Referred Shoulder Pain

Pain in the shoulder can be referred or caused by a problem in another area of the body such as the neck or spine.

What is referred shoulder pain?

Referred shoulder pain occurs when pain is experienced in an area away from the actual injury or problem. It is actually quite common in the human body, and you probably already know of several types of referred pain.

Heart attacks can refer pain to the shoulder, arms and neck, throat problems can refer pain to the ear, and eating a very cold food can cause brain freeze resulting in a bad headache due to chilling the vagus nerve. It is not certain why we experience referred pain, however some theories relate it to the way in which the nervous system develops at the foetal stage.

What causes referred pain?

Sections of the spineReferred pain from the cervical spine (and occasionally the thoracic spine) is usually due to compression of a nerve and/or nerve root. This can occur for many reasons, including problems with the vertebral discs, muscle spasms, osteo-arthritic changes, spinal fracture or tumour. For this reason, referred pain is more common amongst older adults except for those cases caused by trauma.

When the nerve is compressed, its ability to transport information to the areas which it serves becomes compromised. Some nerves carry sensory information, which can cause pins and needles, tingling and strange sensations if these are compressed, whereas other nerves carry “motor” information, which causes weakness of muscles and sometimes problems with coordination and movement. Sometimes the compression can affect both types of information.

What are the symptoms?

Nerve route in the spintSymptoms will depend on where the pain is referred from in the thoracic spine but generally include pain which radiates into the arm, neck, chest, or shoulders. Numbness or tingling in fingers or hands may also be present along with muscle weakness and poor coordination, particularly in the hands.

Depending on what level the problem is occurring (meaning at which cervical vertebra), the pain and weakness will be experienced in different areas.

Damage to the nerve root between the C4 and C5 vertebrae (C5 root) will result in

  • Pain at the base of the neck that radiates to the shoulder and upper arm
  • Weakness in the biceps, with some numbness over the shoulder.

Damage to the nerve root at the C5 – C6 level (C6 root) will result in

  • Pain that radiates from the neck to shoulder and scapula, down the outside (lateral) surface of the arm.
  • Weakness in the biceps, with numbness along the thumb and index finger.

Damage to the nerve root at C6 – 7 (C7 root) will result in

  • Pain from the neck and shoulder down the outside (lateral) surface of the arm, to the middle finger.
  • Weakness in the triceps, with decreased sensation along the back of the hand and middle finger.
  • The symptoms may be reduced if you put your hands on the top of your head, which may relieve pressure on the nerve by increasing the space between the cervical vertebrae.

Referral from the Thoracic spine is very uncommon and is usually the result of degenerative disc disease or metabolic conditions such as diabetes mellitus. Due to the fact that these symptoms can often mimic cardiac pains, it is vital to have this investigated urgently, particularly if it is of sudden onset.

What should I do?

It is important to get any referred pain symptoms thoroughly checked out by your doctor or therapist to ensure that there are no serious problems causing this. They can then advise on appropriate treatment if required.

A Chiropractor or Osteopath can perform joint and spinal manipulations to release pressure on nerves which may be causing referred shoulder pain. Sports massage may also be of benefit in loosening back and neck muscles which may be contribution to the problem.

it is also important to look at work and lifestyle related causes for example working at a desk all day with poor posture can be a cause of nerve entrapment and referred shoulder pain.