Shoulder and Neck Stiffness: When to See a Specialist

Symptoms of shoulder and neck stiffness?

Hello Doctor, I have been experiencing sharp pain in my shoulder for several years.
Later, I developed numbness in a patch of skin, and my neck became stiff and slightly swollen.
The side of my face and my eyes feel weak.
I initially thought it was myasthenia gravis, but all tests came back normal.
Now, whenever I close my left eye, my right eye starts to close slowly unless I force it open.
Otherwise, it functions normally.
Additionally, I cannot turn my head to the right while sleeping, and I experience coughing and difficulty breathing.
My entire shoulder, neck, and back feel tight, and my right side feels strange.
X-rays of my cervical spine also appear normal.
Should I consult a neurologist or a neurosurgeon for these symptoms?

Wen, 20~29 year old female. Ask Date: 2016/07/28

Dr. Zhang Junwei reply Neurosurgery

Yes, please consult neurosurgery.

Reply Date: 2016/07/28

More Info

Based on your description, it sounds like you are experiencing a complex set of symptoms that may involve multiple systems, particularly the musculoskeletal and neurological systems. The symptoms of shoulder pain, neck stiffness, skin numbness, and facial weakness you are experiencing can be indicative of several underlying conditions, and it is crucial to approach this systematically.

Understanding Your Symptoms
1. Shoulder Pain and Stiffness: Chronic shoulder pain can arise from various issues, including rotator cuff injuries, bursitis, or even referred pain from cervical spine problems. Given your history of shoulder pain and the fact that it has persisted for years, it is essential to consider whether there might be a rotator cuff tear or impingement syndrome, which can lead to significant discomfort and functional limitations.

2. Neck Stiffness and Numbness: The stiffness in your neck and the numbness in the skin could suggest cervical radiculopathy, where a nerve in the neck is compressed or irritated, leading to pain, weakness, or numbness radiating down the arm. This can be caused by degenerative changes in the cervical spine, such as herniated discs or spondylosis.

3. Facial Weakness and Eye Closure Issues: The symptoms you describe regarding your eyelid and facial weakness could be related to neurological issues. Conditions such as Bell's palsy or other cranial nerve dysfunctions could manifest in this way. The fact that you have difficulty closing one eye and that it seems to be related to your neck and shoulder issues suggests a possible connection that should be evaluated.

4. Breathing Difficulties and Coughing: If you are experiencing difficulty breathing or coughing, this could be a sign of a more serious condition that requires immediate attention. It is essential to rule out any respiratory issues or other systemic conditions that could be contributing to your symptoms.

When to See a Specialist
Given the complexity of your symptoms, it is advisable to see a specialist who can provide a comprehensive evaluation. Here are some recommendations:
- Neurologist: A neurologist can assess your neurological symptoms, including the facial weakness and eyelid issues. They may perform tests such as an MRI of the brain and cervical spine to rule out any central nervous system issues.

- Orthopedic Surgeon or Sports Medicine Specialist: If your primary concern is the shoulder and neck pain, an orthopedic specialist can evaluate your musculoskeletal system. They may recommend imaging studies such as MRI or CT scans to assess for rotator cuff tears, cervical disc herniation, or other structural problems.

- Physical Therapist: A physical therapist can help with rehabilitation and strengthening exercises for your shoulder and neck. They can also provide modalities for pain relief and improve your range of motion.

Conclusion
In summary, your symptoms warrant a thorough evaluation by both a neurologist and an orthopedic specialist. It is crucial to address each symptom comprehensively, as they may be interconnected. Early intervention can prevent further complications and improve your quality of life. If you experience any acute changes, such as worsening pain, sudden weakness, or breathing difficulties, seek immediate medical attention.

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