Chronic Shoulder Pain Often Signals a Little-Known Nerve Condition

For weeks, Kirti had tried to carry on despite a persistent ache in her shoulder and upper arm.

But the pain was not the only thing troubling her. She was also experiencing a sudden ‘zinging’ sensation, like an electric shock travelling down her arm and, at times, reaching her little finger. When it began to frighten her, she made an appointment to see me.

After taking her medical history, I told her I wanted to examine her, beginning with her neck. She looked puzzled, as if I had misunderstood her entirely. The pain, she reminded me, was in her shoulder and arm – not her neck.

I had understood her. It is a question I hear frequently: why examine an area that does not hurt? The answer is that nerves follow interconnected pathways, meaning pain may be felt in one part of the body while its true source lies somewhere else.

In Kirti’s case, the origin was her neck. Wear and tear affecting the joints and discs of her spine had caused cervical radiculopathy – commonly known as a trapped or pinched nerve.

Most people are familiar with sciatica, in which an irritated nerve root in the lower back, often because of a disc problem, sends pain down the leg. Cervical radiculopathy is essentially the same process, but in the neck.

Nerve branches leave the spinal cord through narrow openings between the bones of the neck. When one of these nerve roots becomes compressed, inflamed or irritated, symptoms can appear anywhere along its route.

The result may be neck pain spreading into the shoulder, arm or hand. In some cases, however, the discomfort is felt only in the shoulder or arm and the neck feels completely normal.

Other symptoms can include pins and needles in the arm, hand or fingers, areas of numbness and, occasionally, weakness.

The condition becomes more common from middle age, and I see it repeatedly in middle-aged women. Over time, the joints and discs in the neck naturally deteriorate, sometimes narrowing the channels through which the nerves pass.

Modern habits can add to the strain. Hours spent hunched over a desk, looking down at a phone or holding it between the ear and shoulder all place extra pressure on the neck. Stress is another factor.

When we are tense, we tend to raise our shoulders and pull our necks into a ‘turtle’ position, with the head pushed forward as though emerging from a shell. Combined with ageing joints, that sustained tension can leave nearby nerves increasingly irritated.

So why is cervical radiculopathy so often overlooked? One reason is that people quite reasonably assume the source of pain must be the place where they feel it. Like Kirti, they may conclude they have a shoulder problem and tolerate the symptoms for weeks or even months.

If the examination is limited to the shoulder, the underlying neck problem may be missed. Nerve pain can also respond poorly to standard painkillers, leaving people with the impression that nothing will help.

Fortunately, most people improve with time. One of the most important steps is to keep moving.

When the neck is painful, the muscles around it automatically tighten in an attempt to protect the area – much as you might keep a painful wrist still. Unfortunately, that protective spasm can become painful in its own right.

As the muscles tighten, they compress the tiny blood vessels within them, reducing circulation. They can also pull on nearby joints and nerves, adding to the irritation.

Pain then encourages even less movement. The shoulders become rigid and turning the head feels unsafe. Although this may seem protective, it creates a vicious cycle: muscles and joints become stiffer and weaker, recovery slows, and tight muscles are more likely to go into spasm. The pain intensifies as a result.

Gentle movement performed regularly can help break that cycle by reducing stiffness, improving blood flow and easing tense muscles. The once-common advice to stay in bed is more likely to prolong the problem than solve it.

That doesn’t mean pushing through severe pain – just carrying on with normal life and doing simple exercises. Mild discomfort doesn’t mean you’re causing damage.

There are even a specific set of exercises that cervical radiculopathy patients are recommended.

Do them several times a day, ideally after a warm shower when the muscles are looser. Slowly tilt your ear towards your shoulder, hold for a few seconds, then repeat on the other side. Lower your chin to your chest, then slowly look up.

Turn your head to look over one shoulder, then the other. Pull your chin back into a double chin and hold. Add shoulder shrugs and rolls. Move slowly, and stop if anything sharply worsens your symptoms.

Another important step is to take regular breaks from sitting, and raise your computer screen to eye level to avoid hunching the shoulders.

Heat relaxes tight muscles and cold eases pain – so a heat patch or ice pack, each for about 15 minutes, can help ease some of the uncomfortable symptoms.

Research suggests that managing stress matters to avoid the strain it puts on the joints. This is, of course, often easier said than done.

But relaxation, mindfulness, exercise and good sleep all ease the tension that makes us hunch and clench.

What I’d absolutely avoid is a neck brace or collar. They weaken muscles and prolong stiffness.

If symptoms haven’t improved after a few weeks, or you have weakness, see your GP, who may refer you to a physiotherapist.

In particularly severe cases, patients might be offered injections of local anaesthetic, often with steroid, into tight, tender knots in the muscle can help you get moving again, or steroid injections around the nerve root to reduce inflammation, which can make rehab easier.

Most neck pain is painful but not serious. But see a doctor if you have increasing weakness in your arm or hand, spreading numbness, pain that keeps worsening, or pain after an injury. In rare cases, this can be something serious like cancer.

Thankfully, for Kirti, the problem was indeed cervical radiculopathy and, with the right exercises sustained over several weeks, eventually solved.

But it worries me that so many patients are dealing with this exact injury without doing anything about it. So, if you have shoulder or arm pain, it’s always worth seeing your GP. Suffering like this is needless.