Our necks are incredibly handy for everyday tasks, like turning our heads to look around, finding a comfy sleeping position, and providing support for our heads while we’re cooking or working. The neck houses the cervical spine, which has two important jobs: It holds up your head and lets you move it around, and it keeps your spinal cord safe, which is like the body’s message highway between the brain and the rest of your body. Our neck works together with the muscles and tendons of the rest of our bodies. Because of the neck, we can do all these tasks and keep us in good shape.

Sometimes, when we feel pain in our neck or shoulders, it’s not just in one spot. It can spread to other places in our body. This pain may radiate to other parts of your body throughout the day. For example, if your neck hurts, it might make your arm hurt too, making it seem like you have a pinched nerve or a problem in your shoulder. And if your shoulder hurts, it can feel like your upper back or even your chest hurts, which can be confusing and make you think it’s a heart problem. Understanding this helps orthopaedic surgeons figure out where the real issue is.

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Understanding the Causes of Chronic Neck and Shoulder Pain

Neck pain can happen for different reasons. It’s often because of problems with the intervertebral discs in your spine, the facet joints, or the muscles in your neck. The discs slip out of place, causing pain mainly in the neck area. Sometimes, the discs can press on your spinal cord or nerves, which can lead to chronic pain. On the other hand, the facet joints play an important role in your mobility. Facet joints can get injured by trauma or the normal wear and tear of daily life. This pain may also spread to your shoulders. Your neck has muscles that help you move it and keep it steady. This pain might also be felt in your shoulders and upper back. Usually, neck pain is a mix of these problems, so orthopaedic surgeons need to figure out the exact cause. Orthopaedic surgeons are specialists who diagnose and treat conditions involving your bones, joints, or muscles. These specialists perform diagnostic tests and then they decide on a personalised treatment plan for you. An orthopaedic surgeon’s goal is to help you alleviate pain and regain your mobility.

You should seek medical attention if you experience neck and shoulder pain that does not go away after rest and home treatments. Neck pain can cause various symptoms, including numbness and weakness in the upper limbs, shooting pain down the arms, loss of hand agility, unsteadiness in walking, posterior headaches, and tingling sensation over the back of the head. Lower limb complaints are less common and are usually due to concomitant lower back problems. These symptoms may indicate cervical radiculopathy, which is caused by the compression or irritation of a nerve in the neck that can lead to pain, numbness, and weakness in the shoulder, arm, and hand. Other possible causes of hand pain and numbness include carpal tunnel syndrome.

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Diagnosis and Treatments for Neck and Shoulder Pain

When your neck or shoulder hurts, the orthopaedic surgeon will first conduct a medical interview of your current lifestyle, condition, and other important details. They may perform a physical inspection of the affected areas by moving your body and gently pressing on it to see where it hurts. You may undergo X-rays or MRI scans so your orthopaedic surgeon can diagnose your condition. All these tests will help your orthopaedic surgeon understand why your neck or shoulder hurts. Once they figure out the case, they can recommend ways to treat your condition, like prescribing medicine or requiring you to take physiotherapy sessions. Orthopaedic surgeons may also recommend pain procedures to target the source of pain.

There are different ways to alleviate pain and other symptoms associated with neck and shoulder pain. While following the specific instructions of your orthopaedic surgeon, you may need to take medications, engage in lifestyle changes, and do exercise to strengthen your neck and shoulders. In severe cases, patients may need to undergo surgery. Remember, neck and shoulder pain can have various causes. It is risky to try diagnosing and treating it yourself, especially for those who experience chronic pain.

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Debunking Myths About Neck & Shoulder Pain

Myth 1: Neck pain only happens to people with physically demanding jobs.

• Some people think that only those with tough physical jobs can get neck pain, but that’s not true. Neck pain can happen to anyone, even if you have a desk job or if you sleep in a funny position. It’s crucial to find out why your neck hurts to get the right help.

Myth 2: Open surgery is the only option for treating orthopaedic conditions.

