Why is there a muscle tension in my shoulders, arms, and hands?

Q. Why is there a muscle tension in my shoulders, arms, and hands?

Answered by
Dr. Solanki Chirag Natwarbhai
and medically reviewed by iCliniq medical review team.
This is a premium question & answer published on Dec 23, 2017 and last reviewed on: Jun 30, 2023

Hello doctor,

I have problems with clear thinking. When I am in a wrong position, there will be tension in my shoulders and arms, and in my face muscles, but also I cannot think clearly anymore. It is like a blackout. When I bend my head forward for a few seconds, my body reacts with sweating, rapid breathing. My chiropractor thinks it has to do with the absence of lordosis in my neck. When I bend my neck forward, there will be pressure on the brainstem. The result is a fight or flight reaction. My symptoms are a headache between my ears and above in my neck and earache after an hour of thinking. So I am not able to do my job anymore for nearly two years. I have trouble with clear thinking. The biggest problem is that sometimes I feel muscle tension in my shoulders, arms, and hands, and in my face. In that case, my consciousness is impaired. I visited a neurologist, but she could not explain it. Can you help me? Of note, when I was 12, I broke my nose. My current medications are Paroxetine 10 mg twice a week and Ibuprofen and Paracetamol. Some weeks ago, I had an MRI (Magnetic Resonance Imaging) of the cervical spine and it showed spondylosis at C4-C5. No significant neural foraminal bony stenosis was seen. Degenerative changes in the atlantoaxial joint I also had an MRI of the cerebrum that showed no relevant MRI for comparison. Current research concerns an MRI of cerebrum according to standard protocol. The results were as follows: There were some punctiform supratentorial white matter abnormalities, a specific but most likely on the basis of microangiopathy. These are not striking for the age. Normal aspect of the basal nuclei, brainstem and the cerebellum. Normal grey/white matter differentiation and gyri/sulci patron. Slim/slender ventricular system and peripheral liquor areas. Results of the MRI of the cervical spine were: Modic-2 endplate changes around the anterior intervertebral spaces C4-C5. Degenerative changes of the atlantoaxial joint, with known osteophytes, in accordance with the CT CWK from 2007. C2-C3: Free from significance. C3-C4: Uncovertebral disc disease and osteoarthritis. Combined bony and discogenic narrowing of C3-C4 neuroforamen left, possibly with the involvement of root C4 left. No significant spinal canal stenosis. C4-C5: Disc disease with posterior bulging. Uncovertebral osteoarthritis. Combined bonyand discogenic neuroforamen C4-C5 on each side, possibly with the involvement of root C5 on each side. Mild to moderate spinal canal stenosis with reduced liquor signal around the myelum, but with no obvious compression. C5-C6: Disc disease with posterior bulging. Uncovertebral osteoarthritis. Combined bony and discogenic narrowing of C5-C6 neuroforamen on each side, possibly with the involvement of root C6 on each side. C6-C7: Disc disease with posterior bulging. Uncovertebral osteoarthritis. Combined bony/discogenic neuroforamen C6-C7 on each side, possibly with the involvement of root C7 on each side. C7-T1: No abnormalities of any significance. Conclusion: Intracerebral are free from abnormalities of any significance. Degenerative disorders of the cervical spine, however without significant spinal canal stenosis or demonstrable cord compression. I have attached all the reports for your reference.


Hello, Welcome to icliniq.com.

I have gone through the attachments (attachments removed to protect patient identity). From your complaints, it looks like you are having tension type of pain. Actually, it occurs because of tensed tightened neck muscles. Some patients also feel similar pain in temple region. You also have anxiety. I suggest you start on tablet Tolperisone (muscle relaxant) 150 mg twice a day for 10 days and tablet Naproxen (non-steroidal anti-inflammatory drug) 500 mg twice a day for a week. I suggest you continue Paroxetine (selective serotonin-reuptake inhibitors). Consult your specialist doctor, discuss with him or her and with their consent take the above medicines. I think you should be fine. There is nothing much to worry about all the investigations done. I hope this was helpful.

Thank you doctor,

My chiropractor thinks there is also a problem with the CSF (Cerebrospinal Fluid) flow as a result of kyphosis and osteophytes. He feels that should be the cause of the headaches. What do you think about that? Could you explain the relation between tightened neck muscles and brain fog?

Please reply.


Hello, Welcome back to icliniq.com.

I do not think there is any problem related to CSF (cerebrospinal fluid) circulation and regarding brain fog and thinking related issues. I thought it is basically related to mental fatigue, stress or anxiety more than any structural or functional brain problems. I think meditation would really help in that. The pain is not related to your thinking problem. So the drugs I suggested along with physiotherapy would help you get rid of the pain. Again, consult your specialist doctor, discuss with him or her and with their consent take the medicines. Meditation and work relaxation would help your brain fog. Do not worry as you are not having any issue related to brain or spine.

I hope this has helped.

Thank you doctor,

One thing I do not yet understand. If I bend my neck (a few seconds is enough), I immediately get muscle pain in my neck. That pain draws to my shoulders and arms. I also feel hot and start to sweat. My breathing and my heartbeat also go up and I get dizzy. All these things within half a minute. I am having these symptoms for the past eight years. When I use a neck collar, these complaints are much less. When I stretch my neck through traction, the pain disappears. Does this not indicate pressure on a nerve root, or pressure on the brainstem? I read on the Internet that a well-known neurosurgeon says that a combination of kyphosis and flexion causes pressure on the nervous system and leads to neurological complaints. If so, is it next to medication and physiotherapy? Perhaps is it useful to continue with neck traction? Please give your suggestions.



Welcome back to icliniq.com.

Pain on bending the neck is an indirect indication that your neck muscles are under tension and on bending they get stretched that is why you get pain and other symptoms and it confirms what I said you earlier.

Neck collar restricts neck movements so you feel relief in pain.

The symptoms related to nerve compression are different and anyways MRI (magnetic resonance imaging) is not showing such compression so do not worry about that.

I am not in favor of neck traction as it sometimes aggravates pain if not done properly.

Another thing I would like to add is to avoid pillow while sleeping. This also would help in pain and recovery.

I hope this helps.

Thank you for the reply doctor,

My neurologist does not want to give me the tablet Tolperisone. I think she does not want to give me any medicine. Do you know an alternative medicine that I can but in my country? I am now trying CBD oil, but it seems to help a little. The tension in my shoulders and arms is gone now, but not in my neck.

Please help.



Welcome back to icliniq.com.

The availability of medicines varies depending on the region you live. Neck pain would gradually improve after physiotherapy, and avoid pillow while sleeping.

I hope this helps.

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