Neck or Shoulder? How to Tell Where Your Arm Pain is Coming From

Shoulder or arm pain can be surprisingly tricky to diagnose. Many patients come to our office convinced they have a shoulder injury, only to find out the pain is actually coming from their neck — or vice versa. That is because the neck (cervical spine) and shoulder share overlapping nerves, muscles, and motion patterns. Understanding where your pain is truly coming from is the first step toward proper treatment and lasting relief.

Let’s take a quick look at the anatomy:

The Cervical Spine
Your neck is made up of seven cervical vertebrae (C1–C7) stacked one on top of another, separated by intervertebral discs that act as cushions. From this area, the spinal nerves branch out and travel through small openings in the vertebrae, extending down into your shoulder, arm, and hand. These nerves control sensation (feeling) and motor function (movement). The sensory nerves follow a “dermatome” and the motor nerves follow a “myotome” or pathway. If one or more of these nerves becomes pinched or irritated — for example, by a bulging disc, arthritis, or muscle spasm — it can cause pain, tingling, or weakness, often driven by inflammation, along its pathway.

The Shoulder
The shoulder is one of the most mobile joints in the body, formed where the head of the humerus (upper arm bone) meets the glenoid (the "socket" part of your scapula or shoulder blade). It is stabilized by a group of muscles and tendons called the rotator cuff, along with a rubbery suction cup called the labrum, and ligaments investing in the joint capsule. When these structures become inflamed, torn, or degenerated, they can cause localized shoulder pain, limited motion, and weakness.

How Neck and Shoulder Pain Can Overlap
Because nerves from the neck supply sensation to the shoulder and arm, neck problems can “refer” pain into those areas within its dermatome. For instance: a pinched nerve at C6 can cause pain along the outer shoulder and upper arm, down the forearm and into the thumb. This can make it feel like a shoulder injury, even when the shoulder joint itself is perfectly healthy.

Clues That Pain May Be Coming From the Neck

• Pain radiates past the shoulder and into the forearm or hand
• Tingling, numbness, or burning sensations Weakness in the arm, grip, or shoulder muscles
• Pain that worsens with neck movement (looking up or turning your head) Normal shoulder range of motion, despite significant pain
• Relief of arm pain with placing the arm overhead

Common causes include cervical disc herniation, arthritis (cervical spondylosis), nerve impingement, or muscle strain in the neck.

Clues That Pain May Be Coming From the Shoulder

• Pain with lifting your arm overhead or reaching behind your back
• Nighttime pain, particularly when lying on the affected side
• Stiffness or catching in the shoulder joint itself
• Pain relieved when the arm is supported or the shoulder is rested

Common shoulder sources include rotator cuff injuries, impingement syndrome, labral tears, and arthritis of the shoulder joint.

When to See an Orthopedic Specialist
If your pain persists for more than a few weeks, interrupts your sleep, or affects your daily activities, it’s time for an evaluation. An orthopedic specialist will:

• Review your medical history and symptom pattern
• Perform a physical exam assessing both neck and shoulder movement
• Order imaging tests such as X-rays and/or MRI
• Immediately start supportive conservative measures to alleviate symptoms

Identifying the true origin of your pain is essential because neck-related nerve pain and shoulder joint problems are treated very differently.

Clear Diagnosis, Better Outcomes
Shoulder and neck pain often overlap, but the right diagnosis leads to faster, more lasting relief. Whether it’s a pinched nerve in your neck, a rotator cuff injury, or both, our orthopedic team can help determine the source of your discomfort and develop a personalized plan to restore mobility, reduce pain, and get you back to your normal activities. If you are experiencing persistent shoulder or arm pain, we’ll help you find the root cause and the best path to recovery.