Back and Shoulder Pain

Back and Shoulder Pain All of the structures of the upper body are interconnected, including the hands, arm, shoulder, and cervical spine (C-Spine). Any type of injury or degenerative condition which affects the spinal nerves may also affect the upper extremities, as these nerves supply them. Due to inflammation and the encroachment of certain soft tissue structures onto the nerve roots of the cervical spine, a person may experience neck pain as well as headaches, arm pain, and shoulder pain. Here, we will take a look at the types of spinal conditions which may cause back and shoulder pain.

Structures of the C-Spine (Neck): The cervical spine, or C-Spine, includes the first seven vertebrae, and they are labeled according to their position from the top. The top of the cervical spine includes the Atlas and Axis (C1 and C2) followed by C3 below them and so on. There are 8 cervical spinal nerves, and they are labeled according to the vertebra that is located just above the. The exception is the 8th cervical nerve, which is located just below C7. These spinal nerves carry autonomic, sensory and motor signals to the head and neck, upper body, shoulders, and arms. Any irritation, damage, or nerve root compression of one of these nerves may cause neck pain and neurologic changes to the structures that these nerve supply.

Neurologic changes may be described in one or more of these symptoms: numbness, radiating pain, burning pain, electrical change type pain, weakness, and loss of mobility. These neurologic changes may become permanent if whatever factor that is putting pressure on the nerve is not eliminated.

Here's a brief and not comprehensive overview of which cervical spinal nerves supply which parts of the upper body to enables us the ability to look, feel, and react to our surrounding environment.

C1 Spinal Nerve- back of the hand

C2 Spinal Nerve - various areas of the head

C3 Spinal Nerve - side and front of the neck

C4 Spinal Nerve - upper back of neck

C5 Spinal Nerve - middle of neck and upper part of arms

C6 Spinal Nerve - lower part of neck, arms, and elbows

C7 Spinal Nerve - lower part of arms, shoulders

C8 Spinal Nerve - hands, wrist, fingers, thyroid

Based on the chart as provided above from medical websites and journals, it may be inferred that patients with back and shoulder pain may have a compressed nerve at the 7th cervical spinal nerve.

Let's take a look at the types of C-Spine disorders that may affect the nerves and discs.

Cervical foraminal stenosis: Cervical foraminal stenosis is caused by a narrowing of the disc space between the vertebral bodies. This disc space narrowing results in pressure being put on the nerve roots, usually to one side. These types of conditions do not usually develop overnight. Rather, these conditions progress over a period of years, along with the associated symptoms. As the disc space narrows, incrementally more pressure continues to elicit the following symptoms:
  • Pain that is triggered by certain activities and positions of the head and neck

  • Pain that comes and goes

  • Pain that develops slowly

This condition is usually caused by the enlargement of a joint (uncinate process). The joint enlargement may be confirmed by high contract and resolution imaging tests such as CTs and MRIs.

Rotator Cuff Tendonitis: In some cases, the origin of back and shoulder pain is not close to the spin itself, but in the tendons and muscles that support the shoulder girdle. Rotator cuff tendonitis may develop in the shoulder due to accidents or overuse injuries associated with job requirements or sports. The rotator cuff is a set of four muscles (Teres minor, subscapularis, Infraspinatus, and Supraspinatus). These muscles may become strained or inflamed from falls, throwing type motions, and may also affect the elderly.

The symptoms of Rotator Cuff Tendonitis are often very similar to that of cervical radiculopathy - radiating arm and shoulder pain associated with compression of the cervical nerve roots. To help distinguish between the two problems, doctors may to an injection procedure in which a numbing agent (usually Lidocaine) is injected near the nerve though to be causing the shoulder pain. If the Lidocaine injection produces immediate pain relief, it will provide more direct evidence of radiculopathy as the cause of the back and shoulder pain.