Neck and Shoulder Stiffness: Finding the Right Specialist

Q: Neck and Shoulder Stiffness: Finding the Right Specialist

Hello： Indeed, issues related to the cervical spine can be addressed by various specialties, including Physical Medicine and Rehabilitation, Neurology, Neurosurgery, Pain Management, and Orthopedics. <br>Although these specialties are diverse, the choice depends on what specific

Shoulder and neck stiffness with an unconscious tendency to hunch the body, feeling of restricted blood flow?

Hello Doctor, a few months ago I started experiencing a tingling sensation in one of my eyes, as if blood flow was not very smooth, and I occasionally saw "stars" for a few seconds.
The timing of these episodes is unpredictable.
To identify the issue, I visited an ophthalmologist several times, but there was no improvement.
I was then referred to a neurologist, and I have gone back and forth between these two specialties multiple times without any alleviation of symptoms or a clear diagnosis.
The neurologist suspects that my symptoms may be related to high stress and anxiety, and suggested that I keep a record of when the symptoms occur, as neurological issues typically present with persistent symptoms, which I do not have.

After I started keeping a record, I also switched to a slightly lower pillow and noticed a reduction in the frequency of seeing "stars." Additionally, I realized that I tend to hunch my shoulders and neck, and I feel more anxious and fatigued, especially when looking down or changing positions.
During a visit to a traditional Chinese medicine practitioner for body adjustment, it was noted that the cervical vertebrae on the side where I see "stars" were misaligned, leading to poor blood circulation.

Since I am unsure which Western medical specialty to consult, I searched online and found recommendations to see rehabilitation medicine, neurology, pain management, and orthopedics, all of which seem necessary.
I am truly uncertain about which specialty I should start with.
If it is indeed a cervical spine issue, will I need to keep going back and forth among these specialties? I apologize for the lengthy message, and thank you for reading, Doctor.

Kunhuo de ren, 20~29 year old female. Ask Date: 2023/02/12

Dr. Lin Zhebin reply Family Medicine

Hello: Indeed, issues related to the cervical spine can be addressed by various specialties, including Physical Medicine and Rehabilitation, Neurology, Neurosurgery, Pain Management, and Orthopedics.
Although these specialties are diverse, the choice depends on what specific aspect you wish to address.
Here are some examples: 1.
If you want to undergo further examinations of the cervical spine (such as MRI or nerve conduction studies), I would recommend visiting a Neurologist.
2.
If you prefer to try rehabilitation instead of surgery for your cervical spine issues, I would suggest seeing a Physical Medicine and Rehabilitation specialist.
3.
If you want to quickly alleviate shoulder and neck discomfort without surgery, I would recommend consulting a Pain Management specialist, which can be effective for short-term symptom relief; however, long-term solutions should still consider rehabilitation or surgery.
4.
If you are considering surgery for your cervical spine issues, I would advise seeing a Neurosurgeon or Orthopedic Surgeon.
In summary, based on your description, it seems you have not yet undergone further examinations related to the cervical spine, so I would suggest starting with a visit to either a Neurologist or a Physical Medicine and Rehabilitation specialist.

Reply Date: 2023/02/12

More Info

Hello,
Thank you for sharing your concerns regarding your symptoms, which seem to be quite complex and multifaceted. Based on your description, it appears that you are experiencing a combination of neck stiffness, shoulder discomfort, and visual disturbances, which have been persistent and have not improved despite consultations with various specialists.
From a medical perspective, the symptoms you are experiencing could be related to several underlying issues, including cervical spine problems, muscle tension, anxiety, or even vascular issues. The fact that you have experienced visual disturbances, such as seeing "stars," could indicate transient ischemic episodes or other neurological concerns, which is why the neurologist suggested keeping a symptom diary. This is a useful approach as it can help identify triggers or patterns associated with your symptoms.

Given your situation, it would be advisable to start with a specialist who can address the most likely underlying cause of your symptoms. Here are some recommendations:
1. Physical Medicine and Rehabilitation (PM&R): A rehabilitation specialist can assess your musculoskeletal system, including your neck and shoulder, and determine if there are any issues related to muscle tightness, posture, or cervical spine alignment. They can also provide you with exercises and therapies to improve your condition.

2. Orthopedic Specialist: If there is a suspicion of structural issues with your cervical spine, such as herniated discs or degenerative changes, an orthopedic doctor specializing in spine health can perform a thorough evaluation and recommend imaging studies like an MRI if necessary.

3. Neurologist: Since you have experienced neurological symptoms, continuing to work with a neurologist is important. They can help rule out any serious neurological conditions and provide insights into how stress and anxiety may be contributing to your symptoms.

4. Pain Management Specialist: If your symptoms are significantly affecting your quality of life, a pain management specialist can help you manage pain through various modalities, including medications, physical therapy, and possibly injections.

5. Chiropractor or Osteopath: If you suspect that your neck is misaligned, a chiropractor or osteopathic physician may provide manual adjustments to help restore proper alignment and improve blood flow.

As for your concern about bouncing between different specialists, it is common for patients with complex symptoms to see multiple providers. However, it may be beneficial to have a primary care physician or a specialist coordinate your care. This can help streamline the process and ensure that all aspects of your health are being considered.

In addition to seeking medical advice, consider lifestyle modifications that may alleviate your symptoms. These include:
- Posture Correction: Ensure that your workstation is ergonomically set up to reduce strain on your neck and shoulders.

- Stress Management: Engage in relaxation techniques such as yoga, meditation, or deep breathing exercises to help manage anxiety.

- Regular Exercise: Gentle stretching and strengthening exercises can improve flexibility and reduce muscle tension.

- Adequate Sleep: Ensure that your sleeping position supports your neck and spine properly. A supportive pillow can make a significant difference.

In conclusion, I recommend starting with a physical medicine and rehabilitation specialist or an orthopedic doctor who can evaluate your neck and shoulder issues. They can guide you on whether further evaluations or referrals to other specialists are necessary. Keeping a detailed record of your symptoms, as suggested by your neurologist, will be invaluable in your consultations.
I hope this information helps you navigate your healthcare journey, and I wish you a speedy recovery. Please feel free to reach out if you have further questions or concerns.

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