You may recall reading an OAW blog explaining the complexities of differentiating between low back and hip pain. A similar dilemma exists in the shoulder and neck area. Often times our shoulder specialists see patients who believe the pain is coming from the shoulder joint or surrounding area when in reality it is stemming from the cervical spine or neck. On the other hand, sometimes our spine specialists start treating a patient for a cervical spine (neck) pathology and find that a shoulder component is present as well. If you feel like you’ve been shuffled back and forth between doctors, please bear with us. We are trying to get you the best possible care from the most appropriate physician for every pathology found to be present.
True shoulder pain is often described as being painful with motion of the shoulder joint, specifically overhead motions. It is often worsened with lifting as well. Our side-sleeping patients often report significant discomfort at night. Shoulder discomfort is usually alleviated by holding the arm in a neutral position such as in a sling, and the pain usually comes and goes depending on daily activity. Any weakness of the rotator cuff muscles specifically supporting the shoulder is likely to be treated as a shoulder problem initially. If a patient can recreate the pain by reaching the arm up overhead or reaching behind to scratch his/her back while keeping the neck straight, it is likely a shoulder-specific pathology.
Typically, numbness, tingling, and burning (especially from the elbow to the fingertips) are most often associated with cervical pathology due to the common presence of stenosis (narrowing of the spinal column) and disc pathologies. Reflex testing can help your physician determine if and where a nerve issue exists. In some cases generalized weakness in the upper extremity can be a problem with the nerves that innervate those regions which stem from the cervical spine. Neck pain is often unrelenting and constantly achy rather than affected by activity. If movement of the neck elicits the discomfort, it is likely that a true neck problem exists. Functionality, or lack thereof, in either the neck or shoulder is often indicative of where the problem may be occurring. The problem is that it is not uncommon for a pathology in one area to affect functionality in another area. Compensatory pain can make the diagnostic process that much more challenging.
In trying to differentiate between shoulder problems and neck problems, our board-certified physicians will take x-rays of the affected area and perform special tests during their examination to help determine the cause of your symptoms. These tests are meant to invoke the discomfort that brought you to our office. If your physician can recreate your pain with a special test of the shoulder, then treatment typically begins with the shoulder. Alternatively, if your physician starts performing special tests on your neck and replicates your pain, he is probably going to recommend pursuing treatment of the cervical spine. MRIs and EMGs can be helpful in determining where pathology is present. Physicians also use cortisone injections as both diagnostic tools and forms of treatment. If a patient’s symptoms resolve after a cortisone injection administered in the subacromial space of the shoulder, the problem is likely the shoulder. If discomfort persists, the problem may very well be in the cervical spine.
Unfortunately, sometimes patients have pathologies in both the neck and shoulder that are contributing to their general discomfort and lack of function. We have you covered! Our spine and shoulder specialists work closely with one another (and often our physical and occupational therapists) to help piece you back together. It can be hard to tell the difference between shoulder issues and neck issues. If you come see us at OAW, we will help you get to the bottom of your discomfort.
This blog is written by one of our very own-Morgan. She is a certified athletic trainer working as a medical assistant with our providers each and every day in our clinic. She obtained a bachelor's degree in athletic training from Carroll University in Waukesha and a master's degree in Kinesiology from Michigan State University. She is excited to bring you updates and information about the happenings at OAW.