• Some folks believe that surgery is the only fix for neck pain, but that’s usually the last thing to consider. Many other treatments don’t involve surgery and can help a lot. It all depends on what’s causing your neck pain, and your orthopaedic surgeon can figure that out.

Myth 3: Neck and shoulder pain only comes from injurious sources (accidents or falls).

• People might think that shoulder pain always comes from an injury, but as we get older, our shoulders can hurt just from everyday use. Sometimes, issues in the neck and upper back can also make your shoulders ache.

Myth 4: My neck or shoulder pain will go away on its own.

• Some folks hope that neck pain will just go away on its own, but that’s not always the case. It could be a sign of a bigger problem, so it’s essential to get it checked out. There are different ways to treat it, but it all depends on the diagnosis and treatment plan recommended by your orthopaedic surgeon.

Myth 5: Neck and shoulder pain is always a result of aging.

• While neck pain can become more common as people get older due to wear and tear, it can affect individuals of all ages. Factors like poor posture, injury, and lifestyle choices can contribute to neck pain at any stage of life.

The Benefits of Physiotherapy in Reducing Chronic Pain Symptoms

Physiotherapy is an important part of healthcare because it helps people get better after they’ve been hurt or sick or had surgery. It’s like a special kind of treatment that helps people move better, feel less pain, and get back to doing the things they used to do. These are the benefits of physiotherapy:

• Pain Relief: Physiotherapy can make your body hurt less and feel more comfortable.
• Mobility and Movement: It helps you move more easily and do things like walking or bending without trouble.
• Healing and Recovery: Physiotherapy can speed up your recovery from injuries or surgeries.
• Stronger Muscles: It makes your muscles stronger, so you can be more active and stable.
• Prevention: It can prevent future injuries by making your body stronger and healthier.

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Practical Tips to Help Manage Neck and Shoulder Pain

Lifestyle changes and tips to manage neck and shoulder pain at home:

• Pay attention to your posture while sitting and standing. Keep your back straight and shoulders relaxed.
• Arrange your workspace or computer setup to be ergonomic. Adjust your chair, desk, and monitor height to reduce strain.
• Take short breaks every 30 minutes to stretch and move around, especially if you sit for extended periods.
• Perform simple neck stretches and exercises to relieve tension. Gently tilt your head side to side and forward and backwards.
• Apply a warm compress or ice pack to the sore areas for 15-20 minutes to reduce pain and inflammation.

Lifestyle changes and tips to manage neck and shoulder pain at work:

• Ensure your desk and chair are at the right height to maintain good posture. Use an ergonomic chair and keyboard.
• Position your computer monitor at eye level to avoid straining your neck by looking up or down.
• Stand up, walk around, or perform quick stretches during breaks to keep your muscles active.
• Practice stress-relief techniques like deep breathing, meditation, or yoga to reduce tension that can contribute to neck and shoulder pain.
• Consider using ergonomic accessories like a neck pillow, lumbar support cushion, or a standing desk converter if possible.

Non-pharmacological Treatment Options

There are several non-pharmacological treatments that can be considered in patients with chronic neck pain and chronic shoulder blade pain. A holistic approach is proposed whereby treatment is not merely an intervention but rather encompasses the combination of interventions aimed at affecting the experience of pain, suffering, and/or disability by influencing the physical, psychological, and/or social components of health. Patients should be educated about their condition, the normal course of healing, and that recovery is dependent on multidimensional factors. An individualized care plan should be agreed upon, which may consider some of the modalities discussed below. Emphasis should be placed on promoting the goals of self-management: self-efficacy, physical and emotional well-being, and activity participation. Exercise programs should include an activity-based approach, and exercise programs that focus on strength, endurance, control, and coordination of the musculoskeletal system are recommended.

