Neck & shoulder pain has become the third most common cause of musculoskeletal visits in primary care. The majority of working professionals seem to be affected by this condition. Fast-paced environment & continuously sitting in the same position for prolonged hours may lead to several back & neck problems. Self-reported prevalence of neck &shoulder pain is between 25% &40%. The mobility of neck & shoulder depends on the coordination of musculoskeletal structures & ligaments. Repetitive motion, injury & stress can make them vulnerable. Several health studies have proven that people who spend more than 60 % of their time sitting in front of a computer are at a higher risk for neck & shoulder pain.
Shoulders & Neck comprise various bones, muscles, nerves, arteries, veins as well as other ligaments & supporting structures. The shoulder is a ball & socket joint providing a range of motion whereas, the neck is the most flexible part of human body. Various conditions causing instability & weakness in the neck & shoulder region can lead to discomforting pain. Any major trauma or simply stress can aggravate the pain.
Injuries to delicate tissues & ligaments within the neck & shoulder region are the most common cause of neck & shoulder pain. Sometimes, degenerative arthritis of the cervical spine can compress the nerves resulting in severe neck & shoulder pain. The following unusual conditions involving lungs, heart & spinal cord may also lead to neck & shoulder pain.
• Damaged Collarbone -When patient’s collarbone is broken due to falling from a height or an accident.
• Fractured Shoulder Blade – An injured shoulder blade can cause severe neck & shoulder pain.
• Heart Attack – Heart attacks can also lead to shoulder & neck pain. The condition is termed as ‘referred pain’.
• Stiff Bursae-When Bursae become rigid & painful due to injuries.
• Tendonitis -The tendons join the bones &muscles. Tendons can become inflated due to high strain & may result in harsh pain. This condition is known as ‘tendinitis.
• Sprain in Rotator Cuff – A group of tendons which Cushions & supports the shoulder joint is known as the rotator cuff. Rotator cuff injuries can cause severe pain in neck & shoulder region.
The most common risk factors for neck & shoulder pain are listed below.
• Heavy lifting
• Carrying luggage or excessive weight
• Strenuous work
When not treated properly on time, neck & shoulder pain can lead to several serious conditions. The primary signs & symptoms of neck & shoulder pain include the following.
• Swollen glands
• Severe neck & shoulder pain without apparent cause
• Lump in the neck region
• Difficulty in breathing
• Trouble swallowing
• Tingling sensation
• Pain that spreads arms or legs
• Inability to touch the chin to chest
• Inability to move neck
• Stiffness in Shoulder region restricting the range of motion
• Bowel / bladder dysfunction
If the above-mentioned symptoms do not dissolve with self-care measures &remain for a longer duration, then patients must contact orthopedic surgeons.
Persisting neck & shoulder pain can be distressing. Orthopedic surgeons may recommend the following imaging tests to patients for diagnosing the severity of neck & shoulder pain.
• X-Ray Test– Orthopedic surgeons may recommend x-ray tests for identifying the root cause of neck & shoulder pain. It can reveal the degree of narrowing of spinal cord, fractures & spinal instability.
• CT scan-When x-rays are not sufficient in detecting the condition, doctors may order CT scan test. It provides a better clarity & aids in precise diagnosis.
• Magnetic Resonance Imaging (MRI) Scan – An MRI scan can detect the nerve-related aspects. It is helpful in determining the comprehensive view of internal structures such as inflamed ligaments & tendons.
• Electro-Diagnostic Studies – Nerve conduction velocity (NCV)&electromyography (EMG)may help in diagnosing the reason for weakness & pain in shoulder & neck area of the patients.
Patients must follow the below guidelines while preparing for an initial consultation with an orthopedic surgeon.
• Signs & Symptoms – Orthopedic surgeons may ask the patients about their experiences signs & symptoms. Patients should make a list of all the major symptoms before going to the clinic.
• Injury – If patients have suffered from any vital injury in the past, they should frankly discuss the whole episode with the surgeons. The injury may be the possible cause behind the development of severe neck & shoulder pain.
• Medications – Patients should note down the names of all medicines, drugs or vitamin supplements which they consume on a regular basis. Orthopedic surgeons may allow or discontinue some of them.
• Severity of Pain – Surgeons may ask the patients to rate their pain on a scale of zero to ten. It will help the surgeons understand the level of patient’s discomfort.
• Home Remedies – Patients should make a list of self-care remedies that they have already tried at home.
Depending on the results of diagnosis & consultation, surgeons will decide a suitable treatment for the patients.
It is important for the patients to understand the complete treatment procedure. Patients may take help of the following questions in order to clear their doubts & concerns related to the treatment.
• What is my current health status?
