Pain in your neck and shoulders can come from many different conditions and injuries, such as Thoracic Outlet Syndrome or rotator cuff injuries. Due to the complicated and intricate nature of your neck and shoulders, it is common for an injury or disorder that affects one to affect the other. Issues can arise in the shared bones, nerves, connective tissues, and muscles in the area.
Causes of Neck and Shoulder Pain
There are a variety of underlying causes that commonly affect your neck and shoulders. Your neck and shoulder pain may have originated in one area and extended into the other. Below are some common reasons for neck and shoulder pain.
Poor Posture
The simplest cause of neck and shoulder pain is poor posture. Making sure you sit up straight can help reduce the strain on your neck and shoulders. If you work a desk job, you can develop slumped shoulders and a rounded back due to poor posture while sitting.
Poor posture can also lead to forward head posture, where the muscles in your neck shorten over time and cause you to look more downwards over time. This makes it harder for you to look up when you need to see in front of you without creating more posture issues and pain.
Broken Collarbone
Your collarbone, or clavicle, extends from the top of your sternum to the outer tip of your shoulder blade. When you break your collarbone, you experience pain and loss of function in your arm and shoulder, and the pain can extend into your neck through the soft tissues that connect your shoulder and neck.
Broken collarbones or clavicle fractures commonly occur from falling on your shoulder or an outstretched arm. If you have recently had a fall or other trauma to your shoulder, make sure to talk to a doctor to assess the damage and make a recovery plan.
Soft Tissue Damage
Your neck and shoulder is made up of soft tissues, nerves, and bones. The soft tissues in your shoulder and neck consist of the muscles, tendons, ligaments, and fascia that can be the primary source of pain or affected by pain in your bones and joints.
A common cause of soft tissue damage is whiplash, which can cause muscle strain or a ligament sprain that creates pain and restricted movement in your neck and shoulder. When you experience trauma to your neck, you may experience weak muscles in your shoulder and vice versa.
Rotator Cuff Injury
Your rotator cuff is a group of connective tissues and muscles that keep your arm in your shoulder socket. When your rotator cuff is injured, the tendons and muscles are torn and cause pain in your shoulder and neck when you try to move your arm. Rotator cuff injuries are caused through sports injuries or repetitive motion wearing down the tissues.
Pericarditis
Pericarditis is an example of an issue that occurs outside of your neck and shoulders but has symptoms that manifest as pain in your neck and shoulders. Pericarditis is the inflammation of your pericardium, which is the sac that surrounds your heart. If you notice that the pain also extends to your chest when you breathe, make sure to reach out to your doctor to evaluate your symptoms and see if you have pericarditis.
Cervical Radiculopathy
Pain from cervical radiculopathy occurs when your spinal nerve roots become compressed or irritated. Symptoms that point to cervical radiculopathy include:
- Impaired reflexes
- Headaches towards the back of your head
- Sharp or tingling pain in your neck, shoulder, arm or hand
- Sharp or aching pain when looking up
- Numbness
- Weakness
Cervical radiculopathy can occur due to anything that aggravates or comes in contact with your spinal cord, such as herniated discs or bone spurs.
Shoulder Bursitis
Shoulder bursitis occurs when bursa, a small fluid sac that cushions between bones and soft tissues, in your shoulder become inflamed due to injury, disease, or infection. As a result, you may experience stiffness, swelling, or pain in your shoulder joint and potentially your neck.
Shoulder Impingement Syndrome
As a result of a rotator cuff injury, you may have shoulder impingement syndrome where your shoulder tendons become compressed against the acromion (a prominent bony portion) in your shoulder. Shoulder impingement syndrome occurs specifically with repeated overhead movements in addition to the typical causes of rotator cuff injuries.
Pleurisy
Another condition that manifests in your neck and shoulders while occurring in another art of your body is pleurisy. Pleurisy occurs when the lining of your chest cavity and lungs swells and causes pain when you take a deep breath. You may also experience fever, cough, sudden chest pain while coughing, and shortness of breath.
