Telling the Difference Between Shoulder and Neck Pain

The neck, or cervical spine, is made up of seven vertebrae and eight nerves that come out on the sides. Inside is a canal that protects your spinal cord. Each joint is made of 3 parts: one disc in the front and two facet joints. The disc and facet joints provide for motion and protect the nerves and spinal cord. Each of the nerves have a slightly different function. Unfortunately, like anything else, degenerative changes can happen in the neck. If a degenerative change such as a disc herniation, bone spur, or facet cyst touches a nerve, it can cause severe pain. Patients typically have radiating pain shooting down the arm.

8 stretches and exercises for a pinched nerve in your shoulder

A pinched nerve in your shoulder can have many uncomfortable side effects. Not only does it cause pain or discomfort in your neck and shoulders, but it can also cause pain that radiates all the way down to your hands.

At the same time, it can cause you to lose strength in your shoulders and arms, and it can even cause you to lose feeling in those areas.

In this article, we’ll share eight stretches and exercises for a pinched nerve in your shoulder. These stretches will help to take the pressure off the nerves where your pain is stemming from. The exercises will help you build strength in your neck and shoulders.

What causes a pinched nerve in the shoulder?

A pinched shoulder nerve, clinically known as cervical radiculopathy, actually starts in the neck. It occurs when one of the nerves in your neck ” not your shoulder ” is compressed.

Sometimes it’s a herniated disc that slips out of place and pinches a nerve in your neck. Other times degenerative disc disease allows one of your intervertebral discs to bulge out and pinch the nerve. In some cases, a traumatic injury may be the source of the problem.

Whatever the case, this can cause a pain that radiates out into the shoulder, often making it seem like you’ve pinched a nerve in your shoulder. Many times, the pain can radiate to other parts of your upper extremities as well.

Postural stretches for a pinched nerve in the shoulder

Here are some stretches that can help to relieve a pinched nerve in your shoulder. Please note that if any of these exercises makes your neck, shoulders or any other body part hurt worse, you should call a doctor or physical therapist immediately.

1. Trap stretches ” Looking straight ahead of you, slowly move your neck downward to the left. Lower your right shoulder as much as you can so you feel your upper trapezius muscles stretching. Hold these stretches for 30 seconds each and repeat three or four times for each side of your body.

1. Chin tucks ” Place your fingers on your chin and slowly push back until you have a double chin. Hold this position for three to five seconds. Repeat five times.

1. Shoulder rolls ” Lift both shoulder blades up toward your neck. Push them backward toward each other as you slowly lower them. Repeat, but push your shoulders forward as you lower them. Repeat five times in each direction.

1. Neck bends ” Slowly lower your chin toward your chest. Hold for 10 seconds, pushing your chin toward your chest so you can feel it stretching. Slowly lift your head. Repeat five to 10 times.

1. Head turns ” Looking straight ahead, slowly turn your head to the right as far as you can. Hold for five to 10 seconds. Repeat on the other side.

Exercises for building strength in your neck and shoulders

Stretches can be helpful for a pinched nerve in your shoulder, but exercises can be helpful as well. These exercises will help you strengthen your neck and shoulders so that your head and spine are better supported.

1. External shoulder rotations ” Hold an exercise band with two hands. Starting with your hands by your side, lift them outward next to your body until they are in a T position. Repeat 10 times, pause, and repeat another 10 times.

1. Standing row exercises ” Hold an exercise band with two hands in front of your chest. Keeping your elbows bent, pull the band outward and backward, pushing your shoulder blades together. Repeat 10 times, pause, and repeat another 10 times.

1. Serratus pushes ” Lying on your back, lift a barbell (or object of your choice) and push it up toward the ceiling. Allow your shoulder blades to lift off the floor. Hold for three seconds before lowering. Repeat 10 times, pause, and repeat another 10 times.

Physical therapy for a pinched nerve in your shoulder

Instead of doing stretches for your pinched shoulder nerve at home, consider scheduling an appointment with a physical therapist. There are many benefits to physical therapy, especially for people with pinched nerve pain.

