Chronic Neck and Shoulder Pain: When to Seek Specialized Care?

Q: Chronic Neck and Shoulder Pain: When to Seek Specialized Care?

Hello Lucy035： Based on your description, it appears to be nerve root compression. <br>If rehabilitation treatment is ineffective and the pain is unbearable, it is recommended to go to a major hospital for further examination. <br>Additionally, for neck pain, if treatment with th

Neck and shoulder pain for several months?

Hello Doctor, I have been experiencing pain in my right shoulder that prevents me from raising my arm.
I visited a rehabilitation clinic, and the doctor diagnosed it as a rotator cuff strain.
After rehabilitation, my condition improved, but then I started having pain in my neck that radiates to the inner side of my left shoulder.
An X-ray revealed that I have a straightened cervical spine.
Although switching to a supportive cervical pillow has helped my shoulder, when the pain flares up, the pillow's support position causes neck pain and numbness.
I find it more comfortable to lie flat on the bed without any pillow.
Additionally, my neck often makes cracking sounds when I turn it.
Since the onset of my right shoulder pain, I have been experiencing various shoulder and neck symptoms for six months, and I have been undergoing rehabilitation for three months.
The rehabilitation therapist at the clinic suggested that I visit a larger hospital, while other therapists believe I can continue traction therapy at the clinic.
Should I go to a larger hospital for treatment? Would it be more beneficial for me to see a specialist in the rehabilitation department or the neurology department at the hospital? Thank you.

Lucy035, 20~29 year old female. Ask Date: 2023/07/12

Dr. Lin Ruixiang reply Rehabilitation

Hello Lucy035: Based on your description, it appears to be nerve root compression.
If rehabilitation treatment is ineffective and the pain is unbearable, it is recommended to go to a major hospital for further examination.
Additionally, for neck pain, if treatment with three different medications for more than three months does not result in improvement, localized injection therapy is advised.
The Hualien Hospital of the Ministry of Health and Welfare cares about your health.

Reply Date: 2023/07/12

More Info

Chronic neck and shoulder pain can significantly impact your quality of life, and it’s essential to understand when to seek specialized care. Based on your description, it seems you have been experiencing persistent pain for six months, which has evolved from a shoulder issue to neck pain and discomfort radiating to the left shoulder. This progression of symptoms, especially following a diagnosis of a rotator cuff strain and subsequent neck issues, warrants careful consideration.

Firstly, it’s important to recognize that neck and shoulder pain can stem from various underlying conditions, including muscle strains, cervical spine issues, nerve compression, or even referred pain from other areas. The fact that you have already undergone rehabilitation and have seen some improvement suggests that conservative management can be effective, but the persistence and evolution of your symptoms indicate that further evaluation may be necessary.

When to Seek Specialized Care
1. Duration of Symptoms: Chronic pain lasting more than three months often requires specialized evaluation. Since your symptoms have persisted for six months, this is a strong indicator that further investigation is warranted.

2. Progression of Symptoms: The transition from shoulder pain to neck pain, along with the development of new symptoms, suggests that there may be an underlying issue that has not been fully addressed. This could include cervical spine problems such as disc herniation, degenerative changes, or even nerve root compression.

3. Impact on Daily Life: If your pain is affecting your ability to perform daily activities, such as lifting your arm or sleeping comfortably, it is crucial to seek further evaluation. Pain that limits your functional capacity should not be ignored.

4. Response to Treatment: While you have experienced some improvement with rehabilitation, the fact that your symptoms have not fully resolved and have even changed in nature suggests that the current treatment plan may need to be reassessed.

Recommendations for Specialized Care
Given your situation, it would be advisable to consult with a specialist. Here are two potential pathways:
- Physical Medicine and Rehabilitation (PM&R): A physiatrist can provide a comprehensive evaluation of your musculoskeletal system. They can assess your neck and shoulder pain in the context of your overall health and may recommend advanced imaging studies (like MRI) to evaluate for any structural issues that may not be visible on X-rays. They can also guide you through a tailored rehabilitation program that may include physical therapy, medication management, and possibly interventional procedures if necessary.

- Neurology: If there are signs of nerve involvement, such as numbness, tingling, or weakness in your arms, a neurologist can perform nerve conduction studies or electromyography (EMG) to assess for any nerve damage or compression. This is particularly relevant given your description of pain radiating to the left shoulder and any associated symptoms.

Additional Considerations
- Ergonomics and Posture: Since you mentioned that certain pillow positions exacerbate your pain, it may be beneficial to explore ergonomic adjustments in your sleeping and working environments. A physical therapist can provide guidance on optimal positioning and exercises to strengthen the neck and shoulder muscles.

- Pain Management: If pain persists, consider discussing pain management options with your healthcare provider. This may include medications, injections, or alternative therapies such as acupuncture or chiropractic care.

In conclusion, given the chronic nature of your symptoms, their progression, and the impact on your daily life, it is advisable to seek specialized care. A multidisciplinary approach involving both rehabilitation and possibly neurology can provide a comprehensive assessment and tailored treatment plan to address your neck and shoulder pain effectively. Don’t hesitate to advocate for your health and seek the care you need to improve your quality of life.

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