Maybe you have a tight spot in your upper back, a twinge where your neck meets your shoulder or a pain you feel when you move your arm. If you’ve ever felt pain in your upper back, shoulder or arm, you may have wondered whether the pain was coming from your shoulder or your neck.
The truth is it can be hard to tell. Nerves and muscles connect these areas and pain in one area can sometimes show up in the other.
Understanding where your pain is coming from can help you get the right treatment as quickly as possible. Kade McQuivey, MD, an orthopedic surgeon with Banner Health, explained more about how to tell whether it’s neck pain or shoulder pain and when it’s time to see a specialist.
Common signs of neck-related pain
Pain that starts in the neck and travels downward often points to a nerve issue in the cervical spine, which is the part of your spine located in your neck. It may also travel up and cause headaches.
You may be dealing with neck-related pain if you notice:
- Neck pain that radiates into your shoulder blade, upper arm or hand
- Tingling, numbness or weakness in the arm or fingers, sometimes with an electric or zinging quality
- Stiffness or limited movement when turning your head
- Symptoms that get worse when looking up, down or to the side or when you tilt your ear toward your shoulder
Conditions like a pinched nerve, herniated disc, degenerative disc disease or bone spurs in the cervical spine often cause neck pain.
Common signs of shoulder-related pain
If your pain stays in the shoulder or upper arm area and doesn’t move down your arm, the shoulder joint itself may be the problem.
Signs of shoulder-related pain include:
- Pain that gets worse when you lift your arm, reach overhead or move it behind your back
- Discomfort when lying on the affected shoulder
- Pain that is worse at night
- Limited movement in the shoulder but not in your neck
- No numbness or tingling in the fingers
Common causes of shoulder pain include rotator cuff injuries, bursitis, frozen shoulder, impingement and shoulder arthritis.
How a doctor can tell the difference
Since shoulder and neck pain can feel similar, a medical provider will do a full neck and shoulder evaluation to find the source. “They will use a mix of patient history, physical exam and imaging findings,” Dr. McQuivey said.
This may include:
- History: Your provider will ask you to describe your symptoms, when they started, what makes them better or worse and other questions that can help them diagnose the cause.
- Physical exam: A neck and shoulder evaluation and tests will evaluate your strength, range of motion, nerve function and pain triggers.
- Imaging tests: X-rays or an MRI to check for disc problems or joint damage.
- Nerve studies: Electromyography (EMG) or nerve conduction studies may be needed if you have tingling or weakness.
- Diagnostic injections: “If pain is relieved after an injection in the neck, we can attribute pain to the neck. If pain is relieved after an injection in the shoulder, we can attribute pain to the shoulder,” Dr. McQuivey said.
“It’s also possible to have pain in both the neck and the shoulder,” Dr. McQuivey said.
With a clear diagnosis, your provider can recommend the most effective treatment.
Treatment options for neck pain
If your pain is coming from the neck or cervical spine, treatment may include:
- Physical therapy to relieve pressure on nerves and improve posture and neck mobility
- Anti-inflammatory medications or muscle relaxers
- Steroid injections to reduce inflammation and pain
- In more severe cases, surgery to remove or replace damaged discs or relieve nerve compression
Early treatment often leads to better results, especially if you have nerve symptoms.
Treatment options for shoulder pain
For shoulder pain treatment, your provider may recommend:
- Rest, ice and gentle stretching
- Over-the-counter (OTC) medications
- Physical therapy to strengthen and stabilize the shoulder muscles and improve flexibility and shoulder mechanics
- Cortisone injections to reduce inflammation
- Shoulder surgery, such as a rotator cuff repair, if these other treatments don’t help
Most shoulder conditions respond well to care and don’t need surgery if they’re caught early.
When to see a doctor
“If pain limits your quality of life, disrupts your sleep or alters your activity, you should see a care provider,” Dr. McQuivey said.
Make an appointment if you:
- Have pain that lasts more than a week or keeps coming back
- Feel signs of nerve pain like numbness, tingling or weakness in your arm or hand
- Can’t sleep, drive or do daily activities, sports or hobbies because of pain
- Aren’t sure whether the pain is coming from your neck or shoulder
A specialist can help you find answers and start a treatment plan that works for your lifestyle.
How Banner Health can help
At Banner Health, our orthopedic and spine experts work together to get to the root of your neck or shoulder pain. Whether you need physical therapy, a nerve evaluation or advanced surgical care, we’re here to help you feel better and move better.
Schedule a visit with a Banner Health specialist to get the answers and relief you need.
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