Neck Pain – Main Line Spine

Pain felt in your shoulder area can sometimes be coming from your neck. Conversely, neck pain can actually be hiding a shoulder problem.

Why? Because the neck and shoulder muscles share the same densely packed nerve pathways. And when an injury occurs, your nerves don’t always tell your brain the correct location where your problem is located. When you feel pain in one part of your body that is actually caused by pain or injury in another part, it is known as “referred pain.”

Neck Pain Referred to the Shoulder

There are many nerves and muscles that arise from your neck that pass through your shoulder on the way down the arm. Referred neck pain is usually felt at the top of your shoulder over your trapezius muscle. When shoulder pain originates from an injury in the shoulder itself, it normally is felt over your upper arm.

However, further complicating diagnosis is that many who have neck-originating shoulder pain also develop weakness in their shoulder rotator cuff muscles along with shoulder bursitis. Thus, diagnosis often requires your musculoskeletal specialist to distinguish between these different two sources of pain.

Neck-referred shoulder pain can often be from your cervical spine neck joints and ligaments, or from a trapped nerve. The common causes of shoulder pain from the neck include:

Spinal Osteoarthritis: a condition where disks narrow and bone spurs form.
Spinal Stenosis: a narrowing of the space around the spinal cord, usually due to arthritis.
Herniated Disk: when one of the cushioning disks between your spine’s vertebrae tear or leak
Ligament or Muscle Injuries: frequently the result of a sports injury, fall or accident

Shoulder Pain Referred to the Neck

One of the sources of shoulder pain that can be referred to the neck can originate in the acromioclavicular, or AC joint. So let’s simplify that a bit.

The AC joint joins your collarbone, also known as your clavicle, with the acromion section of your shoulder blade (scapula). Just like it is for most parts in your body where bones meet, there is cartilage between the two bones – which is the tissue that allows the bones to move on each other. Think of it like Teflon smoothly allowing two ball bearings to rub against each other.

While the AC joint is vulnerable to many different kinds of injuries, the most common conditions are arthritis, fractures, and separations. And AC joint pain, as well as a number of other shoulder conditions, can radiate pain to the neck.

Woman with neck pain that actually originates in her shoulder joint. — Some neck pain may actually be “referred” from a damaged shoulder joint.

Figuring Out the True Source of Your Shoulder or Neck Pain

Your healthcare provider will start with a physical examination to diagnose referred neck or shoulder pain. They’ll also be looking to rule out other possible conditions. They may couple their initial examination with imaging (MRI, CT, Ultrasound, or X-rays) and blood tests.

Recommended treatments will vary depending on what they determine the underlying condition to be.

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The causes and symptoms of spine issues, including neck pain and lower back pain, are extremely diverse and complex. Accordingly, there are many non-invasive treatment options that your doctor will initially consider to help you address your issues.

However, if your neck or lower back pain is chronic and persists, there is a minimally invasive option, called radiofrequency ablation, that you may want to discuss with your doctor. This procedure is also known as a radiofrequency neurotomy as well as a rhizotomy.

In this nonsurgical procedure, radiofrequency waves are used to generate heat to target specific nerves. It temporarily turns off the ability of those nerves to send pain signals. For some patients, radiofrequency ablation may reduce or eliminate pain for months at a time.

Targeting Facet Joints and Sacroiliac Joints

Radiofrequency ablation is typically used to target pain from the facet joints, which can contribute to chronic pain in the neck or lower back, and the sacroiliac joints, which can contribute to chronic low back pain.

What are facet joints? They are small stabilizing joints that are located in pairs between and above each adjacent vertebra at every level of your spine – except at the uppermost two levels. They are weight bearing structures and are subject to mechanical stress.

Facet joints enable you to bend and twist. However, they have a rich nerve supply – called medial branches – that allows them to perceive pain when they are injured. Those pain signals are carried by these nerves to your spine and brain.

And what about sacroiliac joints? These joints sit between the sacrum and the iliac bones of the lower back, in the lowest part of the spine where the spine meets the pelvis. Like facet joints, they are weight bearing structures and are subject to mechanical stress. We each have two sacroiliac joints – one on either side of the sacrum.

Sacroiliac joints move very little compared to other joints of the spine. They also have a rich nerve supply – called sacral lateral branches and lumbosacral plexus – that allows them to perceive pain when they are injured.

The goal of a radiofrequency ablation is to interrupt the pain signals from the nerves in these joint areas before they reach the brain.

Illustration of active nerve cells — An illustration of active nerve cells.

Testing Prior to the Procedure

In order to determine if you are a good candidate for a radiofrequency ablation, your doctor will first perform a test. This test uses a diagnostic nerve block to determine if the nerves that would be targeted by the ablation procedure are the same nerves that are responsible for your pain.

Depending on the outcome of this test, your doctor will either schedule a radiofrequency ablation procedure for you – or determine that a different procedure will be more appropriate to help your specific symptoms.

How the Radiofrequency Ablation Procedure Is Done

Radiofrequency ablation is a minimally invasive procedure that is done in an outpatient surgery center, so you’ll go home the same day.

During the procedure, you will lie on your stomach, or for some neck procedures, on your side. An intravenous (IV) line will be placed in your arm or hand to deliver medication that will keep you comfortable during the procedure.

