Shoulder bursitis, the inflammation of the small, fluid-filled sacs that cushion the shoulder joint, can be intensely painful. If you are experiencing pain in your neck alongside shoulder bursitis, the answer is yes; the shoulder condition can indeed cause or contribute to neck pain. This complex interplay of symptoms arises from shared nerve pathways and the body’s natural response to protect an injured joint.
Understanding Shoulder Bursitis
Shoulder bursitis occurs when the bursa becomes irritated, swollen, and inflamed. The most frequently affected sac is the subacromial bursa, which sits beneath the highest point of the shoulder blade (the acromion) and above the rotator cuff tendons. This bursa acts as a cushion to reduce friction between the bones and soft tissues during arm movement. When inflamed, the space for the tendons and bursa narrows.
The primary symptoms include sharp, localized pain with movement, particularly when lifting the arm out to the side or overhead. A limited range of motion is common, and many people report pain when trying to sleep on the affected side. Although the pain starts in the shoulder, the inflammation and subsequent loss of function can easily transfer discomfort to the neck and upper back.
The Mechanism of Referred Pain
The connection between the shoulder and neck involves two distinct physiological processes: referred pain and biomechanical compensation. Referred pain occurs because the nerves supplying the shoulder joint originate from the same spinal cord segments (C5 and C6 nerve roots) that innervate the neck. When the subacromial bursa is inflamed, the brain receives a strong pain signal through these shared pathways but can misinterpret the precise location.
This neural confusion leads the brain to perceive the pain as originating from the neck or upper back, even though the source of the irritation is the shoulder bursa. The shoulder pain may radiate along the path of these nerves, manifesting as a dull ache near the shoulder blade or up into the base of the neck.
Biomechanical compensation is the second mechanism, where the body alters movement patterns to protect the painful shoulder. When a person experiences pain, they naturally begin to “guard” the joint by holding the arm and shoulder rigidly. This guarding behavior forces the muscles of the neck and upper back, such as the upper trapezius and levator scapulae, to work harder to stabilize the shoulder girdle.
The chronic tension and spasm in these neck muscles result from being overworked to compensate for the limited mobility of the shoulder joint. Over time, this sustained muscle activity causes stiffness and secondary pain in the neck itself. The postural changes adopted to avoid shoulder discomfort—such as hunching the shoulders—only exacerbate the muscle strain, creating a self-perpetuating cycle of pain that spreads upward.
Differentiating Pain Sources
Neck pain must be differentiated to determine if it is secondary to shoulder bursitis or a separate, primary issue, such as cervical radiculopathy (a pinched nerve in the neck). Neck pain caused by shoulder bursitis is typically a dull, muscular ache that increases when the shoulder is moved or stressed, but is often unchanged by head movements alone. This secondary pain often feels like tightness radiating from the shoulder blade up to the neck.
In contrast, if the neck pain is caused by a problem in the cervical spine, the symptoms are usually sharper and more intense, often following a specific path down the arm. A primary neck issue will frequently be exacerbated by specific neck movements, such as tilting the head to the side or looking up or down. Cervical radiculopathy may include neurological symptoms like numbness, tingling, or weakness that radiates past the elbow and into the hand. If the pain is severe and unresponsive to rest, consulting a healthcare professional is necessary for an accurate diagnosis, as imaging or nerve tests may be required.
Managing the Shoulder-Neck Pain Complex
Treating the combined shoulder and neck pain requires a multi-faceted approach that addresses both the inflammation and the secondary muscle tension. Initial management focuses on reducing the inflammation within the shoulder bursa through rest and anti-inflammatory medications.
Physical therapy (PT) plays a central role in breaking the cycle of compensation and tension. A therapist will design a program to gently restore the shoulder’s pain-free range of motion and strengthen the rotator cuff muscles to improve joint stability. PT incorporates exercises and stretches targeting the neck and upper back muscles to relieve the chronic tension caused by guarding. In cases where conservative measures do not provide relief, a medical provider may suggest a corticosteroid injection directly into the subacromial bursa to rapidly decrease the inflammation.