What Causes Neck and Shoulder Pain?

What Causes Neck and Shoulder Pain?

The neck and shoulders are complex and interconnected areas, and medical problems that affect one often affect the other, as well. Pain and dysfunction from injuries or conditions that impact the joints, muscles, and other structures can easily spread from the neck to the shoulder(s) and from the shoulder(s) to the neck.

These body parts share bones, muscles, connective tissues, and nerves, making it easy for pain to radiate throughout the area.
Causes
With a neck and shoulder pain combination, the underlying causes can be a wide variety of things, including some that originate in the neck and others that originate in the shoulders. Some of the more common ones include:


Cervical radiculopathy
Broken collarbone
Shoulder bursitis
Shoulder blade injury
Rotator cuff injury
Shoulder impingement syndrome
Soft tissue damage (sprain or strain)
Poor posture
Cervical Radiculopathy
One of the most common types of neck and shoulder pain is cervical radiculopathy,1 in which pain comes from compression or irritation of spinal nerve roots (the part where the nerve splits off from the spinal cord). These nerves travel between the neck vertebrae, through the shoulder, and down the arm.2 Cervical radiculopathy symptoms include:3

Sharp or tingling pain in the neck, shoulder, arm, and hand
Sharp or aching pain in your neck when you look up
Headaches in the back of your head
Numbness
Weakness
Impaired reflexes

What is the Cervical Spine?
The cervical spine is the neck region of your spinal column. It's made up of seven small, highly mobile bones, and their associated ligaments, muscles, and shock-absorbing discs.

Anything that aggravates or comes into contact with your spinal nerve roots can lead to radiculopathy, and that includes several common conditions in which growths or abnormalities cause something to invade the space of the nerve root.


Herniated disc: The shock-absorbing discs between vertebrae can become damaged and may develop a bulge and/or leak fluid.4
Synovial cyst: These lumps are caused by a buildup of joint fluid that forms a sac.5
Bone spur: An extra bit of bone forms in response to damage or chronic inflammation.6
Cervical spondylosis (neck arthritis): This condition involves the formation of bone spurs in the neck.7
Spinal stenosis: An advanced stage of spinal arthritis, stenosis occurs when the spaces in the spine become narrowed, usually due to excess bone growth.8
Degenerative disc disease (DDD): Discs between vertebrae erode and fray over time,9 which may cause a herniated disc. In cases of severe degeneration, bone-on-bone contact can cause bone spurs in the joint.10

Broken Collarbone
Also called a clavicle fracture, this is a break of the bone that extends from the top of the sternum to the outer tip of the shoulder blade. Most broken collarbones are the result of falling on the shoulder itself or landing on an outstretched arm.11


In addition to considerable pain and loss of function in the arm and shoulder, a broken collarbone can cause pain in the soft tissues that extend from the shoulder up into the neck.


Shoulder Bursitis
A bursa is a small sac of of fluid in your joints that acts as a cushion and prevents excessive friction between bone and soft tissues. Bursitis is inflammation of the bursa, which can happen due to injury, infection, or disease.12

Shoulder bursitis can cause swelling, stiffness, and pain in the shoulder joint that can radiate into the neck because of all the common structures and connections.

Rotator Cuff Injury
The rotator cuff is made up of the muscles and connective tissues surrounding your shoulder. Together, they keep your arm in the shoulder socket.13

When these muscles and/or tendons are torn, it's called a rotator cuff injury. It may be caused by a sports injury or over time by repetitive wear and tear. You'll most likely feel pain in your shoulder and possibly your neck, as well, when you try to move.

Shoulder Impingement Syndrome
Related to rotator cuff injuries, shoulder impingement syndrome refers to the compression of the tendons of the shoulder against the acromion, a bony prominence in the shoulder. The muscles and tendons of the rotator cuff are located in this “sub-acromial” area as well.

The compression occurs with repeated overhead movements such as those used in throwing sports or swimming. Shoulder impingement may also occur as a result of an injury or fall, weakness in the shoulder muscles, or other things.14

When the rotator cuff swells, it reduces the amount of space between the soft tissues and the acromion bone, which causes further friction. This creates a vicious cycle that's hard to break.14

Soft Tissue Damage
Soft tissue includes muscles, ligaments, tendons, and fascia (a thin covering around muscles, organs, and many other structures). These naturally pliable structures can be involved in pain relating to bones and joints, or they can be the entire cause of pain.

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).15

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.16 It's likely to give you pain and restriction in both your neck and shoulder.

Poor Posture
Failing to sit up straight, especially if you're at a desk all day, can take a toll on the health of your neck and shoulders. People who sit at desks all day may be prone to a rounding of the back (called kyphosis) and shoulders that slump forward.

This, in turn, can lead to a condition known as forward head posture.17 In this way, your shoulder and your neck may collude to create muscle tension and weakness, poor posture, and pain.

Take Pain Seriously
Issues involving your heart, lungs, abdominal organs, and your spinal cord can all cause shoulder pain and sometimes neck pain. Take your symptoms seriously and see your doctor as soon as you can after neck or shoulder pain starts.

Diagnosis
When you go to the doctor complaining of neck and shoulder pain, expect a physical exam involving movement of the neck and shoulder so your doctor can see what's causing your pain and gauge your range of motion. Then, you may be sent for imaging studies, which can include:

X-rays: To look at the bones and joints
Computed tomography (CT) scan: To examine the bone and spinal canal
Magnetic resonance imaging (MRI): To help identify herniated discs or pinched nerves
Electromyography (EMG) and nerve conduction studies: To identify nerve problems
Selective nerve root block: To try to pinpoint the source of nerve problems
Myelogram: To see the spinal canal and nerve roots18
Arthrogram with dye injection: To examine the shoulder joint
Arthroscopy (a surgical procedure using a camera): To evaluate soft-tissue damage19
Treatment
Most neck and shoulder injuries are treated conservatively, at least at first. Common treatments include:1920

Rest
Ice and/or heat
Immobilization, such as with a splint or brace
Pain medications
Corticosteroid injections
Physical therapy
If these approaches don't work, some conditions may require surgery. Surgery is more likely if you have:20

Persistent pain that leads to a decrease in function
Neurological symptoms in the arms and legs that are worsening
Problems with walking or balance
Some injuries, including rotator cuff tears, generally don't benefit as much from conservative treatment, so surgery may be an early recommendation.19

Frequently Asked Questions
What can cause sharp pain in your neck and shoulder when breathing?
A couple of conditions can cause pain in the neck and/or shoulder when you take a deep breath, including:

Pleurisy (swelling in the lining around the lungs and chest cavity): Symptoms include sudden chest pain that may be felt only while coughing or breathing deeply, fever, cough, and shortness of breath.21
Pericarditis (inflammation of the sac that surrounds the heart): Symptoms include rapid-onset stabbing chest pain, possibly pain in the shoulder(s), fever, weakness, and trouble breathing. It gets worse if you lie down or breathe deeply.22
Pleurisy and pericarditis aren't usually medical emergencies but you should treat any chest pain or breathing difficulty as an emergency until you know for sure what's causing it.

A Word From Verywell
The neck and shoulder are so connected and integrated with each other that just about any cause of pain in one area can cause pain in the other. If your neck/shoulder pain comes with troubling symptoms such as chest pain, trouble breathing, or weakness in the limbs, be sure to get immediate medical attention.

If your pain is persistent, getting worse, or interferes with sleep or daily activities, talk to your doctor about it. They can help you identify the cause of your pain and find the right treatments for it so you can preserve or regain your function and quality of life.

Images Powered by Shutterstock