Your Shoulder Pain Might Actually Be Your Neck: What a 2026 Surgeon Study Confirms

By Dr. Jason Forward, DC. Practicing chiropractor in Tulsa, Oklahoma. Posted April 17, 2026.

Why the Neck Sends Pain to the Shoulder

This is basic neurology, and understanding it explains why so many people chase the wrong diagnosis for months.

The nerves that supply the shoulder originate in the cervical spine. Specifically:

• C5 nerve root: Supplies the deltoid muscle and the skin over the lateral shoulder. When irritated, it produces pain and sometimes weakness in the deltoid. This closely mimics rotator cuff pathology.
• C6 nerve root: Supplies the biceps, the lateral forearm, and parts of the hand. Irritation produces pain down the lateral arm that can feel like a shoulder problem radiating.
• C7 nerve root: Supplies the triceps and the back of the arm. Less commonly confused with shoulder pathology, but can contribute to posterior shoulder pain.

When one of these nerve roots is compressed or irritated at the cervical spine level, typically by a disc bulge, foraminal stenosis, or facet joint restriction, the pain is felt in the shoulder. The brain does not always correctly localize the source. It feels the nerve signal arriving from the shoulder region and interprets it as shoulder pain, even though the compression is happening in the neck.

Your brain feels the shoulder pain and assumes the shoulder is the problem. But the nerve carrying that pain signal starts in your neck.

This is called referred pain, and it is one of the most common reasons for failed shoulder treatment. If the problem is in the neck and you are treating the shoulder, you will not get better. Period.

How I See This in My Practice

This is not abstract for me. I see this pattern at Vanguard Chiropractic regularly. The typical story goes like this:

A patient comes in saying their shoulder has been hurting for three months. They have tried rest, ice, physical therapy exercises for the rotator cuff, maybe a cortisone injection into the subacromial space. Nothing has helped. Some have gotten shoulder MRIs that show a minor rotator cuff finding that the orthopedist says is "consistent with symptoms." Sometimes they are scheduled for surgery.

When I examine them, I check the shoulder. But I also check the cervical spine. And what I consistently find in these cases is restricted cervical segments at C5 or C6, with positive Spurling's test (a cervical compression test that reproduces shoulder pain), and frequently a loss of cervical extension range.

When I adjust the cervical spine, the shoulder pain changes. Sometimes in the same visit. Not because I did anything to the shoulder, but because the nerve root irritation at the neck was the driver all along.

The Clinical Red Flags That Point to the Neck

How do you know if your shoulder pain is actually coming from your neck? Here are the patterns I look for:

• Pain does not change with shoulder movement alone. True rotator cuff problems hurt more with specific shoulder movements (reaching overhead, reaching behind the back). If moving your shoulder through its full range does not reliably reproduce the pain, the shoulder may not be the source.
• Pain changes with neck position. If turning your head, looking up, or tilting your head to the painful side makes your shoulder pain worse, the neck is involved.
• Pain radiates past the shoulder. True shoulder pathology usually stays in the shoulder. Cervical radiculopathy often radiates down the arm, into the forearm, or into the hand.
• Numbness or tingling in the arm or hand. The shoulder joint does not produce numbness. If you have tingling in your fingers along with shoulder pain, it is almost certainly a cervical nerve root issue.
• Failed shoulder treatment. If physical therapy for the rotator cuff, shoulder injections, and rest have not helped after six to eight weeks, start looking upstream at the cervical spine.
• History of neck problems. If you have had prior neck pain, neck stiffness, or desk-related neck issues, your current shoulder pain may be an extension of that cervical dysfunction.

Why This Study From Surgeons Matters

Chiropractors have been saying "check the neck" for decades. When we say it, some people dismiss it as scope bias. We are chiropractors, so of course we think the spine is involved.

This study is different because it comes from shoulder surgeons. These are the people who operate on shoulders for a living. When surgeons publish a paper telling other surgeons that shoulder pain is frequently not a shoulder problem, that carries a different weight. It validates the clinical approach that cervical spine screening should be part of every shoulder evaluation.

The implication for patients is direct: before you consent to shoulder surgery, make sure someone has thoroughly examined your cervical spine. If the pain is coming from a C5 or C6 nerve root compression, shoulder surgery will not fix it. You will have surgical recovery time, surgical cost, and the same pain because the source was never addressed.

The Cervical Spine Exam for Shoulder Pain

When you come to Vanguard Chiropractic with shoulder pain, I do not just look at the shoulder. Here is the cervical component of the exam:

1. Cervical range of motion: Checking flexion, extension, lateral flexion, and rotation. Restricted cervical extension is the most common finding in neck-referred shoulder pain.
2. Spurling's test: Compression of the cervical spine with lateral flexion. If this reproduces your shoulder pain, the cervical spine is involved.
3. Upper limb tension test: Puts stretch on the cervical nerve roots. If it reproduces arm or shoulder symptoms, the nerve root is irritable.
4. Segmental palpation: Checking each cervical segment for restriction and tenderness. C5 and C6 are the most common culprits for shoulder-referred pain.
5. Neurological screen: Checking muscle strength, sensation, and reflexes in the arm to determine which nerve root, if any, is compromised.

If the cervical exam is positive, I start with the neck. If the shoulder responds to cervical treatment, we have the answer. If it does not, we shift focus to the shoulder itself.

Chiropractic Treatment for Neck-Referred Shoulder Pain

When the cervical spine is the driver, the treatment is cervical-focused:

• Cervical adjustment: Restoring motion to the restricted C5, C6, or C7 segments opens the intervertebral foramen and reduces nerve root compression.
• Upper thoracic adjustment: T1 through T4 restrictions often accompany cervical dysfunction and contribute to the neural compression pattern.
• Soft tissue work: Scalene and upper trapezius work to reduce muscle guarding that is compressing the brachial plexus as it exits the neck.
• Home protocol: Cervical extension exercises, posture correction, and ergonomic adjustments for desk workers.

Most neck-referred shoulder pain responds within four to six visits. The first improvement patients notice is usually less radiating pain down the arm, followed by improved shoulder range of motion that the "shoulder problem" never responded to.

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