Your doctor will numb a small area of skin around your spine with an anesthetic before inserting the radiofrequency needles. The doctor will then use a special X-ray machine (fluoroscope) to help guide a the needle alongside the targeted nerves.

To confirm proper position, a small amount of electrical current is then used to test nerve targeting. Once proper position is confirmed, the radiofrequency ablation is performed.

The length of the procedure depends on the treatment site and number of treatments performed, but frequently lasts less than an hour. From arrival to departure at the surgery center, the entire experience normally lasts between 3 and 4 hours.

It can take three or more weeks for the full effects of radiofrequency ablation to be felt. Although results vary from patient to patient, the effectiveness of radiofrequency ablation may last from six months to a year or even longer.

Sometimes, nerves do grow back. In such cases, the radiofrequency ablation may be repeated.

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Losing weight is a challenge. But not losing those extra pounds you are carrying around can have a severe negative long-term impact on your joints and musculoskeletal system.

Excess weight and obesity are linked to heart disease, stroke, some cancers, diabetes, high blood pressure, gallbladder disease, and osteoarthritis. Unhealthy weight stresses almost every organ in the body, so it is no surprise that it also increases the risk for back pain, joint pain, and muscle strain.

This issue is widespread. According to the CDC, more than 73% of all U.S. adults over the age of 20 are overweight or obese. This leads to back, neck, and joint issues that are significantly impacting the quality of their lives.

What impacts are we talking about?

Neck and Back Pain

If your weight slips into an unhealthy range, your chance of degenerative disc disease increases by 30 to 79 percent.

Every extra pound pulls your pelvis forward, adding strain to back muscles and ligaments. Discs adjust for that excess weight, and they can become herniated in the process of doing so. In turn, this damage can compress the spaces between the bones in the spine, causing pinched nerves and piriformis syndrome, where muscle spasms cause pain and sciatic nerve irritation.

If you have arthritis, extra weight can aggravate this condition and trigger the onset of osteoarthritis. Excess body fat also stimulates the production of chemicals that contribute to joint damage.

Joint Pain

Are you aware that the stress on your knees is 1.5 times your body weight when you walk on a flat surface? So, if you weigh 160 pounds, your knees experience stress that feels more like 240 pounds. When you are walking up an incline, your knees’ stress increases to 3 to 4 times your weight. So the knees of a 160-pound person can feel as much as 640 pounds of pressure.

If you are 20 pounds overweight, you are taxing your knees with up to 80 pounds of extra stress and strain. This additional weight on your knee may lead to pain or an injury. And there are similar excess weight impacts on your other joints, particularly with your spine and hips.

Studies have shown that losing just 10 percent of our body weight can make a significant difference. Following a diet and exercise program can reduce pain, improve joint function and lead to less arthritic inflammation.

Your Goal Weight Based on the Body Mass Index

How much should you weigh? The most common tool to evaluate proper weight is the body mass index (BMI). It is a number calculated from an individual’s height and weight. In most people, it represents a relative measure of body fat, although in some cases it may be inaccurate. It tends to overestimate body fat in individuals who are more muscular than the norm.

The BMI that you should target for yourself should be determined in a conversation with your healthcare provider.

BMI is classified as follows:

BMI under 18.5 is underweight.
BMI 18.5 to 24.9 is typically healthy weight.
BMI 25.0 to 29.9 may indicate overweight status.
BMI 30.0 to 39.9 may indicate obesity.

You can calculate your BMI by referring to the chart below, or using the Body Mass Calculator provided by the National Heart, Lung, and Blood Institute, found at the link HERE.

Tanita weight, body fat & body water scale.

Set Diet and Exercise Goals that Will Work for You

Some of us love exercise, others of us hate it. Regardless of your own preferences, the bottom line is that exercise and physical activity are good for you. Study after study show that individuals who exercise regularly not only live longer, they live better.

If you can’t do a vigorous exercise program, just doing everyday physical activities can provide positive impact. Gardening, walking the dog, or taking the stairs instead of an elevator are a good start. And it will help you stave off some diseases and disabilities that often occur with aging.

Studies now even suggest that people who begin exercise training in later life, such as in their 60s and 70s, can build their physical strength and also experience improved heart function.

Controlling your weight can be a more complex problem. Food selection can both have an impact on packing on pounds, as well as how you age. Don’t skip breakfast. Eat a balanced morning meal that includes protein, fat, and carbs that will give you the energy you need for your day.

It’s best to talk to your doctor before starting any diet to get their guidance. But after you do, consider eating small meals with a few snacks in between, or consider fasting. Eat until you are no longer hungry, but not until you’re full. Exercise daily, even if it is only in moderation. And be wary of eating when you are stressed or starved for comfort – emotionally motivated eating can ruin any diet.

Strive for a Lower BMI – and Fewer Medical Visits

Excess weight and lack of exercise can lead to spinal disorders and neck, back, or joint problems. Specialized care is available when that happens – but it is better that you try to avoid these issues if you can.

At Main Line Spine’s practice, we see many musculoskeletal issues and pain problems daily that are the result of BMIs in the overweight range and above. By taking control of your weight, you’ll enjoy far fewer medical visits and a happier life.

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