Neck and Shoulder Pain

• Where bone, muscle, and nerve converge
  • The bones
  • The connectors: Disks and facet joints
  • Muscles, tendons, and ligaments
  • Shoulder connections: How the neck and shoulders interact
• Describing neck pain
  • Types of pain
  • Non-pain symptoms
• Common causes of pain
  • Muscle strain and other soft-tissue injuries
  • Degenerative conditions
  • Nerve pain
  • Whiplash
  • General pain syndromes
• Evaluating neck pain
  • Your medical history
  • Physical exam
  • Imaging studies and other tests
• Managing your neck pain
  • Physical therapy
  • Exercise
• SPECIAL SECTION: Preventing neck pain
  • Ergonomics: Moving and sitting safely
  • Healthy neck posture
  • Athletics and your neck
• Medication
  • Acetaminophen
  • Nonsteroidal anti-inflammatory drugs
  • Muscle relaxants
  • Opioids
  • Antidepressants and anticonvulsants
  • Corticosteroids
  • Injectable drugs
• The mind-body connection
  • Cognitive behavioral therapy
  • Relaxation therapies
• Alternative and complementary therapies
  • Acupuncture
  • Biofeedback
  • Mindfulness: Body scan
  • Massage
  • Chiropractic medicine
  • Herbal treatments
  • Dietary Supplements for neck pain
• Surgery for neck pain
  • Types of surgery
• Glossary
• Resources

Describing neck pain

Neck pain isn’t all the same. There is no shortage of ways to describe it, in part because people have different perceptions of how they experience pain. The type of pain will also vary based on what is causing it.

How would you describe your neck pain? Are your neck and shoulders stiff? Do they ache? Do you feel a sharp pain or hear a grinding noise when you turn your head? Pain can be mild or severe, achy or sharp, stationary or shooting. It may stand alone or be accompanied by other troublesome complaints. By clearly describing your specific neck symptom—or combination of symptoms, because they often overlap—you can help your doctor determine what’s wrong and how to help.

Types of pain

The following descriptions will help you clearly explain your symptoms to your doctor.

Muscle pain. Aching or sore neck and shoulder muscles may occur in response to overexertion, prolonged physical stress (usually from poor neck positioning during everyday activities), or emotional tension. Muscles may also develop hard knots that are sore to the touch, sometimes called trigger points.

Muscle spasm. This is a sudden, powerful contraction of neck muscles. When you wake up with a painful stiff neck, that’s likely a muscle spasm—what is sometimes called a “crick” in your neck. The muscle usually feels painful, tight, or knotted, and may be impossible to move. Muscle spasm can result from a muscle injury, but it may also occur if there is a deeper problem (say, in a disk or nerve) and the muscle tenses in order to stabilize the neck and prevent you from moving in a way to cause pain or further damage. Neck muscle spasms sometimes accompany emotional stress, but often there is no identifiable reason for muscle spasm.

Headache. Neck-related headache, called cervicogenic headache or cervical headache, is most often felt in the back of the head and upper neck, where muscles extending along the skull are contiguous with neck muscles that may become tense or go into spasm. Neck-related headache pain is typically dull or aching, rather than sharp. It is aggravated by neck movement and often accompanied by stiffness and tenderness of neck muscles.

Facet joint pain. Often described as deep, sharp, or aching, facet joint pain typically worsens if you lean your head toward the affected side, and may radiate to your shoulder or upper back. Arthritis in the facet joints, as in other locations, may feel worse in the morning or after a period of inactivity.
Nerve pain. Irritation or pinching of the roots of the spinal nerves causes pain that may be sharp, fleeting, severe, or accompanied by pins and needles. Depending on the nerve involved, the pain may shoot down the arm or even into the hand.

Referred pain. When you feel pain at a site removed from the area where the problem lies, it is said to be “referred.” A variety of conditions may cause referred neck pain. For example, neck pain that worsens with exertion may indicate a heart problem, while pain when you eat may stem from a problem in the esophagus. You may feel pain in your neck from shoulder damage; conversely, what you feel as pain in your shoulder, head, arms, hands, or chest may actually be referred pain from your neck.

Bone pain. Pain and tenderness in the cervical vertebrae are far less common than neck pain from the soft tissues. Bone pain needs medical evaluation because it can stem from serious conditions such as cancer or infection.