The dorsocervical fat pad, commonly known as a buffalo hump, is an accumulation of adipose tissue located at the base of the neck between the shoulder blades. While often considered cosmetic, this mass can lead to discomfort, tenderness, and localized pain. The fat pad is frequently a visible indicator of an underlying systemic issue, such as a hormonal imbalance or a side effect of certain medications. Understanding the distinction between mechanical pain and the medical conditions that trigger its formation is the first step toward effective management.
Understanding Localized Strain and Inflammation
The physical presence of the dorsocervical fat pad introduces biomechanical changes that directly cause pain and discomfort in the neck and upper back. The added weight and volume disrupt the natural curvature of the cervical and thoracic spine, increasing the mechanical load on surrounding structures. This imbalance often exacerbates forward head posture, forcing the head forward and placing sustained tension on the muscles holding the head upright.
The increased strain is particularly felt by the trapezius and rhomboid muscles, which must work harder to counterbalance the forward shift in the center of gravity. This chronic muscle tension can lead to painful muscle knots (trigger points) and a persistent, dull ache across the upper shoulders and neck. The adipose tissue within the hump can also become inflamed, leading to localized tenderness and increased sensitivity to pressure.
In some cases, a very large fat pad can press on the surrounding soft tissues and nerves, leading to radiating pain, numbness, or tingling sensations. The sheer volume can restrict the normal range of motion in the neck and shoulders, making everyday movements difficult and further contributing to stiffness and chronic pain. The density of the fat is sometimes described as being more fibrous or dense than typical subcutaneous fat, which may contribute to its stubborn nature.
Underlying Hormonal and Medication-Related Causes
The formation of the dorsocervical fat pad is primarily a symptom of a systemic problem that affects how the body creates, uses, and distributes fat. The most well-known cause is hypercortisolism, characterized by prolonged exposure to high levels of the stress hormone cortisol, often seen in Cushing’s syndrome. Excess cortisol triggers an abnormal redistribution of adipose tissue away from the limbs and toward the trunk, face, and the dorsocervical area.
In Cushing’s syndrome, the adrenal glands may produce too much cortisol, or the patient may be taking high doses of synthetic glucocorticoid medications that mimic cortisol’s effects. These powerful anti-inflammatory drugs, such as prednisone or hydrocortisone, can lead to the fat redistribution that results in a buffalo hump, especially with long-term use. The fat pad is thus a manifestation of the underlying endocrine disorder.
Another significant cause is lipodystrophy associated with antiretroviral therapy (ART) used to treat Human Immunodeficiency Virus (HIV). This condition involves an abnormal distribution of fat, including fat loss in areas like the face and limbs, and fat accumulation (lipohypertrophy) in the neck and abdomen. While newer HIV medications are less likely to cause this side effect, older classes of drugs, like certain protease inhibitors, were strongly linked to the development of a dorsocervical fat pad.
Metabolic issues also contribute to the development of a dorsocervical fat pad, though often secondary to hormonal or medication-related causes. Conditions like severe obesity and metabolic syndrome are associated with generalized fat accumulation that can include the neck region. The presence of a buffalo hump is often linked to other metabolic abnormalities, such as insulin resistance and elevated triglycerides.
Immediate Relief and When to Consult a Physician
Managing the pain associated with a buffalo hump involves addressing localized strain while simultaneously seeking treatment for the underlying cause. Improving posture is a practical first step, as poor alignment places undue stress on the neck muscles. Simple exercises like chin tucks and shoulder blade retractions can strengthen the upper back muscles and help pull the head back over the spine, lessening the mechanical pressure on the fat pad.
Non-prescription methods can provide temporary relief from muscle soreness and inflammation. Applying heat can help relax tight muscles in the trapezius and rhomboids, while cold packs may reduce localized inflammation and tenderness. Over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs) can mitigate pain and minor swelling, but long-term use should be discussed with a healthcare provider.
It is important to consult a physician promptly if an unexplained hump develops or if existing pain worsens. Medical attention is warranted if the mass is growing rapidly, or if the pain is severe, radiating, or accompanied by other systemic symptoms. These “red flag” symptoms can indicate a serious underlying condition like Cushing’s syndrome, and include:
- Unexplained weight gain
- Easy bruising
- Muscle weakness
- A rounded or “moon” face
- High blood pressure
Diagnosis requires a comprehensive evaluation, including a review of medication history, blood tests to measure hormone levels, and imaging studies to determine the specific cause.