Here are a few of the treatment methods physical therapists use to treat pinched nerves:

• Manual therapy” Manual therapy is a form of treatment in which the therapist manually manipulates your muscle tissue with their hands to relieve tension. This loosens your muscles, which can relieve nerve pain and other forms of chronic shoulder or neck pain.

• Therapeutic exercises ” Your physical therapist will guide you through exercises and stretches to relieve your pinched nerve pain. They will ensure that you’re doing these exercises correctly so you don’t injure yourself further.

• Movement coaching ” A physical therapist can assess your posture and identify any bad habits that may have led to your pinched nerve. They’ll work with you to correct this problem, which can relieve pain while helping you avoid similar incidents in the future.

Alliance PTP is ready to help you find top-notch PT for pinched nerves

At Alliance Physical Therapy Partners, we’re proudly bringing together physical therapy practices across the country to help people get the high-quality PT they need. Want to see a physical therapist in person? We can put you in touch with an Alliance PTP partner that’s close to you and that can help you address the pinched nerve in your shoulder.

Not keen on in-person PT sessions or not close to an Alliance PTP partner? No worries. We also offer effective and affordable virtual physical therapy through our Agile Virtual Physical Therapy platform.

Contact our team today so we can help you find the most effective physical therapy services for your injury or condition.

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Telling the Difference Between Shoulder and Neck Pain

Diagnosing neck versus shoulder pain can be very confusing and difficult to figure out. Patients may come in and be frustrated because of previous misdiagnoses and ineffective treatments, so finding the right diagnosis and getting you into the right treatment plan is key. The earlier you do that, the sooner you can get back to your life and your activities.

Neck and Shoulder Anatomy

The neck, or cervical spine, is made up of seven vertebrae and eight nerves that come out on the sides. Inside is a canal that protects your spinal cord. Each joint is made of 3 parts: one disc in the front and two facet joints. The disc and facet joints provide for motion and protect the nerves and spinal cord. Each of the nerves have a slightly different function. Unfortunately, like anything else, degenerative changes can happen in the neck. If a degenerative change such as a disc herniation, bone spur, or facet cyst touches a nerve, it can cause severe pain. Patients typically have radiating pain shooting down the arm.

The shoulder is a ball and socket joint, like a golf ball on a tee. It’s an unconstrained joint, so the golf ball can fall off. As a result, your body has created ways to create a high range of motion while keeping stability. (Your hip is also a ball and socket joint but has a low range of motion.) The stability comes from deepening the socket, or the tee in the golf ball analogy, by adding the labrum like a rim around it. Your dynamic stabilizers are your muscles. The rotator cuff is a group of four muscles that go around the ball and suck the ball onto the tee to prevent dislocations or abnormal motion. Over time, especially with above-head activities, aging and degeneration, the tendons can have tendonitis, inflammation, or tearing, which can cause pain in the shoulder.

Classic Findings

Most people who have a pinched nerve have pain starting from the back of the neck and going into the shoulder blade area. Typically, the pain does not go to the front of the neck. Each different nerve radiates pain into a different place in the body. The C3 nerve comes to the top of the ear and the back of the neck. The C4 nerve goes to where you would have a shawl on the sides of your neck and into the shoulder blade. The C5 nerve, which is a common one to have pain in, goes to the outside of the shoulder, and can often cause the neck versus shoulder pain confusion. The C6 nerve comes to the shoulder blade, down to the bicep and to the index finger and the thumb. The C7 nerve, another one commonly pinched, is lower on the shoulder blade, down the triceps with some potential triceps weakness, and it goes to the middle finger. If the pain goes to your ring finger and little finger, it’s either a C8 nerve or a problem with the ulnar nerve from the elbow.

Shoulder pain presents typically with pain more in front of the shoulder. Most of the time pain in the back of the shoulder is from a pinched nerve and pain in the front of the shoulder is from a biceps tendon issue, a problem with your rotator cuff, or adhesive capsulitis (frozen shoulder).

Diagnosing a Patient

The first step in diagnosing a patient is to ask what their symptom history is. When did the symptoms start? Where is the pain or numbness going? How painful is it? What treatments have you tried and how did the symptoms respond?

