is advisable to allow the body time to heal, especially if bruising is present and the area is tender to the touch. In a small number of cases a heavy blow to the upper chest and shoulder can cause a fracture of the cervical rib, lower ribs, or the clavicle which would in many cases cause neck and shoulder pain. It is important to be assessed by a doctor to ensure that everything is done to aid a quick and optimal recovery.
Neck and Shoulder Pain Treatment | Conservative methods
Those who are experiencing pain and seeking neck and shoulder pain treatment due to tight muscles and stress can try to relieve the tension through massage, acupuncture, and/or thermotherapy. It is important to ensure that there is no underlying problem with nerve compression, or a structural defect in the area prior to having massage treatment as wrongly applied pressure could worsen the symptoms. A heat pad held to the neck and shoulder can help draw blood to the region and should relieve cramps and tension in the area. Lying chest down on an acupressure mat can also help to stimulate circulation to the area and relieve pain. Using NSAIDs and analgesic medications may be helpful for acute pain but are not ideal for long term use due to their plethora of side effects including the potential for liver damage and cardiovascular complications. If someone suffering from chronic neck and shoulder pain has come to rely on such drugs to function on a daily basis then it is important to get a physical assessment to determine the root cause of the pain and tackle it from that angle. It may be that something as simple as using different chair at work, carrying a bag with better weight distribution, or avoiding a draught in the office can help.
There are also a number of anti-inflammatory massage gels and creams that can be rubbed into the shoulder and neck to produce a similar effect to a heat pad or acupressure as they usually work either by drawing blood and nutrients into the region, reducing inflammation in the tissues, or blocking nerve pain signals through an effect on acetycholine. Some patients with chronic neck and shoulder pain and tension may choose to have botox injections in the area to effectively reduce these symptoms for a longer period of time by blocking acetycholine receptors for weeks, or even months until the toxin wears off. This can be helpful for some sufferers but it may lead to hypermobility and poor muscle control that could actually exacerbate a condition in the long run. Discussing appropriate treatments for neck and shoulder pain with the doctor is the best option as the symptoms could be part of an underlying condition not yet recognized such as cervical arthritis, fibromyalgia, or rheumatoid arthritis.
Quick Tips to Treat a Painful Shoulder
1. Apply ice – this can relieve inflammation and prevent further injury to the nerve. Heat may actually exacerbate a problem, causing increased blood-flow and oedema.
2. Devise a physical therapy regime that is appropriate to the injury. Some good exercises for pinched neck nerves may help to relieve the pain. Talk to your doctor before conducting these in order to avoid the possibility of worsening your injury.
3. Correct your posture and maintain it! A daily regime of gentle stretching and strengthening neck exercises can really help you avoid potential injuries, neck pain, and shoulder pain. Checking your posture when at work and taking a break every half hour to stand and stretch, or even just squeeze your shoulder blades together can relieve muscle tension and make you more aware of any undue stresses and strains.