What Causes Concurrent Neck and Shoulder Pain, and How Do I Treat It?

Simultaneous pain in the neck and shoulder is common, and is usually the result of a strain or sprain.

Pain can range from mild to very severe and can include:

• tingling
• shooting pain
• stiffness
• numbness
• spasms
• soreness

In some cases, neck and shoulder pain can be a sign of a heart attack or a stroke. These are serious medical emergencies that require immediate help.

Rarely, it can be caused by gallstones and certain cancers.

Most neck and shoulder pain is due to sprains and strains from sports, overexertion, or incorrect posture.

Soft tissue injuries

Neck and shoulder pain is often due to an injury of the soft tissue. Soft tissue includes your muscles, tendons, and ligaments. The term is used to distinguish it from the hard tissue of bones and cartilage.

Soft tissue injuries can cause many kinds of pain, including:

• stiffness
• headache
• muscle spasms

Rotator cuff tear

The rotator cuff is a group of four tendons that hold your upper arm (humerus) into your shoulder blade.

A rotator cuff tear can be caused by a singular injury (such as a fall) or by repeated stress over time, which can be common in sports that require a lot of arm and shoulder use.

Aging can also contribute to rotator cuff tears. Reduced blood supply can slow down the body’s natural ability to repair damage. And bone spurs can form at the joint, damaging the rotator cuff tendons.

A sudden tear will usually cause intense pain in your shoulder and immediate weakness in your upper arm.

Tears due to repetitive use may cause shoulder pain and arm weakness over time. Activities that require reaching up or behind, such as combing your hair, may become painful.

Whiplash

Whiplash is the tearing of muscles, tendons, and ligaments in your neck from a sudden movement of your neck. It typically occurs in an auto collision.

Other common causes include:

• contact sports
• being shaken
• falls
• a blow to the head

Symptoms can take 24 hours or longer to appear and include:

• neck pain and stiffness
• headaches
• dizziness
• blurred vision
• constant tiredness

Most people recover fully within three months but some can have chronic pain and headaches for years afterward.

Cervical spondylosis (cervical osteoarthritis)

Cervical spondylosis is the name given to age-related wear of the spinal discs of your neck. It’s a very common condition, affecting more than 85 percent of people over age 60.

Your spine is made up of bony segments known as vertebrae. In between each vertebra is soft material known as discs.

As you age, your discs lose water content and become stiffer. Your vertebrae move closer together. This can irritate the lining of the joints in a condition known as cervical osteoarthritis.

As part of the arthritis, you can also develop bone spurs.

Symptoms of cervical osteoarthritis typically include neck pain and stiffness. In more severe cases it can lead to a pinched nerve.

Pinched nerve (cervical radiculopathy)

A pinched nerve in your neck can cause pain that radiates toward your shoulder. This is also known as cervical radiculopathy.

Cervical radiculopathy most often comes from changes in your spine due to aging or injury.

Bone spurs can cause a pinching of the nerves that run through the hollow space in the vertebrae. If this happens in your neck, it can cause a pinched nerve.

Symptoms include:

• tingling or numbness in your fingers or hand
• weakness in the muscles of your arm, shoulder, or hand

Herniated disc

When cervical discs shrink, vertebrae come closer together and can sometimes lead to one or more of the discs getting damaged.

If the soft inner portion of a disc protrudes through its harder exterior, it’s called a slipped, herniated, or prolapsed disc.

Symptoms of a slipped or herniated disc include:

• pain
• numbness
• tingling
• aching
• a burning sensation in your neck

Posture and sleeping position

Holding your neck in an awkward position for a prolonged time can lead to strains in the muscles and tendons of your neck and shoulders.

Some of the postures and activities that commonly contribute to neck and shoulder pain are:

• sleeping on too high a pillow or a stack of pillows
• grinding or clenching your teeth at night
• sitting at a computer or over a phone with your neck strained forward or tilted up
• suddenly jerking your neck during exercise

Heart attack

While sudden pain in the chest or arms may be a sign of a heart attack, pain and numbness in the neck, back, or jaw are also symptoms.

Medical emergency

Call 911 or go to the nearest emergency room if you feel sudden pain in the neck, back, or jaw that comes on without trauma.

Stable angina

Pain in the shoulders, neck, back, or jaw can also be a symptom of stable angina. It occurs when the heart isn’t getting enough oxygen due to a narrowing of the coronary arteries.

There’s usually pain in the center of the chest, which can spread to the left arm, shoulders, neck, back, and jaw.

It should be diagnosed and treated promptly.

Stroke or cervical artery dissection

Neck pain can be a symptom of a serious type of stroke called cervical artery dissection. This condition is rare but it’s one of the most common causes of stroke in people under 50.

