Neck and Shoulder Pain – A Painful, But Overlooked Combination

By Debra K. Brinker, RN

Neck pain alone can be complicated, due to the multifaceted issues that stem from cervical instability. Shoulder pain can also be complicated, because the joint is so flexible, making it more prone to injuries. The duo can also be interconnected, particularly in this age where so many people sit at computers for hours each day, adding to the complexity and the need to address the link between them. Pain is a signal that there is tissue damage. The pain referral patterns in the body make it easier to understand why we can feel pain in one area, even if it is not the true source of the tissue injury or weakness. Why the shoulder may be treated but may not heal due to the connection to the neck, which may need to be treated as well, or how neck pain and cervical instability can refer to the shoulder and scapula area. (See figure 1.)

The Neck
When the cervical spine is stable, it moves and functions normally. It’s able to remain in proper physiologic alignment and protect the blood vessels, nerves and spinal cord. The neck has 7 cervical vertebrae, with facet joints adjoining them that move and wiggle. They can get too much movement when the capsular ligaments become injured. Injury to the ligaments leads to cervical instability. (See figure 2.) At this point, support becomes inadequate when loads or demands are placed upon it. A cycle of imbalance is created, generating changes in the vertebral alignment and adjacent joint structures. Cervical instability involves increased motion between adjacent vertebrae and the adjacent joint structures, including the shoulder joint, which causes excessive stress on the supporting ligamentous structures and the nerve endings within those structures eliciting pain and a variety of symptoms.

The Shoulder
The shoulder is one of the most flexible joints in the body, a ball and socket joint, with a huge range of motion. That mobility and flexibility usually benefit us as we engage in the activities and sports we revel in. At times, wear and tear from repetitive movements or previous injuries can cause the supporting ring of ligaments in the shoulder to become too loose, allowing for excessive movement in the shoulder, causing pain and susceptibility to further injury. (See figure 3.) The muscles that move the shoulder, the rotator cuff muscles, are then called upon to try and keep the shoulder stable. The muscles will spasm from overuse, eventually fatiguing the rotator cuff and possibly leading to rotator cuff tears or injury to other joint structures.

The neck and shoulder are interconnected via joint structures and attachments, and injury to one of these areas can affect the other. The anatomy of the cervical spine and shoulder involves muscles and soft tissue that overlap, requiring a skilled clinician to examine the body in order to discern where the pain is coming from. It is important to obtain a thorough history, physically examine the patient, and carry out a functional exam. However, in today’s average medical practice this is often a missed step because of the over reliance on MRI. If an MRI is ordered, only one area is imaged (rather than both), and the root problem may be missed.  More importantly, MRI of these areas are also notoriously misleading, often showing abnormalities in people with zero symptoms, as well as discrepancies in findings in patients with chronic pain symptoms.

In most cases of neck and shoulder pain, the underlying problem lies with the tendons and ligament laxity. The ligaments become unstable at some point, which causes the tendons to wear out. For example, a patient may be seen because their MRI shows they have shoulder spurs. Upon examination the spurs are often not causing problems, but rather the supra and infraspinatus tendons, which have become weakened by taking up the slack caused by injured ligaments.

The neck and shoulder ligamentous degeneration may be from old injuries in the shoulder or neck structures, which occurred earlier in life, such as sports injuries or motor vehicle accidents. Or degeneration that occurred slowly, such as that caused by prolonged sitting, poor posture, or forward head positioning from repetitive mobile device usage. These injuries progress to chronic pain conditions, which may be helped temporarily by chiropractic care and physical therapy, but often remain unresolved, because these modalities are unable to heal the underlying ligament degeneration. For these chronic neck and shoulder pain cases, regenerative injection therapy (known as Prolotherapy) is a preferred option to bring healing cells directly to the ligament and tendons.  By giving the body the boost needed to heal itself, it is often the missing piece of the puzzle that helps people realize permanent pain relief and more stable, strong, and pain-free shoulder and neck movement.

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