Why Your Shoulder Pain Might Actually Be a Neck Problem (And What To Do About It)

Margaret came to our clinic frustrated. She’d been dealing with persistent shoulder pain for months — a deep ache that radiated down her arm, particularly when she reached overhead or lifted anything heavier than a coffee cup. She’d tried physical therapy focused on the shoulder, rotator cuff exercises, and even cortisone injections into the joint itself. Nothing provided lasting relief.

After a thorough evaluation and electrodiagnostic testing, we discovered something Margaret hadn’t anticipated: her shoulder wasn’t the problem at all. The true culprit was cervical radiculopathy — nerve compression in her neck.

Margaret’s story isn’t unique. At SOAR Spine and Orthopedics, we frequently evaluate patients who present with shoulder complaints, only to discover that the cervical spine is the actual source of their symptoms. Understanding this connection is essential for accurate diagnosis and effective treatment.

The Cervical Spine-Shoulder Connection: Understanding Referred Pain

The relationship between the neck and shoulder is more intimate than many people realize. The cervical spine houses nerve roots that provide sensation and motor control not only to the neck but also to the shoulder, upper back, and arm. When these nerve roots become irritated — a condition known as cervical radiculopathy — pain can radiate far from its actual source.

The C5 and C6 nerve roots are particularly relevant to shoulder complaints. The C5 nerve root innervates the deltoid muscle and provides sensation to the lateral shoulder. The C6 nerve root supplies the biceps and provides sensation down the arm into the thumb. When either of these nerve roots is compressed by a herniated disc, bone spur, or degenerative changes in the cervical spine, patients often experience pain that they localize to the shoulder region.

This phenomenon of referred pain can be misleading. The brain perceives discomfort in the shoulder because that’s where the affected nerve distributes, even though the pathology exists in the neck. Without careful clinical evaluation, the true source of pain can easily be missed, leading to treatments directed at a shoulder that isn’t actually injured.

Recognizing the Red Flags: When Shoulder Pain Signals a Cervical Problem

Not all shoulder pain originates from the neck, of course. However, certain clinical features should raise suspicion for cervical spine pathology:Pain distribution patterns are often the first clue. True shoulder pathology — such as rotator cuff tears, impingement, or glenohumeral arthritis — typically produces pain localized to the shoulder joint itself, often worsening with specific shoulder movements. In contrast, cervical radiculopathy tends to cause pain that radiates into the nerve distribution territory in the arm and shoulder region that can be variable in distribution at different times, as opposed to true shoulder pain that tends to localize and not travel or vary

Associated neurological symptoms provide additional diagnostic value. Cervical radiculopathy frequently may present with numbness, tingling, or altered sensation in the affected dermatome. Patients may describe a pins-and-needles sensation in the thumb and index finger with C6 involvement, or weakness in specific muscle groups. True shoulder pathology rarely causes these neurological symptoms. A discussion of differential shoulder injections, which are undertaken under ultrasound guidance with the installation of local anesthetic into suspected painful areas, with physical examination to follow to determine if the pain was relieved. If the symptoms are coming from the cervical spine, differential shoulder injections will not change the pain pattern.

Neck position sensitivity is another important indicator. Patients with cervical radiculopathy often report that neck movements — particularly extension, rotation, or lateral bending toward the symptomatic side — reproduce or intensify their shoulder and arm pain. This is known as

Spurling’s sign in clinical examination. Shoulder pathology typically doesn’t demonstrate this neck position dependence.

Response to shoulder-focused treatment can also be telling. When patients have undergone appropriate treatment directed at the shoulder — including physical therapy, anti-inflammatory medications, or injections — without meaningful improvement, cervical spine pathology should be strongly considered.

The SOAR Diagnostic Advantage: Electrodiagnostic Testing

At SOAR Spine and Orthopedics, our diagnostic approach emphasizes precision. While imaging studies such as MRI can visualize anatomical abnormalities in both the shoulder and cervical spine, they don’t always clarify which structures are actually generating symptoms. This is where electrodiagnostic testing becomes invaluable.

Electrodiagnostic testing includes nerve conduction studies and electromyography (EMG). These studies assess the electrical function of nerves and muscles, allowing us to identify nerve root compression and localize pathology with remarkable accuracy. For patients like Margaret,

EMG can definitively demonstrate whether cervical nerve roots are compromised, confirming the diagnosis of cervical radiculopathy.

This testing is particularly useful when imaging findings are ambiguous or when multiple potential pain generators exist. Many patients have both shoulder pathology and cervical spinedegenerative changes visible on MRI.

Electrodiagnostic studies help us determine which abnormality is clinically relevant — guiding treatment toward the actual source of symptoms rather than incidental findings.

The precision of electrodiagnostic testing allows us to avoid unnecessary interventions. If we can confirm that shoulder pain originates from cervical nerve compression rather than rotator cuff pathology, we can spare patients from shoulder surgery that wouldn’t address their underlying problem.