Thoracic Outlet Syndrome
Another potential cause of your neck and shoulder pain could be Thoracic Outlet Syndrome, which has overlapping symptoms with multiple other conditions. Thoracic Outlet Syndrome is a group of three disorders that affects the nerves and blood vessels in your lower neck and upper chest. You can have any type of Thoracic Outlet Syndrome in one or both of your shoulders with the following symptoms:
- Pain in your shoulder, arm, hand, or fingers
- Tingling or “pins and needles” feeling in your shoulder or arm
- Numb or weak feeling arms and shoulders
- Swelling or heaviness in arms or shoulders
- Pale or cool to the touch skin
What is Thoracic Outlet Syndrome?
Thoracic Outlet Syndrome (TOS) occurs when the nerves, arteries, and veins in your upper chest and lower neck become compressed. This area is called the thoracic outlet and it is formed by the top ribs in your body creating the opening between your chest and neck.
Symptoms of Thoracic Outlet Syndrome are caused by the compression of specific nerves and blood vessels in the thoracic outlet. There are three main components of the thoracic outlet that, when compressed, cause negative symptoms:
- Subclavian Artery: supplies blood to your arm below your collarbone
- Subclavian Vein: drains blood from your arm and back to your heart from deep underneath your clavicle
- Brachial Plexus: a nerve network connected to the spinal cord through your neck and shoulders that controls movement and feeling in your arms, shoulders, hands, and forearms
There are three types of Thoracic Outlet Syndrome that each come with differences in symptoms according to the compression location. These types are called Neurogenic TOS, Venous TOS, and Arterial TOS. TOS can affect one or both sides of your body, and it is possible to have more than one type of TOS at a time.
Neurogenic Thoracic Outlet Syndrome
When you are diagnosed with neurogenic Thoracic Outlet Syndrome, it means that a nerve in your brachial plexus is compressed. This can affect the feeling and movement from the top of your shoulder down to your fingertips. Neurogenic Thoracic Outlet Syndrome is the most common type of TOS.
A key symptom of neurogenic Thoracic Outlet Syndrome is “Gillian-Sumner hand”, which occurs when you have severe weakening in the base of your thumb. In addition to Gillian-Sumner hand, you may experience:
- Cold hands
- Dull aching pain in your neck, shoulder, or armpit
- Change in skin color
- Feeling of “pins and needles” in your fingers and hands
Venous Thoracic Outlet Syndrome
Venous Thoracic Outlet Syndrome is much more rare than neurogenic TOS, with venous TOS accounting for 3-5% of cases. When your subclavian vein is compressed in venous Thoracic Outlet Syndrome, your blood cannot drain from your arm efficiently. This can cause blood clots to form in the vein, which can further block the artery and create the risk of a pulmonary embolism.
Symptoms of venous Thoracic Outlet Syndrome mainly affect your arms, but it is not limited to just that area. Potential symptoms include:
- Pale skin
- Weakness in your arm or neck
- Weak or absent pulse
- Low temperature
- Numbness
- Tinling
- Aching
- Swelling
Arterial Thoracic Outlet Syndrome
If your subclavian artery is compressed, you have the most rare case of TOS: arterial thoracic artery syndrome. Only 1-2% of cases are arterial, and in these cases it is possible for damage to the inner layer of your artery to occur. Due to this damage, you can have an increased risk of an aneurysm and blood clots. Lodged blood clots and create further damage to your vessels.
