Neck Pain or Shoulder Pain, Why it Hurts and How to Deal with It

Nabil Ebraheim M.D., Matthew Grothaus M.D., Seth Phillips D.O.

Can Scapular Pain or shoulder pain come from the Neck?

Cervical spine and shoulder problems overlap. In case of cervical disc herniation, the patient will come to the doctor with unilateral arm pain that is relieved by arm elevation. The numbness and paresthesia will occur in a specific dermatome. The patient may also have upper trapezius pain or intrascapular pain. The diagram below shows the area of referred pain to the back of the neck and the upper shoulder area (area of intrascapular pain). The muscles and nerves that arise from the neck area will pass through and around the shoulder on their way down the arm and the pain may radiate down to the shoulder or the scapula. The pain is usually at the superior aspect of the scapula.

Below is an example of the most common area of referred pain from neck pathology and disc herniation. The pain originating from the neck region may overlap the shoulder. Usually the pain in the neck is felt on top of the shoulder over the area of the trapezius muscle. Pain from the shoulder itself is usually felt at the top of the arm. If the shoulder moves freely without pain, then the neck is the source of the pain.

The shoulder abduction test is different from the Spurling’s test. The patient’s symptoms are relieved by shoulder abduction by placing the hand over the head. This test helps to differentiate between cervical spine pathology and other causes of shoulder pain. This is an important test for cervical radicular compressive diseases. Relief of symptoms occurs due to decreased tension on the nerve roots. If there is relief of symptoms by shoulder abduction, then the cause of shoulder pain is not a shoulder pathology but it is pain that is coming from the cervical nerve root pathology due to nerve irritation.

Thank you to Nathan Elkins, The University of Toledo, OH for his contributions.