Referred Pain into the Shoulder
Sometimes shoulder pain can originate from the cervical spine (neck). Referred pain is a phenomenon where pain in a certain body part is felt away from its’ actual source. This is a result of interconnecting sensory nerves in our nervous system. Some nerves can supply more than one tissue in the body and so when pain is felt in one area, it can be interpreted by the brain as coming from another area supplied by the same sensory nerve. Injury to any structures in the neck zone can cause referred pain into the shoulder tricking our brains to believe our shoulders are injured.
Types of Referred Pain
Somatic Referred Pain
Somatic Referred Pain is injury to other structures apart from spinal nerves themselves. When structures such as ligaments, tendons, muscles and joints are injured, the pain chemicals produced can irritate nearby sensory nerves and if these nerves innervate other structures elsewhere, the brain can interpret the pain to come from those other areas. As a rule, somatic referred pain is perceived in regions that share the same segmental innervation as the source.
This type of pain is described as
a dull gnawing achy pain. It is often hard to localize and the area of pain is
wide. This pain is different to pain caused by injury to an actual nerve
Radicular Referred Pain
Radicular pain is a type of referred pain from injury to a spinal nerve. This causes a sharper pain to be felt in a much smaller distinct area as well as paraesthesia (changes in sensation eg numbness) and weakness in the muscles innervated by the spinal nerve injured. The area of pain is felt in the area supplied by the spinal nerve. Radicular pain can be the result of issues such as herniated discs. When symptoms are felt down the arm in the distribution of the spinal nerve affected, we call this radiculopathy.
Key Diagnostic Features of Referred Pain vs Shoulder Pathology
- The mechanism of injury – was the neck twisted or pulled in an awkward position at the time of onset of the pain. Any trauma to the neck can mean that the shoulder pain is referred pain.
- Is there neck pain as well as shoulder pain? When there is neck pain concurrent with shoulder pain, referred pain may be the issue.
- Is there any previous history of neck issues? An extensive history of neck injuries may predispose to referred shoulder pain. Whiplash for example consists of soft tissue injury in the cervical spine which can cause somatic referred pain into the shoulder.
- Is the shoulder joint clicking or clunking? Any shoulder joint pathology can cause symptoms such as clicking in the shoulder. This is often linked with the pain felt in the shoulder.
Steps to manage referred shoulder pain
- Figure out the nature of the pain – is it from a proper injury to any of the shoulder structures or is it referred pain from the neck? This is when seeing a physiotherapist is useful. They will perform a comprehensive assessment to figure out the nature of the injury.
- Regardless of whether it is a neck issue or a shoulder issue, some basic principles apply such as the RICE regime including relative rest by avoiding aggravating activities and icing the area of pain for desensitization.
- Apply the correct neck and shoulder posture. The head should sit nicely over the body and not protrude forwards. The shoulder blades should also be retracted and not sit rolled forwards. Correct positioning even during an injury ensures that you don’t make the injury worse by stressing the structures in unwanted positions.
- Maintaining gentle movement. Even in the presence of pain, some light movement is advised to avoid excessive stiffness. Light cardiovascular such as walking ensures the blood is continuously pumped to the injured area which can be a means of pain desensitization.
Are you suffering from referred shoulder pain? Pivotal Motion Physiotherapy is here to help! Located in Newmarket, Brisbane. Call us on 07 3352 5116 today for your appointment.