• Is my condition serious?
• What factors are responsible for my condition?
• What are the available treatment options?
• What is the most suitable treatment for me?
• Are there any medications which can provide complete pain relief?
• What are the potential side-effects of these medications?
• Will physical therapy & essential exercises help me?
• Will acupuncture & massage therapy helpful in alleviating the pain?
• What is the result of my diagnosis?
• Do I need surgery? What are the potential risks & complications related to the suggested surgery?
• Will I be able to live a pain-free life following the neck & shoulder pain surgery?
• How much time will it take for me to recover completely?
• What measures can I take to get complete relief from neck & shoulder pain?
Additionally, patients can discuss the serious complications associated with the recommended treatment procedure.
Neck & shoulder pain can be caused due to a variety of reasons. If the pain has resulted due to mild injury, patients can initiate self-care plan at home for treating it. Patients can perform the following set of measures at home.
• Adequate Rest -Sufficient amount of rest can help in healing the injured/fractured area. It is highly recommended that patients should not exert themselves & take ample rest.
• Hot Pack /Cold Pack -Patients can apply hot packs or cold packs for soothing the inflated neck & shoulder region.
• Gentle Massage – Patients can gently massage the neck & shoulder area. Severe pain can be relieved by appropriate messaging techniques.
• Special Pillow – Patients should use a special neck pillow to reduce the stress while sleeping.
If these measures don’t seem to reduce the inflammation & pain around the neck & shoulder region, patients should consult a surgeon. Surgeons may begin with primary treatment methods which include the following.
• Pain Relievers -Orthopedic surgeons may recommend naproxen (Aleve) or ibuprofen (Advil or Motrin) for alleviating the harsh neck & shoulder pain.
• Anti-depressants & Muscle Relaxers – Some muscle relaxers & antidepressants may also be helpful in relieving the sharp pain.
• Corticosteroid Injections – Depending on patient’s health condition, corticosteroid injections may be suggested by the orthopedic surgeons for alleviating the shoulder pain.
• Acupuncture Therapy – It has been observed that acupuncture therapy provides a large number of benefits. Surgeons may advise acupuncture therapy to patients.
• Physical Therapy – Physical therapy & exercises may be helpful for the patients with severe neck & shoulder pain. Patients can perform light exercises under the guidance of orthopedic surgeons.
In the worst scenario, where these treatments fail to provide relief then surgery may be considered. The enumerated surgeries may prove to be favorable.
• Cervical Disc Replacement -Cervical spine is composed of seven bones.If neck pain has occurred due to rupturing of a cervical disc, then surgeons may recommend cervical disc replacement surgery. In this procedure, the impaired cervical disc is replaced by an artificial disc. It helps in restoring the mobility of patient’s neck & relieving the neck pain.
• Spinal Fusion Surgery – A spinal fusion surgery is useful in helping to relieve the intense neck pain caused by a number of spinal diseases or disorders. The procedure aims to join or fuse, together two or more adjacent vertebral that have been affected by an injury or a disease. By connecting together vertebra the motion of the discomforting vertebra is restricted& the patient gets relief.
• Shoulder Replacement Surgery -During a shoulder replacement surgery, damaged parts of shoulders are removed & replaced with a prosthesis which is basically artificial components made of different materials. This surgical procedure minimizes the sharp shoulder pain to a great extent.
• Shoulder Arthroscopy -An arthroscopic shoulder surgery is used to treat the orthopedic condition which results in the shoulder becoming painful & stiff. It is a minimally invasive surgical treatment for restoring movement in a shoulder joint affected with frozen shoulder syndrome.
The majority of patients gets relief from their persisting neck & shoulder pain from the surgical procedure. It may take up to 4 months for a complete recovery. Patients should continue strengthening exercises & physical therapy till they become absolutely fit. Regularly visiting the orthopedists will ensure a speedy recovery. Patients who faithfully follow the guidelines of their surgeons & regularly perform recommended exercises prescribed by the physical therapist will have the best clinical outcome after the neck & shoulder pain surgery.
Several risks & complications that may follow the surgery for neck & shoulder pain is listed below.
• Unusual bleeding
• Wound infection
• Severe headache
Patients should not stress as these complications can be smoothly handled by the respective orthopedic surgeons.
The success rate of the majority of surgeries performed for treating neck & shoulder pain is usually high. It is essential that patients follow a healthy lifestyle following the surgery. The neck is a fragile part of body & thus needs good care. Patients must adopt proper posture while sleeping, standing or merely sitting.Light exercises will also enhance the muscle strength around neck & shoulder. Proper lifestyle will help in maintaining the outcomes of surgery for a longer period of time & will help to control further neck & shoulder complications.
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