Interventional Pain Management Specialist Dr. Kaliq Chang discusses spinal triggers and treatments of shoulder woes

Shoulder PainPain Management

When our shoulder hurts, we naturally assume we have a problem in, well, the shoulder. But in reality, shoulder pain often indicates a spine problem, according to Kaliq Chang, MD, of Atlantic Spine Center.

Shoulder pain and injuries certainly aren’t rare, accounting for nearly 20% of visits to doctor’s offices, according to the Cleveland Clinic. But our bodies don’t always report pain in dependable ways, explains Dr. Chang, an interventional pain management specialist.

With 8 nerve roots stemming from each side of the cervical spine in the neck, 5 of these roots pass through part of the shoulder on each side. If any of these nerve roots become pinched or irritated, pain and other resulting symptoms can land in the shoulder area. This is known as “referred pain,” which is felt somewhere other than where it originates, Dr. Chang says.

“Sometimes, pain in our shoulder is really due to an undiagnosed or unrecognized condition in the cervical spine,” Dr. Chang says. “That’s because the neck and shoulder are highly connected by many nerve pathways. While it can seem puzzling, it actually makes perfect sense that shoulder pain can be caused by spine problems.”

Symptoms and causes of shoulder pain from the spine

According to Dr. Chang, when a nerve root in the neck gets pinched (a scenario known medically as cervical radiculopathy) shoulder pain and other symptoms can feel:

  • Sharp and severe
  • Dull or mild
  • In one place, such as the shoulder blade, or radiating from shoulder to arm
  • Tingling and numbness
  • Occasional or constant weakness
  • Pain, numbness or tingling past the elbow

Of course, nerves in the cervical spine don’t get pinched all by themselves. Several spine problems in the neck area can trigger these shoulder symptoms, Dr. Chang says. These conditions include:

Degenerative disc disease, disc hydration lose usually due to aging

Herniated disc, which happens when the disc’s outer layer tears and lets inner gel leak out

Osteoarthritis, the “wear and tear” or thinning that can happen at almost any joint location

Foraminal stenosis, which occurs when a nerve root becomes compressed while passing through a small hole called a foramen in the bony vertebrae

“Other, less-likely conditions such as a spinal tumor can also potentially cause pinched nerves in the neck that trigger shoulder pain,” Dr. Chang says. “But the vast majority of the time, shoulder pain originating in the neck has a straightforward cause that isn’t dangerous and can be readily addressed.”

Extensive treatment options

Like most pain originating in the spine, shoulder pain from spine problems tends to ease on its own within several weeks, Dr. Chang says. But if pain persists, or your range of motion is seriously affected, it’s best to see a doctor. “Occasionally, permanent nerve damage can occur if the problem isn’t monitored or treated,” he says.

To diagnose a spine condition causing shoulder pain, tests such as x-rays, CT or MRI scans may be used to visualize the body’s hard and soft tissues. A nerve conduction test known as electromyography, or EMG, can also tell your doctor if your symptoms are caused by pressure on spinal nerve roots.

In the meantime, a variety of non-surgical treatments may help. These include:

  • Soft cervical collar, which can help reduce nerve root pinching
  • Physical therapy, which can teach exercises to strengthen neck muscles, reduce pain and improve range of motion
  • Medications such as NSAIDs (nonsteroidal anti-inflammatory drugs) or prescription oral corticosteroids, which can cut swelling and inflammation around spine nerves
  • Steroid injections near the affected nerve

“If conservative treatments don’t help, surgery may be recommended as a last resort to relieve symptoms,” Dr. Chang explains. “A variety of procedures can tackle the cervical radiculopathy that underlies shoulder pain, and a thorough work-up will almost always reveal an ideal solution.”

For additional information on pinched nerves and a short video, visit our dedicated webpage on Pinched Nerves.