This article is a transcribed edited summary of a video Bob and Brad recorded in March of 2024. For the original video go to https://youtu.be/Uz3h4Z53ULY
Mike: Is your shoulder pain really coming from your shoulder or is it referring from your neck?
Brad: Now as physical therapists, I know Bob and I have both had patients come in with a diagnosis from the doctor with shoulder pain and we actually treated them for neck pain and the problem disappeared very quickly.
Mike: So, we're going to show you how to figure out if your pain is actually coming from your shoulder joint or if it's referring from your neck.
Brad: Right, so there are some tests that you can do to actually isolate where the source of pain is coming from, and we're going to get at that in just a few minutes. What do you say, Mike?
Mike: Let's get to it.
Brad: Yeah, you sound enthused.
Mike: I am.
Brad: All right now one of the big reasons that we have problems determining where the pain is from the neck or from the shoulder is the nervous system. Now if we look at the neck, look at a close situation, here we've got the nerves that come out, the peripheral nerves that come out from the neck area. Now these nerves do not stop there like here. They actually come through the shoulder area and then form the brachial plexus, it's a bundle of nerves, through the shoulder down into the arm to the hands and fingers.
Brad: Now if there was a problem in the nerve in the neck, you can have pain there, but it also can refer pain. In other words, pain can- you can feel it. The sensation is in the shoulder, but the source is a pinched nerve in the neck. So that's something that we need to differentiate and find out what needs to be treated. Mike, you want to talk a little bit about the muscles and why the muscles can cause referred pain?
Mike: Yes, most of the muscles referring from the neck to the shoulder blade and the shoulder joint, they're all connected. We have upper trap muscles, we have middle trap muscles and lower trap. We also have the lats, which can affect the scapula, and we have deltoids. Now if these get tight in certain areas, specifically up in the neck region, it can actually radiate the pain to your shoulder region. So all the muscles in this general region are attached. They can be problematic as well.
Brad: That's right. So let's go and see how to differentiate. All right, now as far as referred pain coming from the neck, the location people typically feel this is actually down over the shoulder blade in the upper trap and it radiates in this area.
Brad: Mike, what about if you have pain specifically from the shoulder?
Mike: Now, if you're feeling pain specifically in your shoulder joint, meaning on the lateral aspect of your shoulder right here, it's more than likely that it's actually coming from your shoulder joint itself.
Brad: That's right. As far as characteristics of the pain, how does it actually feel? If it's from the neck and you feel this pain in here, oftentimes the people talk about it as feeling like either pins and needles, maybe some numbness, an achy- dull aching. And sometimes the pain can actually refer and radiate down the arm if it's a really bad pinched nerve. And as far as the shoulder, Mike?
Mike: It can often be a sharp pain, especially with movement. There can be a dull achingness to it as well. But that's more common you're just feeling it on the lateral aspect of your shoulder.
Brad: That's right. Now a key thing, if it's from the neck, this is my way of doing it in the clinic to really isolate it. The pain is in the shoulder, and it's getting a little confusing. I'll have the person sit down. You can do it standing, but seated is best. Have them relax, and then keep their shoulders still and relaxed, and simply have them move their neck forward, backward, side, side, and rotation with no movement in the shoulder at all.
Brad: Now if when that movement occurs in the neck, it actually increases or decreases symptoms where the pain location is, it's a very positive sign that the pain is from the neck, not from the shoulder. Mike, do you want to talk about isolating the shoulder?
Mike: So if your pain is coming from your shoulder, more commonly you will have issues with actually moving your shoulder joint up. So you can do any motion if it's forward, flexing your shoulder, out to the side, reaching back behind you, or putting on a shirt or arm in a coat. Any of these positions, rotating in and out, causing pain, making it worse, it's more than likely an issue in your shoulder joint.
Brad: Right. It can be a little confusing because sometimes pain from the neck still can be irritated with shoulder movement. But if you isolate the two and look at it... One thing about shoulder movement, if you go up like this and it hurts, and then you bring your hand in like here and it doesn't hurt, that's kind of a problem with the shoulder joint.
Brad: That's kind of a professional diagnosis. So this is not always easy. We're giving you some good general guidelines. Now, one other symptom I do want to go through is lying down in bed. If you're lying- say Mike's left shoulder is where the pain is. He's lying on that shoulder. It feels okay at first, but after a while, it starts to ache. Well, that's a good indication it's from the shoulder joint.
Brad: However, it still could be referred from the neck, so we want to make sure that Mike does not have his neck in an unnatural or not neutral position like he has right now. So that can be from either too many pillows where the head is up and kinked up or maybe not enough pillows and his head is down. So to correct that and make sure it's from the shoulder, make sure you've got the right pillows so that the neck is comfortable and in a neutral position.
Brad: Another thing, if you're lying on your back, go ahead, Mike, and you got too many pillows, and his head is actually tilted forward, and that creates shoulder pain, well the shoulder is in a comfortable position. There's no reason why the shoulder should be hurting and the head is up. That's an indication it may be from the neck. Let's say we take the pillow out, get down to a neutral position, and things get better just because we remove the pillow, that's a strong indication it's from the neck. So some more ways to differentiate the problem.
Mike: I feel you're going to whack me in the face with your hand.
Brad: Well, I did consider it.
Mike: Now, there are some instances where you do all these things but you're still not getting better. So you should go seek some professional help. Some big issues are if you're really having tingling or numbness in your hand and you can't control your fingers as well. You really should go see a doctor and get a proper diagnosis.
Brad: Right, and if you feel like that arm is getting weaker and the strength of your grip and whatnot is clearly weaker, get to see a doctor. Make sure you have that diagnosed. Another thing, if you're feeling chills, fever, or unexplained weight loss, get to the doctor, get things checked out, and do it right.
Mike: So give those things a try to tell if your pain is coming from your neck or your shoulder. If you're having neck pain, we do have a video called "Neck and Shoulder Pain Fast Relief, 55 & UP." This video has some exercises in it. If you think it is purely shoulder pain, we have another video called "Only 1 in 5,000 People Know This About Treating Shoulder Pain."
Brad: And that's actually from Rick Olderman's work, isn't it?
Mike: It is. Those are his strategies.
Brad: That's right. Very good. Good luck with the shoulder, and neck, and be healthy, fit, and pain-free.
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