Persistent Shoulder and Neck Pain: When to Seek Neurology Care?

Shoulder and neck pain?

I have been experiencing shoulder and neck pain (without numbness, just a tight sensation and discomfort) for over four months.
I have tried physical therapy, traditional Chinese medicine, chiropractic care, and even massage, but my condition has not improved.
I am worried that there might be other underlying issues causing this.
Which specialist should I see in this situation? Would a doctor recommend an MRI? Thank you.

yu, 20~29 year old female. Ask Date: 2022/08/02

Dr. Jiang Junyi reply Neurology

Dear Miss Yu,
You mentioned that you have been experiencing "shoulder and neck pain (without numbness, just a tight feeling and discomfort) for over four months, and have visited rehabilitation, traditional Chinese medicine, and out-of-pocket chiropractic doctors..." Your symptoms may warrant consideration of fibromyalgia, which could be related to an imbalance of neurotransmitters in the central nervous system.
The primary symptoms of fibromyalgia include chronic widespread pain and tenderness.
Epidemiological studies indicate that the prevalence of fibromyalgia in the general population is 2-4%, with a higher incidence in females, with a female-to-male ratio of approximately 7:1, typically affecting individuals aged 30 to 50 years.
Clinically, there are no specific tests to definitively diagnose this condition; the primary task in diagnosis is to rule out other diseases with similar symptoms, such as inflammatory/degenerative arthritis, inflammatory myopathies, thyroid disorders, vitamin D deficiency, infections, etc.
Additionally, certain clinical conditions may coexist with fibromyalgia.
If possible, you may consider undergoing an MRI at your own expense to rule out peripheral nerve issues.
Nerve conduction studies can assess the conduction velocity and waveform of large fiber nerves.
Electromyography (EMG) can evaluate the muscle response in the areas supplied by the nerves.
I recommend that you consult a neurologist for further evaluation and follow-up.
Thank you for your inquiry, and feel free to discuss any related questions!
Wishing you good health, peace, and happiness.
Dr.
Jiang Junyi, Taoyuan Medical Center

Reply Date: 2022/08/02

More Info

Persistent shoulder and neck pain can be quite debilitating, especially when it lingers for several months without improvement. Given your description of the pain as a tight sensation without numbness, it’s essential to consider a few factors before determining the appropriate course of action.

First and foremost, it’s important to understand that persistent pain in the neck and shoulders can stem from various causes, including musculoskeletal issues, nerve compression, or even referred pain from other areas of the body. Since you have already sought treatment from rehabilitation specialists, traditional Chinese medicine practitioners, chiropractors, and massage therapists without significant relief, it may be time to consider a more comprehensive evaluation by a neurologist.

Neurologists specialize in diagnosing and treating conditions related to the nervous system, which includes the brain, spinal cord, and peripheral nerves. If there is a concern that your shoulder and neck pain may be related to nerve involvement, such as cervical radiculopathy (where a nerve in the neck is compressed or irritated), a neurologist can provide a thorough assessment. They may perform a neurological examination to evaluate your reflexes, muscle strength, and sensory function, which can help identify any underlying nerve issues.

Regarding the question of whether an MRI (Magnetic Resonance Imaging) is advisable, it can be a valuable diagnostic tool in this context. An MRI can provide detailed images of the soft tissues, including muscles, ligaments, and nerves, and can help identify any abnormalities such as herniated discs, spinal stenosis, or other structural issues that may be contributing to your pain. If your neurologist deems it necessary based on your clinical evaluation, they may recommend an MRI of the cervical spine to rule out any significant pathology.

In addition to imaging, the neurologist may also consider other diagnostic tests, such as electromyography (EMG) or nerve conduction studies, to assess the electrical activity of your muscles and the function of your nerves. These tests can help determine if there is any nerve damage or dysfunction that could be contributing to your symptoms.

It’s also worth noting that chronic pain can sometimes lead to psychological factors, such as anxiety or depression, which can further exacerbate the perception of pain. If your neurologist finds no significant physical cause for your symptoms, they may refer you to a pain management specialist or a psychologist who specializes in chronic pain management. This multidisciplinary approach can be beneficial in addressing both the physical and emotional aspects of persistent pain.

In summary, given the duration and persistence of your shoulder and neck pain, it would be prudent to seek an evaluation from a neurologist. They can help determine if there is an underlying neurological issue that requires attention and whether further imaging, such as an MRI, is warranted. Early intervention can be key in managing chronic pain effectively and improving your quality of life. Don’t hesitate to advocate for your health and seek the care you need to address your concerns.

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