Neck and Shoulder pain with a crunching feeling


Q: I have a realy painful shoulder and sumtimes get shooting pains up the back of my neck and i wen i move my neck i get a crunching feeling it does not affect me evrday it comes and goes but has been coming and going on and off for about 2mnths now


A:   The pain in the shoulder and neck as you described it might be due to a cervical nerve compression (C7-C8), but it would be important to rule out inflammation of the peripheral nerves at the level of the arm. In the younger patients, cervical radiculopathy may be a result of a disc herniation or an acute injury causing impingement of an exiting nerve. In the older patient, cervical radiculopathy is often a result of spinal canal narrowing from bone (osteophyte) formation, decreased disc height and degenerative changes due to aging process. The same described before for the cervical spine applies to the lower back in terms of cause of pain and numbness in the legs, same causes, different spinal level. Also might be important rule out Fibromyalgia because according with your description most likely those sharp pains in your shoulder muscles are localized contractures called: trigger points, when you touch or rub them they produce (trigger) pain. Fibromyalgia is a widespread or global pain, it can start in one site, as in your case in the back, but becomes generalized pain for more than 3 months of duration, it can affect individuals of any age, and more women than men, but just the 2% of the general population in US meet the criteria to be diagnosed of Fibromyalgia. The treatment strategy usually includes: physical therapy program aimed to reduce pain and inflammation, and the use of anti-inflammatory drugs (as ibuprofen), also a re-education of habits and posture to improve quality of life. You should be independent in a stretching and strengthening program and continue with these exercises under the periodic supervision of a physical therapist initially and then completely on their own. If your condition fails to improve with a comprehensive rehabilitation program then selective injections should be presented with a surgical evaluation. Often, patients should show progressive improvement over the first 6-8 weeks with conservative treatment. If there is no significant improvement in this time frame, consider a surgical evaluation.

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