Oftentimes when clients finally reach out to me with shoulder pain, they’ve already tried several approaches without success. But what’s really wrong is that everyone they’ve seen up to that point has failed to give them an accurate diagnosis. Without an accurate diagnosis, treatment fails. It’s not surprising. The true cause of shoulder pain is missed by many and can actually be difficult to diagnose. Sometimes it’s really your shoulder, but in other cases it’s actually a problem in your neck. If there is irritation or inflammation in your neck, but someone is aggressively treating your shoulder, guess what? You aren’t going to see results and your pain may even worsen.
Here are some ways to tell if you really have a shoulder problem – or if you should be getting help for your neck instead.
Where is your pain?
When you have an actual shoulder problem, pain is always going to be just in your shoulder. The most common areas to have pain are directly in front of your shoulder, directly on top of your shoulder, or in a more involved shoulder problem – like a rotator cuff injury – you might feel achiness on the side of your shoulder and down into the side of your arm a little. If the pain goes past your elbow, is above your shoulder and into your neck (the upper trap area), deep inside of your shoulder, or in the back into the shoulder blade, it’s entirely possible (and maybe even likely) that your neck is involved or totally responsible for your “shoulder pain”.
Do you have numbness, tingling or burning?
These are signs of nerve compression or irritation. If that’s happening in your neck – say due to a bulging disc or restricted/faulty movement patterns that irritate your nerve roots– you can feel it into your shoulder, shoulder blade, or even down into your arm.
What’s particularly misleading is that all of this nerve difficulty in the neck is only felt in your shoulder or arm.
When do you feel stiff?
Lack of mobility and stiffness are common symptoms associated with a rotator cuff injury or the dreaded “frozen shoulder”. If your neck moves well, is pain free, and your shoulder is stiff, odds are that the problem is in your shoulder. Now, let’s say you’ve got stiffness in your neck as well as your shoulder. It’s possible the neck stiffness is a result of your shoulder not moving properly, but you’ll never know for sure without a proper assessment. If there is even a hint of a neck issue being fully or partially responsible for your shoulder problem, it must be addressed or you will never achieve full recovery.
I do all the exercises and everything I’m told, why won’t my shoulder get better?
This is probably the number one sign that your shoulder problem is not really a shoulder problem at all. If you’ve had pain for months, or if you fix your pain but it keeps coming back, then there is a very good chance someone has missed something, and quite possibly it’s a hidden neck problem. I can’t tell you how many times I’ve seen this happen. I’ve seen people try three different therapists who’ve prescribed the best rotator cuff exercises on the planet. I’ve seen people get multiple cortisone injections in their shoulder. And worse, I’ve seen people get surgery – only to have their shoulder problem return months or years later. If this sounds like you, then someone has missed the boat and your shoulder problem may not be a shoulder problem at all. You need to get properly assessed.
If this post has struck a cord, and you’re wondering if your shoulder problem is really a shoulder problem, then I recommend you find a physical therapist who is a specialist and can properly assess you. They’ll know the right questions to ask, take their time doing a thorough and proper assessment, and get you on the right track to getting better. I’ll be writing a blog soon on how to know when you need a physical therapist who is a specialist versus a generalist and how to find a specialist when you need one. In the meantime, feel free to reach out to me personally and I’d be happy to help point you in the right direction.