Physical therapy is a potent non-pharmacological intervention for patients presenting with chronic neck pain and chronic shoulder blade pain. Interventions, such as massage, manipulations, and exercise therapy, activate neural pathways responsible for pain modulation, increase mobility, ease muscle spasm and tension from surrounding structures, and usually limit stiffness and soreness. There is moderate quality evidence to support the effect of physical therapy on pain and function in chronic and sub-acute nonspecific neck pain, and some evidence for benefit in combination with acupuncture or massage in chronic shoulder problems. Massage may increase blood flow, which aids in the healing process and releases chemicals that are similar to anti-inflammatories. Massage can be particularly helpful for musculoskeletal-related pains as massage increases blood flow and drains accumulation of waste from stagnant tissues.

Exercise and Stretching

Regular physical activity can improve strength, flexibility, and overall musculoskeletal health. For chronic neck and shoulder pain, specific exercises and stretching or yoga can reduce muscle tension, increase blood flow, and alleviate stiffness that might arise from weak posture muscles. Neck exercises and stretching can increase neck mobility, increase muscle strength in the neck, and prevent pain after inactivity. Shoulder exercises and stretching can decrease pain in the area of the deltoid, decrease pain in the AC joint, as well as improve posture. Before beginning an exercise program, it is important to discuss with a doctor or physical therapist for instruction on proper form and regimen for slow progressive increase. All exercises should be free of pain; stop an exercise if pain does not decrease or increases with progression. Every person is on a different level of physical activity, so progression should occur gradually over weeks to months. Exercise for chronic pain prevention should be part of daily life and not seen as a chore.

To maintain the added strength and flexibility, it is best to engage in 30 minutes of stretching or strengthening exercises 3-5 times a week. Regular low-stress exercises help in decreasing chronic pain conditions. Engaging in regular physical activity can decrease chronic pain manifestations. Overall, exercise can help manage chronic pain symptoms in a wide variety of conditions when added to the management regimen.

Massage Therapy

Massage therapy is a frequently used adjunct treatment for the management of chronic neck pain and shoulder pain. Common massage techniques include Swedish massage, deep tissue massage, and myofascial release. Deep tissue massage helps relieve muscle pain and stiffness. Over time, a massage therapist can learn what level of pressure an individual can manage. This may help a person avoid any pain while undergoing the procedure. Massage also boosts blood flow and reduces muscle tension. Swedish massage is a gentler type of massage with the goal of relaxation. Deep tissue massage and myofascial release are therapeutic. Some of the possible benefits of massage for people with chronic pain include reducing inflammation, improving blood flow, muscle relaxation, stress reduction, and stress relief.

While limited data exist regarding the use of massage in the management of pain in the neck and shoulders, appropriately applied massage therapies may be effective in relieving pain and reducing the use of analgesics. However, the skill, training, and experience of the massage therapist are important. Practitioners who underwent pre-certification courses of at least 12 months and who were currently practicing in an established therapeutic setting were found to more effectively address patients’ needs compared to those who only had post-certification massage training. Massage should not be the primary treatment; rather, it should be considered adjunctive and combined with exercises. Professional pain management or wellness programs are the best bet and have the greatest chance for success rather than reflexology, relaxation massage, or other less outcome-driven treatments.

Pharmacological Treatment Options

For some cases of chronic neck and shoulder pain, the use of medications may be necessary. There are different medication options: over-the-counter medications can be purchased without a prescription, while prescription medications require a doctor’s order. Medications can be useful by reducing inflammation, easing pain, improving sleep, and reducing muscle tension. Treatments can range from over-the-counter medications to more serious prescription drugs; doctors will often work with you to create a good solution and, as always, be sure to inform your doctor of your complete medical history and any medications you may be taking.

These can be purchased over the counter or obtained with a doctor’s prescription. The dosage is different for these two types of medication. It is suggested to use nonsteroidal anti-inflammatory drugs when over-the-counter medications are needed, with the recommended dose consisting of a standard tablet every 6-8 hours (or as needed). However, discuss this with a pharmacist or doctor before using these for an extended period of time. Other pain relievers, such as paracetamol and muscle relaxants, may be more appropriate to use over-the-counter when treating chronic neck and shoulder pain, as they can decrease muscle spasms. The dosage is an acetaminophen 500 mg tablet that can be taken every 4-6 hours (or as needed) for a lower back strain. Use four tablets – no more – in a total of 24 hours. Muscle relaxants work by numbing the central nervous system and may cause drowsiness, dry mouth, and lightheadedness. As a result, muscle relaxants should be used with extreme caution.