In general, a person who has shoulder problems doesn’t like doing things above their head. If the patient says that it really hurts when they move their arm above their head—they can’t put the dishes away in the cupboards or can’t do above head activities—that’s usually a shoulder problem.

A person with a pinched nerve, on the other hand, will frequently relax with an arm lifted up so their hand is above their head: they talk, drive, and sleep with their arm raised. It’s called the shoulder abduction sign and patients feel a lot better when they do above head activities.

If someone can’t move their arm, we figure out if they can’t move it because of weakness, because of pain, or because something is blocking their motion. I watch how they hold their arms and how they move when I ask them to move. Watching for symmetry of how they’re moving their arms can give signs of where the problem is coming from.

We ask about sleeping conditions at home. People with pinched nerves like to bring their neck forward to reduce pressure on the nerve, so they add extra pillows or sleep on a recliner. Hyperextension of the neck exasperates it and rotating to the side where the nerve is pinched makes it worse. Patients with rotator cuff issues don’t like to lay on that side, and rotating in bed wakes them up.

We look at the neck range of motion, moving the neck and arm in specific ways and squeezing certain muscles to see if there is pain and where the pain is. Depending on how they react, we may be able to see if they have a pinched nerve, a frozen shoulder, a rotator cuff tear, tendonitis, bursitis, and so on.

If the diagnosis isn’t clear after a physical exam, we look at x-rays. If the x-rays can’t give enough detail, we’ll have an MRI done. MRIs are very inclusive for diagnostic modality, as they show all of the soft tissue, the disc, the bone spurs, the nerves in the spinal cord, and so on, so you have a much better understanding. However, if you get an MRI of the neck of anybody above age 50 or 60, you’ll probably see some degenerative changes. Are the degenerative changes that I’m seeing on the MRI consistent with your exam? Matching up imaging and exam to find a diagnosis is one of the most difficult parts.

If an MRI of the neck doesn’t give enough detail, an ultrasound or MIR of the shoulder may be helpful, or an EMG or nerve conduction test. The EMG isolates which nerves, if any, are angry. Finally, injections are a diagnostic modality as well as a treatment modality. If an injection takes care of your pain, we’ve been able to find out the source of your pain, which may not be where you feel the pain. For example, people may have neck pain from the trapezius muscle working overtime because their rotator cuff muscle doesn’t work very well.

Surgical Treatments

If non-surgical treatments don’t work, surgical treatments are available. Disc replacement and fusion both have their pros and cons, but both are great treatments. If the pain is coming from the shoulder, I work with my shoulder colleagues here to make sure the patient is taken care of. If a patient has a problem with both their neck and their shoulder, we’ll coordinate our treatments.

Neck and shoulder pathology can be very hard to figure out. Oftentimes, if it’s in the front of the shoulder and it hurts with above head activities, that’s more the shoulder. If it’s in the back of the neck and radiates all the way down with numbness and tingling down your hands, it’s typically the neck. And neck pain can come from the shoulder and the shoulder pain can come from the neck. Finding that appropriate cause of it and finding it early so you can get in the proper treatment options is key to making sure that you’re not having prolonged pain.

Frequently asked questions

Does age play a factor in making a diagnosis?

Yes, age is a factor. When someone is 20 years old and they come in with symptoms, it’s more likely to be a soft tissue disc herniation in the neck, while an older person with the same set of symptoms is probably having some arthritis that’s causing the pinching of the nerves. However, both may have problems with their rotator cuff.

Is pain starting in the arm and moving toward the shoulder a pinched nerve?

It can be, depending on where it starts and how it travels. In patients who feel the sensation moving up, we worry more about a peripheral nerve being compressed, like carpal tunnel syndrome from the wrist up or cubital tunnel syndrome from the elbow up. Or we worry about biceps pathology or other muscle and tendons issues. So it does change how we think about it, but certainly a pinched nerve can present as traveling up versus down.

For these issues, what are some of the treatments?

For the neck pathology and pinched nerves that we’re talking about, I would say probably 75 to 85% of people get better with conservative care. Conservative care includes waiting and letting nature settle things down; taking anti-inflammatories such as Advil, Aleve, Motrin or a steroid pack; physical therapy; or cortisone shots. If none of those treatments work, there are surgical options to help.