Overview of neck and shoulder pain
Neck pain is one of the symptoms of cervical spine problem or problem of neck musculature, ligament, vessels, nerves or any systemic problem or any cause in other place that is referred to neck. While neck pain and shoulder pain is a separate entity. Shoulder pain occurs mostly due to injury to the joint associated bursa and tendons. Shoulder pain may also occur in a condition called frozen shoulder. Sometimes neck and shoulder pain both can occur simultaneously. This association may occur in some systemic diseases. Also occurs when neck pain caused by a cause and shoulder pain caused by another cause. But neck and shoulder pain does not show us any disease to suspect other than isolated causes.
Neck pain, a common symptom, usually occurs following injury (e.g. whiplash injury). After falling asleep in an awkward position is another cause of neck pain. Neck pain may result from stress, or in association with osteoarthritis of the spine.
Causes of neck pain:
- Mechanical cause
Injury such as whiplash
Prolapsed of disc
- Inflammatory causes
Infections of neck
Juvenile idiopathic arthritis
- Metabolic causes
- Neoplasia and Metastases
- Others causes
- Referred pains
Referred pain from Pharynx
Referred pain from cervical lymph nodes
Referred pain from Teeth
Referred pain from coronary heart disease
Referred pain from Aortic aneurysm
Referred pain from Pancoast tumour
Referred pain from Diaphragm lesions
Management of neck pain:
Most of the cases of neck pain resolve spontaneously. Where other cases of neck pain resolves with a short course of NSAID or analgesics. Sometimes a soft collar with medications gives a good result. Patients with persistent pain that follows a nerve root distribution requires investigations like X ray MRI etc. Others with neurological signs, with signs of metastatic disease or signs of referred pain should be investigated thoroughly, and if necessary referred for a neurosurgical opinion. Treatment of neck pain of such kind is directed on the diagnosis made.
Shoulder pain is common over the age of 40 in both genders. Shoulder pain is frequently due to degenerative disease of tendons in the rotator cuff in the shoulder.
Causes of shoulder pain:
As a cause of shoulder pain common lesions are:
- Rotator cuff lesion
- Subacromial bursitis
- Bicipital (long head) tendinitis
Shoulder pain due to rotator cuff lesion causes following symptoms:
Pain reproduced when these active movements done in spite of resistance:
Abduction: due to involvement of supraspinatus tendon
External rotation: due to involvement of infraspinatus and teres minor tendons
Internal rotation: due to involvement of subscapularis tendon
Shoulder pain due to Subacromial bursitis causes:
pain on full abduction but no pain on resisted active abduction.
Shoulder pain due to Bicipital (long head) tendinitis causes:
Tenderness occurs over the bicipital groove.
Pain reproduced by resisted active wrist supination or elbow flexion.
Management of shoulder pain:
Management is usually approached with analgesics, NSAIDs, local corticosteroid injections. Physiotherapy with this treatment helps to restore normal movement and function of shoulder. Surgery to repair tendons may be required in patients who have debilitating symptoms and tear of rotator cuff.
Adhesive capsulitis also known as frozen shoulder presents with upper arm pain that can progress over 4–10 weeks before subsiding over a similar time course. Restriction of external rotation movement is characteristic. At first there is marked anterior capsular tenderness and stress pain in a capsular pattern. Then in later stage there is painless restriction. Sometimes all movements are restricted. Frozen shoulder commonly occurs in diabetes mellitus, heart or thyroid disease. Sometimes it is idiopathic and affecting females in their fifties. Shoulder pain may also be triggered by a rotator cuff tear, local trauma, or stroke.
Management of frozen shoulder
Treatment in the early stage is with analgesia, NSAIDs, intra and extra capsular steroid injection. Regular ‘pendulum’ exercises of the arm to prevent the capsule to from over tightening. Exercises like mobilizing and strengthening exercises are the sole treatment in the painless ‘frozen’ stage. Frozen shoulder shows slow but complete recovery. Recovery sometimes takes up to 2 years after onset of disease.