Over-the-Counter Medications

A range of over-the-counter medications is available to treat chronic neck and shoulder pain in the initial stage. Nonsteroidal anti-inflammatory drugs include ibuprofen, naproxen, and aspirin. All are useful and should be used until maximum pain relief is achieved, reduced, or under control. In addition to these, analgesics such as acetaminophen can reduce pain and fever. Moreover, acetaminophen can be combined with NSAIDs to increase therapeutic efficacy. Many OTC drugs are considered effective in pain reduction and are available in pharmacies, supermarkets, and many other stores. Overall, patients with acute musculoskeletal pain are also appropriate candidates for OTC drugs. While these drugs are effective in treating acute and mild pain, evidence and clinical reviews have indicated that some are not very effective in relieving moderate to severe chronic muscle pain. Additionally, improper use of these drugs can lead to potential side effects for any patient who uses more than the indicated dose or has preexisting health conditions, with some indications for allergic reactions, serious side effects, and potential use of both OTC medications and prescription drugs for those under the age of 12. People with liver disease should avoid taking acetaminophen. Patients should not use any medication that increases the effect of alcohol and sedatives in addition to medication. It should be noted that long-term use of OTC drugs is not recommended due to the risk of side effects, reducing symptoms of chronic musculoskeletal pain more than usual, available in combination with non-pharmacological treatments, and resulting in more severe side effects. Consulting healthcare providers or pharmacists before using these drugs will certainly be very useful and will help to reduce or eliminate potential health problems.

Prescription Medications

Clinicians are trained to avoid “shotgun” legal medications, meaning that they throw the book at the patient, hoping that something will work. Many of the agents prescribed for chronic neck and shoulder pain have a high incidence of serious side effects or potential for abuse, often more harmful than leaving the patient in pain. These include oral corticosteroid usage for long periods, which may lead to systemic side effects. Tricyclic antidepressants have an anticholinergic effect and adversely affect patients with glaucoma, prostate problems, dementia, and heart diseases. Selective norepinephrine reuptake inhibitors and gamma-aminobutyric acid agents can affect the patient’s mental status. In conclusion, the treatment of many patients with chronic neck and shoulder pain will involve a variety of over-the-counter and prescription medications. It is beneficial for pain to be treated both orally and topically at the same time. Prescription agents effective for managing chronic neck and shoulder interventions include: centrally acting muscle relaxants, prescription anti-inflammatory oral steroids, and a short duration of opioids. Individual titration of each of these medications will be based on the severity of pain and response to the previous agent. There are multiple papers and numerous additional research papers that discuss the negative long-term effects of many of the current classes of pain medications and have shown that the treatment and care of the patient by a variety of practitioners—the team approach—is more effective in complex pain management.

Interventional Treatment Options

While conservative therapy represents the cornerstone of chronic neck and shoulder pain management, a significant percentage of patients continue to report persistent and disabling symptoms. With no clear consensus on physical therapy treatment regimens and outcomes, interventional treatments can offer an alternative for those patients who fail to respond to conservative measures. Interventional treatment options are typically minimally invasive, offered in an outpatient or ambulatory clinic setting, and are typically performed under fluoroscopic or ultrasound guidance for precise localization. The goals of interventional treatments for chronic neck and shoulder pain are to relieve anatomic pain generators and offer functional restoration. This can be achieved with: 1) chemical ablation, where chemicals are injected to block nerves or inflamed tissues; 2) energy modalities that injure or destroy pain fibers; or 3) mechanical remedies that lessen a narrowed space or broken joint.

