Neck and Shoulder Pain: When to Seek Specialized Care

Stiffness and numbness from the shoulders and back to the neck and face?

Hello Doctor: In my younger years, I often stayed up late using the computer and had poor posture.
At that time, I frequently experienced a sharp pain in the right side of my neck and shoulder, but I didn't pay much attention to it.
Over time, the skin in the area where I felt the pain has lost sensation, and my right shoulder and neck have become completely stiff.
Consequently, my right neck has started to swell.
My entire right face also began to feel uncomfortable, especially around the eyes, where I experience weakness (in my eyebrows), frequent double vision, and a strange sensation when looking at things.
I find it hard to concentrate, and my right face feels tense and numb, extending to my right shoulder and back.
I cannot lie down to sleep on my back or turn my head to the right side while sleeping, as it makes it difficult to breathe and causes an itchy throat and cough.
Every time I see a doctor and undergo X-rays, the nerve conduction tests come back normal.
The muscle relaxants prescribed have not helped either.
I am very troubled by this, as it often makes it difficult for me to face crowds.
I have seen both orthopedic and neurology specialists, but my issues remain unresolved.
Which specialty should I continue to consult?

Yu Wei, 20~29 year old female. Ask Date: 2016/01/11

Dr. Li Weiqiang reply Rehabilitation

Dear Yu-Wei,
Hello.
Due to poor posture, you are experiencing stiffness and numbness from your shoulders and back to your neck and face.
It is important to address this issue and come up with improvement methods.
You may want to consult a rehabilitation physician for a detailed assessment.

Wishing you safety and health,
Li Wei-Chiang
Director, Department of Rehabilitation
Taoyuan General Hospital, Ministry of Health and Welfare

Reply Date: 2016/01/11

More Info

Based on your description, it seems that you are experiencing a complex set of symptoms related to neck and shoulder pain, which have persisted over time and have significantly impacted your quality of life. The symptoms you describe, including numbness, stiffness, and discomfort radiating to your face and eyes, suggest that there may be underlying issues that require specialized evaluation and treatment.

Understanding Your Symptoms
1. Chronic Pain and Numbness: The history of poor posture and prolonged computer use can lead to musculoskeletal issues, including cervical spondylosis or herniated discs, which may compress nerves and lead to symptoms like numbness and pain. The fact that you have lost sensation in the skin over the affected area is concerning and suggests possible nerve involvement.

2. Neurological Symptoms: The discomfort in your face, particularly around the eyes, along with the feeling of weakness and double vision, raises the possibility of cervical radiculopathy or other neurological conditions. These symptoms may indicate that the nerves exiting the cervical spine are being compressed or irritated.

3. Sleep Disturbances: Difficulty sleeping due to pain and discomfort can exacerbate both physical and mental health issues, leading to increased anxiety and stress, which can further complicate your recovery.

When to Seek Specialized Care
Given the complexity of your symptoms and the lack of improvement with previous treatments, it may be beneficial to seek care from a specialist who can provide a comprehensive evaluation. Here are some recommendations:
1. Neurologist: Since you are experiencing neurological symptoms, a neurologist can perform a thorough examination and may recommend additional imaging studies, such as an MRI of the cervical spine, to assess for any nerve compression or other abnormalities.

2. Pain Management Specialist: If your pain is severe and not responding to standard treatments, a pain management specialist can offer various interventions, including nerve blocks, physical therapy, and medication management tailored to your specific needs.

3. Physical Medicine and Rehabilitation (PM&R): A rehabilitation specialist can help develop a comprehensive rehabilitation program that includes physical therapy, which may focus on improving posture, strengthening the neck and shoulder muscles, and enhancing flexibility. They can also provide guidance on ergonomic adjustments to your workspace.

4. Orthopedic Surgeon: If structural issues in the cervical spine are identified, an orthopedic surgeon specializing in spine surgery may be necessary to discuss potential surgical options if conservative treatments fail.

Additional Considerations
- Physical Therapy: Engaging in physical therapy can be crucial. A physical therapist can design a program that focuses on stretching and strengthening exercises, which may help alleviate some of the stiffness and pain you are experiencing.

- Lifestyle Modifications: Consider making ergonomic adjustments to your workspace, taking regular breaks during computer use, and incorporating exercises that promote good posture and spinal health.

- Mental Health Support: Given the impact of chronic pain on mental health, it may be beneficial to seek counseling or support groups to help manage anxiety and stress related to your condition.

Conclusion
In summary, your symptoms warrant further investigation and a multidisciplinary approach to treatment. Seeking care from a neurologist or a pain management specialist may be the next best step. It’s essential to advocate for your health and ensure that you receive the appropriate evaluations and treatments to improve your quality of life. Don’t hesitate to reach out for help, as managing chronic pain and its associated symptoms often requires a team of healthcare professionals working together.

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