Symptoms of a stroke include:

• drooping of the face
• arm numbness of weakness
• difficulty speaking or slurred speech
• vision trouble
• difficulty walking

Medical emergency

If you believe you or someone else may be having a stroke, call 911 or go to the nearest emergency room.

Broken collarbone (clavicle)

The collarbone (clavicle) is the slightly curved bone at the top of your chest that runs from your shoulder blades to your rib cage.

Clavicle fractures often happen when you fall on your outstretched arm.

Signs of a broken clavicle include:

• intense pain
• an inability to lift your arm
• a sagging shoulder
• bruising, swelling, and tenderness

Broken shoulder blade (scapula)

The shoulder blade (scapula) is the large, triangular bone that connects your upper arm to the collarbone.

Scapula fractures can happen in high-impact injuries such as motorcycle or motor vehicle collisions.

Symptoms include intense pain when you move your arm and swelling at the back of your shoulder.

Frozen shoulder (adhesive capsulitis)

Frozen shoulder is a condition where it becomes increasingly difficult and painful to move your shoulder. People between 40 and 60 years old and people with diabetes are at greatest risk.

The cause is not known.

The main symptom of frozen shoulder is a dull or aching pain usually located over the outer shoulder and sometimes the upper arm.

Shoulder tendinitis or bursitis

Tendons are strong fibers that attach muscles to your bone. Bursa are fluid-filled sacs that prevent friction at joints.

Inflammation of the tendons (tendinitis) and the bursa (bursitis) are common causes of shoulder pain, but pain can occur anywhere that inflammation occurs.

The tendons and bursa around your rotator cuff are especially prone to inflammation that causes pain and stiffness around your shoulder.

Shoulder separation

Shoulder separation is an injury to the joint where the collarbone meets the highest point (acromion) of your shoulder blade. The joint is called the acromioclavicular (AC) joint.

Injury to the AC joint commonly happens when you fall directly on your shoulder. Severity can range from a minor sprain to a complete separation that shows a large bump or bulge above the shoulder.

Pain can occur in the surrounding areas.

Shoulder and neck referred pain

Because of the close connection of the nerves serving them, shoulder and neck pain are often mistaken for one another.

You may feel a pain in the shoulder that’s actually coming from your neck, and vice versa. This is called referred pain.

Some of the symptoms of referred pain from your neck include:

• stabbing, burning, or electric-like tingling pain
• pain that radiates to your shoulder blade, elbow, and hand
• pain that radiates down your arm when you twist your neck
• pain that’s relieved when you support your neck

Gallstones or enlarged gallbladder

Pain in your right shoulder can be a sign of a gallstone blocking a duct in your gallbladder. You may also feel pain in your back between your shoulder blades. The pain may be sudden and sharp.

You may or may not feel the more common symptoms of gallstones or gallbladder inflammation. These are:

• sudden pain in your upper right abdomen
• pain in the center of your abdomen, below your breast bone
• nausea or vomiting

Cancer

In some cases persistent neck pain can be a symptom of head or neck cancer.

The most common causes of head and neck cancer are excessive use of alcohol and tobacco. These account for around 75 percent of cases.

Referred pain in the shoulder can also be a symptom of lung cancer.

Pain often occurs on one side of the neck. This is usually due to strains or sprains that have occurred on that side, or due to a bad sleeping position.

Right-handed people may be more likely strain their right neck or shoulder.

Pain specifically in the right shoulder can be a sign of gallstones or an inflamed gallbladder.

Muscle tension in the neck is a very common cause of tension headaches.

This is a type of referred pain known as cervicogenic headache.

Cervicogenic headaches may feel similar to migraine. Symptoms include:

• pain on one side of your head or face
• stiff neck and headache after certain neck movements
• pain around your eyes

If your neck and shoulder pain is mild, you can help relieve the pain with home remedies. For more severe symptoms, see a doctor.

Try some of the following tips and prevention methods at home:

• Take a break from sports or other activities that may aggravate the area.
• Use an ice pack on the area for the first three days after your pain starts. Wrap the ice pack in a towel and use it for up to 20 minutes, 5 times a day. This will help reduce swelling.
• Apply heat using a heating pad or warm compress.
• Take OTC pain relievers.
• Wear a pain-relieving shoulder wrap to reduce swelling and pain. Check them out online.
• Gently massage the neck and shoulder area.
• Use an OTC pain-relieving topical cream. Get some here.

Try these stretches and exercises to relieve neck and shoulder pain. These are gentle movements and stretches for stiffness.

If your pain is more severe, or increases with the exercises, stop them and see a doctor.