Neck pain frequently originates from soft tissue injury and commonly responds to a conservative physical therapy approach. However, shoulder pain may originate intra-articularly and occasionally requires direct procedural intervention. Joint injections, including intra-articular glenohumeral joint steroid injections, can offer both therapeutic and diagnostic benefits in evaluating the contents of the joint and improving shoulder pain complaints. Although often performed as a simple office procedure, shoulder injections do carry some risks. In the right patient, with appropriate technique and caution, risks can be minimized for indicated intervention. It is necessary to thoroughly screen patients to ensure that they are appropriate candidates for such intervention to maximize the intervention’s benefits and minimize its harms.

Injections

Injections are an interventional treatment option that can be used to help in the management of chronic neck and shoulder pain. The most common indication for an injection is pain relief, followed closely by reducing inflammation or facilitating rehabilitation. A multitude of different types of injections are available, including but not limited to trigger point injections, steroid and non-steroid injections, and injections using a variety of needling techniques including dry needling. Corticosteroid injections have good efficacy and are useful to expedite patient recovery from an acute episode of pain to facilitate initiation of rehabilitation. Hyaluronic acid injections, while having limited effect, may be indicated in patients suffering concomitantly from osteoarthritis to the cervicothoracic junction. Even though the therapeutic effect is not substantial, these injections may be indicated as a symptomatic intervention in this patient group. Prolotherapy and regenerative injections from platelet-rich plasma, bone marrow aspirate, and others are currently considered experimental, with placebo-controlled trials having conflicting results.

Before considering injections, the patient should undergo a thorough workup for the physician to determine which treatment is best indicated for the patient. The physician should consider many factors including the level of the injury, the location of the patient’s maximum pain, and whether the patient has already undergone conservative therapy. All of these questions will help the physician determine the most appropriate treatment for the patient. Injections are not largely contraindicated for chronic pain. In general, patients should be made aware of potential risks and side effects, and should also be informed that corticosteroid injections could result in deterioration in muscle function or blood sugar control in rare cases. Patients are in turn usually recommended to avoid strenuous activity for a short period until achieving optimal effect. For other types of non-steroid injections, patient safety is high, though some medications and injection techniques are more complex due to the use of contrast agents and may require further caution. Moreover, interventional techniques as sole treatments are often unable to provide significant or lasting relief, so the use of such interventions is largely adjunctive, and it is best to consider a multidisciplinary approach in order to increase the chances of providing targeted relief for the patient.

FAQs:

References:

1. https://www.ncbi.nlm.nih.gov/books/NBK557555/#
2. https://www.methodisthealthsystem.org/press-releases/2021/may/tips-for-taking-extra-care-of-your-neck/
3. https://www.mayoclinic.org/diseases-conditions/neck-pain/symptoms-causes/syc-20375581
4. https://www.theorthopaedicandpainpractice.com/service/neck-pain/

Dr Yong Ren’s Profile

Dr. Yong Ren graduated from the National University of Singapore’s Medical faculty and embarked on his orthopaedic career soon after. Upon completion of his training locally, he served briefly as an orthopaedic trauma surgeon at Khoo Teck Puat Hospital before embarking on sub-speciality training in Switzerland at the famed Inselspital in Bern.

He underwent sub-specialty training in pelvic and spinal surgery, and upon his return to Singapore served as head of the orthopaedic trauma team till 2019. He continues to serve as a Visiting Consultant at Khoo Teck Puat Hospital.

Well-versed in a variety of orthopaedic surgeries, he also served as a member of the country council for the local branch of the Arbeitsgemeinschaft für Osteosynthesefragen (Trauma) in Singapore. He was also involved in the training of many of the young doctors in Singapore and was appointed as an Assistant Professor by the Yong Loo Lin School of Medicine. Before he entered the private sector, he also served as core faculty for orthopaedic resident training by the National Healthcare Group.

Dr Yong Ren brings to the table his years of experience as a teacher and trainer in orthopaedic surgery. With his expertise in minimally invasive fracture surgery, pelvic reconstructive surgery, hip and knee surgery as well and spinal surgery, he is uniquely equipped with the tools and expertise necessary to help you on your road to recovery.