All symptoms of arterial Thoracic Outlet Syndrome occur in your hands and fingers. These symptoms include:
- Sensitivity to cold
- Change in skin color
- Poor blood circulation
- Swelling
- Heaviness
- ”Pins and needles” sensation
- Numbness
Causes of Thoracic Outlet Syndrome
There are numerous causes for TOS, and TOS is more common in women between the ages of 20 and 50. Potential causes for TOS include:
- Physical trauma
- Repetitive arm and shoulder movements
- Tumors pressing on nerves
- Swollen lymph nodes
- Anatomical defects
Diagnosing Thoracic Outlet Syndrome
When seeking a diagnosis for TOS, you should expect imaging studies, physical exams, nerve conduction studies, and electromyography to determine if you have TOS or another diagnosis with similar symptoms. You may be diagnosed with another disorder that has symptoms similar to TOS, such as:
- Multiple sclerosis
- Fibromyalgia
- Rotator cuff injuries
- Cervical disc disorders
- Tumors on your syrinx or spinal cord
- Complex regional pain syndrome
There are symptoms you can experience during a physical exam that can lead to a Thoracic Outlet Syndrome diagnosis. Your doctor will look out for tenderness around your collarbone or clavicle and the hollow of your neck, weakness in your fifth “little” finger, a weak or “pins and needles” sensation in one or both of your hands when raised, and pale skin in raised hands. These symptoms can be physical representations of Thoracic Outlet Syndrome that can expedite your diagnosis process.
Another test your doctor might try is a muscle block in specific muscles in your neck and upper chest called the anterior scalene and pectoralis minor. Your doctor will inject a local anesthetic into these muscles to see if your symptoms are alleviated. If the test is successful, your doctor will know that there is something compressing your nerves or blood vessels in those muscles and can investigate further to determine a further treatment plan.
Treatments for Thoracic Outlet Syndrome
You can treat Thoracic Outlet Syndrome in different ways depending on your symptoms and the type of TOS you are diagnosed with. TOS is commonly treated through physical therapy, pain medications, blood clot prevention medications, and surgery.
Physical Therapy
Physical therapy is where treatment for Thoracic Outlet Syndrome frequently starts. Exercises in physical therapy aim to restore normal posture, strengthen your chest muscles, and relieve pressure by opening up your thoracic outlet where your nerves pass through.
Lifestyle Changes
Depending on what caused your Thoracic Outlet Syndrome, there are lifestyle changes you can make to reduce the frequency of your symptoms. Practicing relaxing techniques, modifying your work space to improve your posture, avoiding repetitive motion-based activities, and losing weight can make an excellent start towards a healthier lifestyle with less TOS symptoms.
Medications
Medications can also be used to alleviate Thoracic Outlet Syndrome symptoms. Over- the-counter pain relievers can reduce pain and inflammation in the area. Once you have spoken to a doctor, they may prescribe medications to break up or prevent blood clots from forming in your body.
Surgery
In some cases, you may require surgery to address your Thoracic Outlet Syndrome symptoms. The surgery method you need will depend on the type of TOS you have. If you have venous or arterial TOS, you may need surgery to repair your blood vessels to increase your blood flow. Decompression surgery can help remove growths that can be compressing on nerves or veins like with neurogenic TOS.
Can Thoracic Outlet Syndrome be Cured?
In most cases, Thoracic Outlet Syndrome can be successfully treated through physical therapy, surgery, and lifestyle changes. There are some cases of people experiencing recurrent symptoms after their initial treatment, but an additional round of treatment can help relieve symptoms further.
Treatments for Neck and Shoulder Pain
To treat neck and shoulder pain, you can take advantage of a few common at-home remedies first.
Make sure to properly rest your neck and shoulder and avoid any activities that can make the pain worse. You can also use an ice pack to reduce swelling or a heating pad to loosen tight muscles.
Try to gently stretch or massage the area to relieve tension, and if that causes additional pain opt to immobilize your neck or shoulder with a sling or brace. Some over-the-counter pain medications may also help manage pain and swelling.
If your symptoms persist despite your efforts at home, talk to your doctor about other treatments. Your doctor may suggest corticosteroid injections or physical therapy.
Corticosteroid injections help reduce inflammation that can be causing discomfort in the area. Physical therapy can be beneficial if you have had a reduction in your range of motion, as it aims to improve your range of motion, muscle strength, and posture.
Thoracic Outlet Syndrome Treatment at The Surgical Clinic
If you have been diagnosed with Thoracic Outlet Syndrome or are concerned that you might be experiencing symptoms, The Surgical Clinic in Middle Tennessee has a team of vascular surgeons ready to help take care of you. Let us create a treatment plan that gets you back to doing what you love.
Click here to find your surgeon and book an appointment for individualized care.