When Cervical Treatment Resolves “Shoulder” Pain

Once cervical radiculopathy is identified as the source of shoulder pain, treatment strategies shift accordingly. At SOAR, we utilize several interventional approaches that can provide significant relief:

Cervical epidural steroid injections deliver anti-inflammatory medication directly to the epidural space surrounding compressed nerve roots. By reducing inflammation around the affected nerve, these injections can alleviate radicular pain extending into the shoulder and arm.

Many patients experience substantial improvement in symptoms that had been refractory to shoulder-directed treatments.

Cervical facet injections may be appropriate when facet joint arthropathy contributes to nerve root irritation or when facet-mediated pain refers to the shoulder region. Facet joints in the cervical spine can become arthritic and inflamed, producing both local neck pain and referred shoulder discomfort. Inflammation due to arthritis can cause referral zone pain to the shoulder, chest wall, head or face or arm without any evidence of nerve compression, often in the face of a MRI scan, which is largely normal or just has generalized degenerative changes.

Cervical facet injections can be done with corticosteroid or with PRP. Cervical RFA also serves as a treatment for cervical facet joint pain. Each has their distinct profiles and potential advantages that can be discussed with the patient.

The beauty of these interventions is their diagnostic and therapeutic value. When a cervical injection produces dramatic improvement in “shoulder” pain, it confirms the cervical spine as the pain generator and provides meaningful symptom relief simultaneously.

The Exercise Component: Stabilization for Lasting Relief

While interventional procedures can provide significant pain relief, our philosophy at SOAR emphasizes the importance of an exercise-based approach for long-term outcomes. We are committed to treating you as a whole person, not just addressing symptoms in isolation.

For patients with cervical radiculopathy causing shoulder symptoms, neck stabilization exercises are fundamental to recovery. These exercises focus on strengthening the deep cervical flexormuscles and scapular stabilizers, improving posture, and reducing mechanical stress on cervical nerve roots.

Cervical retraction exercises help counteract the forward head posture that many people develop, especially those with desk jobs. This posture increases load on the cervical spine and can exacerbate nerve compression. Teaching patients to maintain neutral cervical alignment reduces pressure on nerve roots.

Deep neck flexor strengthening improves the muscular support around the cervical spine, enhancing stability and reducing the likelihood of recurrent nerve irritation. These muscles often become deconditioned in patients with chronic neck problems.

Scapular stabilization exercises are equally important. The scapula serves as the foundation for shoulder function, and its position is influenced by cervical spine alignment. Strengthening the muscles that control scapular position — including the lower trapezius, serratus anterior, and rhomboids — helps optimize shoulder mechanics and reduces compensatory strain.

Our individualized exercise instruction program allows us to tailor these interventions to each patient’s specific needs, functional goals, and underlying pathology. We don’t simply provide a generic exercise sheet; we teach patients proper technique, progress their programs appropriately, and integrate exercise into a comprehensive rehabilitation strategy.

The Multidisciplinary Advantage

Margaret’s case illustrates the value of our multidisciplinary approach at SOAR. After her electrodiagnostic testing confirmed C6 radiculopathy, we performed a cervical epidural injection that provided substantial relief. We then worked with her through our individualized exercise instruction program to address cervical spine mechanics, scapular stability, and postural habits that had contributed to her condition.

Six months later, Margaret’s “shoulder pain” had resolved. She’d returned to her tennis league and was no longer limited by the symptoms that had frustrated her for so long. Importantly, she’d avoided shoulder surgery that wouldn’t have addressed her actual problem.

This outcome is what we strive for with every patient — accurate diagnosis that identifies the true pain generator, targeted treatment that addresses the underlying pathology, and an exercise-based approach that promotes lasting wellness. Our four decades of experience, research, and teaching have refined our ability to recognize complex pain patterns and deliver the multidisciplinary care that achieves optimal outcomes.

When to Seek Expert Evaluation

If you’re experiencing shoulder pain that hasn’t responded to conventional shoulder treatments, or if your shoulder symptoms are accompanied by arm numbness, tingling, or weakness, acomprehensive evaluation is warranted. Similarly, if neck movements influence your shoulder pain, cervical spine pathology should be considered.

At SOAR Spine and Orthopedics, we are dedicated to the core principle of keeping the “care” in healthcare. We will treat you as a person, not a number, and we’ll invest the time necessary to understand your unique situation and identify the true source of your symptoms.

Don’t let misdiagnosed pain limit your life. Understanding the connection between the cervical spine and shoulder is the first step toward effective treatment and lasting relief. Whether through electrodiagnostic testing, targeted injections, or individualized exercise instruction, we have the expertise and tools to help you return to the activities you love — moving well and living without pain.

If you’re dealing with persistent shoulder symptoms, we encourage you to contact our offices in Redwood City or Santa Clara to schedule a comprehensive evaluation. Together, we’ll determine whether your shoulder pain is truly a shoulder problem — or if the answer lies a little higher up in the cervical spine.