Arm pain: do the symptoms come from the neck or the shoulder?

Pain from the neck can radiate to the head, shoulder and arm [3]. With muscle tension and mechanical load, the pain is usually diffuse and can be on both sides. One-sided radiation more often suggests that a nerve is affected [3].

Many people with neck pain get radiation to the arms [5]. That does not in itself mean that something dangerous is going on. NHI describes non-specific neck pain as a condition that is not dangerous [5].

When a nerve root in the neck is affected, it is called nerve root involvement or cervical radiculopathy. The cause is usually degenerative changes in the neck with a herniated disc or narrowing of the nerve root canal [1]. More than 90 percent of herniations are between the fifth and sixth, or the sixth and seventh cervical vertebra [1].

The condition often starts acutely with pain at the base of the neck that radiates into one arm and varies with head position [2]. Some get reduced sensation and strength in the arm [2]. Numbness and tingling are the most common sensory symptoms, and the weakness is usually mild to moderate [1]. A herniated disc is most common from around 40 to 60 years of age [3].

NHI writes that three out of four people with neck pain radiating to the arm do not have a herniated disc, but degenerative changes in the cervical vertebrae that develop over many years [2]. You can read more on the page about cervical disc herniation.

The shoulder is a common differential diagnosis for pain in the neck and arm. Subacromial impingement is the most common cause, and capsulitis, tendon disorders and problems in the AC joint can also give pain in the neck area [1].

With tendon pain in the shoulder, the pain increases with certain movements, and function can be reduced. With problems in the supraspinatus tendon, lifting the arm out to the side is particularly painful [4]. Overload is regarded as the most common cause [4].

You can read more on the pages about rotator cuff problems, supraspinatus tendinitis and frozen shoulder.

The doctor or therapist starts by asking where the pain is, whether it radiates, and whether you have numbness, tingling or weakness in the arm or hand. You may also be asked whether the pain gets worse with coughing or sneezing [3]. The mobility of the neck, sensation in the arms and strength in the shoulder, elbow and wrist are then examined [2].

Neck mobility and provocation tests are used. Spurling's test is one of them, and it is recommended for radiating arm pain [1]. When the cause is unclear, a shoulder examination should always be done [1]. The clinical examination is better suited to ruling out nerve root involvement and serious disease than to making a specific diagnosis [1].

MRI of the neck is often used to confirm a herniated disc in the neck [2]. When nerve root involvement is suspected and the pain is marked, a Norwegian review article recommends MRI if there is no improvement after four to six weeks [1]. For tendon pain in the shoulder, X-ray is usually not necessary [4].

With a herniated disc in the neck, most people improve regardless of treatment within one to four months, and the herniation can shrink or dissolve over time [2]. The 2010 review article describes that 60 to 90 percent have complete remission in long-term observation without surgery [1]. NHI writes that most people should avoid activities that strain the neck, and one-sided positions, at the start, and that physiotherapy with exercises is relevant for most [2]. Surgery is rare and applies particularly to large herniations or increasing paralysis [2]. The Norwegian review mentions that surgery can be considered for considerable pain lasting eight to twelve weeks [1].

For problems from the shoulder, NHI describes that activity should be adjusted and movements that provoke pain avoided, but the arm should not be held completely still. Rehabilitation should be gradual, with exercises for mobility and later strength [4].

For neck pain without nerve root involvement, exercise has an effect in both acute and long-standing problems, and a combination of exercises and joint mobilisation has shown an effect [1].

NHI mentions three situations: acute, severe pain that radiates into an arm, persistent problems that do not improve, and neck pain together with a general feeling of illness or fatigue [6].

Numbness, clumsiness or difficulty controlling the arms or legs, and affected gait, can indicate involvement of the spinal cord, and such symptoms should be assessed promptly by a doctor [1]. The same applies to increasing paralysis [2]. Other factors that the Norwegian review regards as red flags are known cancer, weight loss, marked tenderness over vertebrae and rheumatic disease with general symptoms [1].

If you are unsure whether the pain in your arm comes from the neck or the shoulder, a physiotherapist can examine both areas, assess the findings and, if needed, refer on to imaging or a specialist. For tendon-related shoulder problems, diagnostic ultrasound may be relevant. You can read more about physiotherapy at Dr.Dropin.

Can the neck cause pain in the arm?

Yes. Pain from the neck can radiate to the head, shoulder and arm. One-sided radiation more often suggests that a nerve is affected [3].

How do I know if the arm pain comes from the neck or the shoulder?

It is difficult to decide on your own. Numbness and tingling in the hand and pain that varies with head position point towards the neck [1][2]. Pain that increases with particular arm movements, such as lifting the arm out to the side, points towards the shoulder [4]. An examination usually clarifies which it is.

How long does arm pain from a herniated disc in the neck last?

Most people improve within one to four months, regardless of treatment [2].

Do I need an MRI for pain that radiates into the arm?

MRI is often used to confirm a herniated disc in the neck [2]. A Norwegian review article recommends MRI when nerve root involvement is suspected and the pain is marked, if there is no improvement after four to six weeks [1].

When should I see a doctor about pain in the arm?

For acute, severe pain that radiates into an arm, for problems that do not improve, and for neck pain together with a general feeling of illness [6].

You can read more about cervical disc herniation and rotator cuff problems. You can find more articles in the overview of articles.

This article was written by Dr.Dropin Fysikalske and is based on the sources listed below. It gives general information and does not replace an examination by a healthcare professional.

The websites were accessed and read on 22 October 2026.

1. Nygaard ØP, Rø M, Andersen TI, Zwart JA. Nakkesmerter med og uten nerverotsaffeksjon (Neck pain with and without nerve root involvement). Tidsskr Nor Legeforen. 2010;130:2252-5. Published 18 November 2010. Link

2. Nakkeprolaps (Cervical disc herniation). NHI.no. Last updated 17 September 2024. Link

3. Nakkesmerter, veiviser (Neck pain, guide). NHI.no. Last updated 5 October 2020. Link

4. Senebetennelse i skulderen (Tendon inflammation in the shoulder). NHI.no. Last updated 15 October 2024. Link

5. Uspesifikke nakkesmerter (Non-specific neck pain). NHI.no. Last updated 31 July 2024. Link

6. Nakkesmerter: når bør du søke lege (Neck pain: when to see a doctor). NHI.no. Last updated 5 October 2020. Link