Signs of Referred Shoulder Pain
If I had a nickel for every time I fixed someone’s shoulder pain in just two visits after they’d seen multiple clinicians for over a year with no improvement, I’d have 10 cents. But still—twice? That’s wild. And in both cases, the same mistake had been made: they were being treated at the wrong joint. Their shoulder pain wasn’t coming from the shoulder at all. I showed them a few simple neck stretches, and just like that, the shoulder pain disappeared.
Unless there’s a clear traumatic injury that’s isolated to the shoulder, I always screen the neck first. Some people find this strange—understandably. If your shoulder hurts, it seems obvious that the shoulder must be the problem. But it stops seeming obvious after you’ve gone through shoulder PT, gotten injections, or even had surgery, and your pain is still there.
When patients with referred pain finally find me and get better (usually not in two visits, but hey—those 10 cents), they’re always glad I insisted on screening their neck. When people without referred pain come in, they usually feel a little unsure while I assess their neck, but they feel validated once it turns out their shoulder really is the problem and we move forward with shoulder treatment.
A stiff neck or a bulging disc can refer pain surprisingly far—sometimes all the way down to the elbow, even without direct nerve compression. Some people with referred pain have obvious neck discomfort. Others don’t. The only way to be 100% sure whether your neck is referring pain to your shoulder is to treat the neck and see if it affects the shoulder.
The good news? If the pain is coming from your neck, you will improve with the right treatment.
Every now and then, someone already knows their neck has issues but believes it’s beyond help. The pain has lasted so long, they see it as a lost cause. They ask me to skip treating the neck and just focus on the shoulder instead. As someone specially trained in neck treatment, that’s hard to hear—because in most of those cases, they just haven’t received the right treatment yet. I’ve seen how often patients give up after being failed by clinicians who didn’t know what to look for or how to help.
These are three signs that may suggest your shoulder pain is actually coming from your neck:
- The location of the pain changes. For example, the pain is sometimes in the back of the shoulder, sometimes in the front, or sometimes on the side. This is especially worth noting if the pain travels up toward your neck or down into the shoulder blade area.
- The pain is between joints. This could mean it sits somewhere between the shoulder and the elbow (like a few inches down the side of your upper arm), or between the shoulder and the neck (like the top or back of the trapezius muscle). While shoulder pain can sometimes refer to these areas, pain between joints increases the chance that it’s coming from the neck.
- You’ve already been treating your shoulder for a while with little to no improvement.
And then there are the screaming signs—the red flags that strongly suggest referred symptoms from the neck. These don’t have to be present, but when they are, I can’t help but silently judge any clinician who missed them:
- The pain switches sides, from one shoulder to the other. Some people assume they’re overcompensating and irritating the other shoulder. But in reality, the pain might be coming from the joint in between—your neck.
- The pain travels to or past your elbow. Shoulder issues almost never cause pain that far down the arm.
- The pain is accompanied by nerve symptoms like numbness, tingling, or shooting sensations. While it’s possible for nerve compression to occur in the shoulder or arm, in my experience, the neck is the culprit 90% of the time.
So how did I get good at identifying and treating referred pain from the neck? After earning my DPT, I completed an additional 112 hours of advanced training in the McKenzie Method—also known as MDT (Mechanical Diagnosis and Treatment). This evaluation and treatment system was developed in New Zealand and is now used worldwide for its effectiveness in treating spinal issues.