Neck and shoulder pain

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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

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

Postural errors

Injury such as whiplash

Prolapsed of disc

Cervical spondylosis

  • Inflammatory causes

Infections of neck

Spondylitis

Juvenile idiopathic arthritis

Rheumatoid arthritis

Polymyalgia rheumatica

  • Metabolic causes

Osteoporosis

Osteomalacia

Paget’s disease

  • Neoplasia and Metastases

Myeloma

Lymphoma

Intrathecal tumours

  • Others causes

Fibromyalgia

Torticollis

  • 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

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.

Frozen shoulder

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.

Neck and shoulder pain

painful arc

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.

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