Shoulder Pain: Could it be Coming From Your Neck?

Differentiating Shoulder Pain from Cervical Pathology: A Comprehensive Guide

Shoulder pain is a common complaint that affects people of all ages and backgrounds. It is certainly a common complaint we see here at Boulder Sports Chiropractic with our high population of climbers, crossfitters, desk workers and swimmers to name a few. Whether from acute injury or chronic conditions, it can be debilitating and significantly impact daily activities and recreation. Recent studies show that up to 50% of cases where the primary complaint is shoulder pain, have a component related to the cervical spine (neck). Understanding the difference between shoulder pain and cervical spine issues is crucial for effective diagnosis and treatment. This article delves into the differences between the two, how to identify what you are experiencing, and how BSC can help.

Understanding Shoulder Pain vs. Cervical Pathology

Shoulder pain typically arises from issues within the shoulder joint or its associated structures, such as tendons, ligaments, muscles, and the bursa. Conditions like rotator cuff tears, frozen shoulder (adhesive capsulitis), and shoulder impingement are examples of shoulder-specific problems. On the other hand, cervical pathology refers to disorders of the cervical spine and its associated components, such as the vertebrae, discs, nerves, and muscles.

One of the challenges in diagnosing shoulder pain is recognizing when the source of the pain is not in the shoulder but rather in the cervical spine. This distinction is essential because treatment approaches for shoulder pathologies differ from those for cervical disorders.

Location of Pain 

When distinguishing between pain originating from the neck or from the shoulder, location of pain is not always a good indication of the source of your pain. Painful structures in both the neck and the shoulder have extensive referral patterns for pain, which means that a local structure can create pain across a wide surface area of the body.  The cervical spine, comprising seven vertebrae (C1 to C7), houses nerve roots that can refer pain to a wide span of areas in the upper body. Both neck and shoulder issues can radiate pain into the neck, shoulder blade area, outer shoulder, and even down the arm. 


Above you can see an image that outlines common pain referral patterns that are created by cervical dysfunction. For example, you can see how dysfunction at the C5-6 (purple) or C6-7 (green) level can create a referral pattern that envelops the shoulder. Gathering a thorough history, understanding the specific patterns of pain and kind of pain, as well as doing a detailed examination with specific movements to provoke the neck or shoulder are all tools providers will use to help differentiate whether the source of pain is more from the cervical spine or from the shoulder.

Symptoms That Would Suggest Cervical Spine Involvement

Here are some symptoms that would suggest that the underlying cause of your pain could be related to the cervical spine:

  1. Radiating Pain: One of the hallmark signs of cervical spine involvement is pain that radiates down the arm. If the pain radiates past the elbow, it is almost surely a problem in the cervical spine. 

  2. Neck Stiffness and Limited Range of Motion: Individuals with cervical spine issues often experience stiffness in the neck and a reduced range of motion. This can be accompanied by muscle spasms and a "locked" feeling in the neck.

  3. Numbness and Tingling: Cervical disorders can result in neuropathic symptoms such as tingling, numbness, or a "pins and needles" sensation that may extend down the arm or into the shoulder area.

  4. Weakness in the Arm: Muscle weakness in the arm or shoulder may indicate nerve root compression in the neck. For instance, a C5 nerve root compression can cause weakness in the deltoid muscle which is the muscle responsible for lifting the arm out to the side.

  5. Pain Aggravated by Neck Movements: If shoulder pain worsens with neck movements, such as turning or bending, it is likely that the cervical spine is contributing to or causing the shoulder pain. 

Tests You Can Do to Differentiate Shoulder Pain from Cervical Pathology

  • Maximal compression in the neck: Turn your head to the direction of your pain and then look up over your shoulder as far as you can. Hold at least 10 seconds and see if you notice any reproduction of your shoulder pain

VIDEO: https://www.youtube.com/shorts/pILu1CBhCn4

  • Nerve tension testing: Try these three movements to determine if the sensation feels different side to side, reproduces your familiar pain during the range of motion, or makes your pain worse when you tip your head away from the side of pain at the end of the motion.

VIDEO: https://www.youtube.com/watch?v=nHFrD7CqZB0

  1. Median nerve: with your arms straight out in front of you at shoulder height and your wrists extended back, slowly open the arms 

  2. Radial nerve: with the arms at your side, rotate your arms inward so that your thumbs are pointing backwards, flex your wrists, then lift the arms to the height of your shoulders

  3. Ulnar nerve: with your elbows bent and lifted to shoulder height, rotate the hands so that your fingers are pointed towards the ears 



Diagnostic and Treatment Management Approaches

Differentiating between shoulder pain and cervical pathology is essential for effective diagnosis and treatment. When you visit BSC for neck or shoulder pain, our chiropractors or physical therapist will take an in depth history including questions to understand the onset, nature, and intensity of your pain, as well as any activities or movements that exacerbate or relieve it. We will conduct a comprehensive physical examination, assessing your range of motion, posture, muscle strength, neurologic symptoms, as well as conducting specific orthopedic tests to identify the source of pain. The outcomes of this in-depth examination will help guide an effective treatment plan tailored to your needs.

Regardless of the source of pain, both our chiropractors and physical therapist will create an individualized treatment plan that could include all or some of the following that best fit your presentation: adjustments, trigger point release technique, active release techniques, exercise, dry needling, shockwave, laser therapy, massage, and/or cupping. By recognizing the nuanced differences and applying targeted treatment strategies, our providers will identify the problem to enhance outcomes and get you back to doing the things you love faster and more effectively. 



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Welcome to Boulder Sports Chiropractic, your premier destination for exceptional sports medicine and rehabilitation services in Boulder, CO. Our dedicated team of highly skilled healthcare professionals is committed to providing comprehensive and personalized care to athletes and individuals of all ages and abilities. With a holistic approach to treatment, state-of-the-art facilities, and a multidisciplinary team, we offer a wide range of services, including injury evaluation and treatment, physical therapy, rehabilitation, sports performance enhancement, and preventive care. At Boulder Sports Chiropractic, we are passionate about helping you recover, improve your athletic performance, and maintain optimal physical well-being. Experience the difference of our expert care and start your journey towards peak performance today.

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