A doctor may also refer you to a physical therapist who can work on your soft tissue and muscles to ease the pain. The therapist can give you a home exercise routine tailored to your needs. This will help strengthen your neck and shoulders to prevent a future injury.

Neck stretches

Perform the following stretches as three or four circuits at a time:

1. Sit in a relaxed position.
2. Tilt your head forward touching your chin to your chest, and hold that position for 5 to 10 seconds.
3. Slowly tilt your head straight back, looking up at the ceiling. Hold it for 5 to 10 seconds.
4. Tilt your head to the right side, as though you’re aiming your ear to your shoulder. Keep your shoulder relaxed and hold the position for 5 to 10 seconds.
5. Repeat the motion on the left side.
6. Rotate your head gently to the right, as though you’re looking over your shoulder. Hold your head there for 5 to 10 seconds.
7. Repeat the motion on the opposite side.

Levator scapula stretch

The levator scapula muscle is located at the side and back of your neck, on each side. It lifts up the scapula bone that connects your upper arm and collarbone.

To stretch:

1. Stand with your side facing a wall and bend your arm up at the elbow, forming a right angle.
2. Turn your head to the opposite side and bend your head until you feel a gentle stretch in your neck and back. Hold for 5 to 10 seconds.
3. Repeat with the other side.

Shoulder stretch

1. Stand in a doorway, with both arms bent at the elbow at a right angle and your hands on the door frame.
2. Lean forward until you feel a gentle stretch under your collarbone.
3. Hold for 5 to 10 seconds.

Treatment of neck and shoulder pain depends on the underlying cause.

Heart attack, stroke, and other serious conditions often include emergency treatment. For most other situations, home remedies, physical therapy, and massage will bring improvement.

Some of the more serious situations that may require surgical treatment include:

Fractures

Arm slings to keep your arm and shoulder in position while the injury heals are the first line of treatment in the case of fractures of the shoulder blade or collarbone.

If surgery is required, the basic procedure is to put the broken ends of the bone back together and fix them in place to prevent them from moving as they heal.

This can involve insertion of plates and screws under anesthesia.

Rotator cuff tear

Nonsurgical treatments are effective for about 80 percent of people with rotator cuff tears.

If you have significant weakness in your shoulder and your symptoms have lasted 6 to 12 months, your doctor may suggest surgery.

Surgery for a torn rotator cuff usually involves reattaching the torn tendons to your upper arm bone.

See a doctor if:

• your range of motion is limited
• you’re in significant pain
• you believe you’re having a medical emergency

You could have a muscle or tendon tear, or something more serious that needs immediate treatment.

You should also see a doctor if the pain persists, worsens, or returns after getting better.

A doctor will physically examine you and take a medical history. They’ll want to know when your pain started and what symptoms you have.

The examination may include an arm squeeze test to determine the origin of the pain.

They can also test your range of motion, by asking you to move your arms, shoulders, and neck. The doctor may then order additional tests to diagnose the issue.

Other tests may include:

• blood tests
• X-rays
• CT and MRI scans
• electromyography (EMG), which uses electrodes to measure the electrical activity of your muscle tissue

The doctor may also order a spinal tap (lumbar puncture), if they suspect an infection.

You can help prevent neck and shoulder pain by sitting and walking with correct posture, and changing your daily movements to avoid stress on your neck or shoulders.

Practice good posture

To check for good posture:

• Stand with your back against the wall. Align your shoulders, hips, and heels against the wall.
• Move your palms against the wall as high as you can and then down.
• Repeat 10 times, and then walk forward.

This should help you stand and sit straight.

Stretch and exercise

Create a stretching routine that relaxes your neck, shoulders, and back. Use the exercises mentioned above or ask your doctor. They may have printouts to share with you.

It’s important to have good form when you exercise, so that you don’t pull or strain a muscle, tendon, or ligament.

Move around

If you sit all day, be sure to get up every 30 minutes and walk around.

Workplace changes

Repetitive activities can put stress on your neck and shoulders. Sometimes these activities aren’t avoidable, so seek help to minimize the stress.

Follow workplace ergonomic tips to break out of bad habits:

• If you’re on the phone a lot, get a headset. Don’t use your neck and shoulders to support the phone.
• Sit in a chair that supports you properly.
• Take frequent breaks.

Neck and shoulder pain is usually the result of strains and sprains from overexertion or bad posture.

Sometimes this pain will go away on its own. Stretching and strengthening exercises can also treat the pain.

Sometimes neck and shoulder pain is due to a fracture in the bones of your shoulder. The severity of the pain will usually alert you that you need to seek medical help.

In very rare cases, it can be referred pain from causes such as gallstones or cancer.

Two emergency conditions — heart attack and stroke — can also cause sudden neck and shoulder pain. These need to be treated immediately.