What is referred shoulder pain?

Commonly, the cause of your shoulder pain could be problems with your shoulder joint or with the muscles, ligaments or tendons, around your shoulder.  But at times it can occur with symptoms elsewhere in your body, in other words the source of your pain can be your heart, belly or something else.  That is called referred shoulder pain.  It is an unexplained shoulder pain that is not related to your neck, shoulder or arm movement.  Referred pain as such means that a problem exists somewhere else in your body other that the area where you feel the pain.  For example, if you have a shoulder problem like a strained muscle or torn muscle, there is a direct relationship between moving the shoulder and pain.  But if you have a referred shoulder pain, you won’t feel any difference if you move your shoulder.


Causes of referred shoulder pain:

There are a number of structures that can cause referred pain to the shoulder.  Some of the health problems behind referred shoulder pain may include:

Spinal issues:  Dysfunctions in the cervical spine, particularly cervical spondylosis and disc prolapse may lead to shoulder pain.  Thoracic outlet syndrome which can cause bony or muscular abnormalities can exert pressure on the brachial plexus and eventually result in shoulder pain

Diaphragmatic issues:  Irritation in diaphragm may cause shoulder pain.  This can occur in cases of biliary colic, liver abscess, subcostal abscess and intestinal perforation.

Systemic diseases:  Conditions such as polymyalgia rheumatica can present itself in the form of shoulder pain.  Pain in the mediastinum can also result in shoulder pain.

Pelvic problems:  Such as ruptured ovarian cyst, pelvic inflammatory disease

Heart problems:  Like heart attack or chest pain that happens when the heart is deprived of oxygen.  Heart or blood vessel problems in which pain is more often felt in the left arm and shoulder, such as inflammation around the heart (pericarditis).

Lung problem:  Such as pneumonia, lung cancer, secondaries from distant malignancies, myeloma and tumors.  Swelling in your lungs may cause shoulder pain where pain may be felt throughout the shoulder, shoulder blade area, upper chest, upper arm, and armpit. Pain is usually felt in the shoulder on the same side as the lung problem.

Blood clot in your lungs:  This is also called pulmonary embolism.  In the beginning, the symptoms are similar to a pulled shoulder muscle, but the pain is intolerable that you might have a hard time lying down and you virtually can’t sleep.  If that happens to you, call your doctor without further delay.

Neck problems:  A pinched nerve in your neck or other neck problems can cause shoulder pain

Abdominal issues:  These include problems, such as gas from laparoscopic abdominal surgery or air entering the vagina under pressure from some gynecological procedures, gallstones, pancreatitis (inflammation of the pancreas) and ectopic pregnancy (a pregnancy that happens in one of your fallopian tubes).  The pain that is due to problems in or around your abdomen can travel all the way up to and between your shoulders.

Abdominal symptoms may also come accompanied by nausea and severe pain in your belly area.  The referred shoulder pain can come on suddenly and feel severe.  If you are suffering from these issues, it is better to go to a hospital or seek the service of a doctor.

Finally, other conditions, such as herpes zoster (shingles), Paget’s disease can lead to shoulder pain.  It should be noted that some causes of the pain may require emergency admission or urgent referral. 

Symptoms of referred shoulder pain:

As a result of a referred shoulder pain, you might experience several different kinds of pain:

  • Sharp pain under your shoulder blade
  • Dull ache in your shoulder
  • Pain that goes from your neck to your shoulder blade (or vice versa)
  • Stabbing, burning, tingling, or even an “electric” feeling in your shoulder

In case of a referred shoulder pain, your shoulder will continue to hurt even when you are resting or not using your arms or shoulder.  However, the intensity of the pain can vary.

Treatment for referred shoulder pain:

The underlying medical condition should be treated to get rid of the referred pain in the shoulder.  Conditions such as MI, suspected ectopic pregnancy, subcostal abscess or intestinal perforation may require immediate admission.

As the first step to treat the referred pain, your doctor should find out the source of your pain so s/he can decide how best to deal with it.  If you are suffering from shoulder pain without any specific trauma to the shoulder and it lasts for over two weeks, it is time to call your doctor.  It is all the more important if you are in a lot of pain or if you suffer from other related symptoms, like shortness of breath or abdominal pain.  Your doctor may ask:

  • Where you feel the pain
  • How long you’ve had it, and if and when it stops
  • Your health history, including any current medical conditions like high blood pressure
  • Any accidents or injuries that could have played a part in your shoulder pain
  • Your doctor also may recommend tests to check for any hidden issues

Ultrasound can give doctors a quick look at your shoulder muscles, joints and tendons to single out problems such as rotator cuff tears.  X-rays can throw light on bone problems.  MRIs can throw light on your muscles, tendons, ligaments and other tissues.  CT scans can reveal issues related to bones and some of your tendons.  However, if your doctor believes that the real cause of your shoulder pain is some other health problems, then s/he may ask you to do blood or other tests.

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Q&As on Referred Shoulder Pain

1) What is referred shoulder pain?

Referred pain from the cervical spine is often brought on by compression of a nerve or a nerve root (and seldom the thoracic spine). This may be brought on by various disorders, such as osteoarthritis, spinal fractures, tumours, problems with the discs in the vertebral column, and muscle spasms.

While some nerves carry “motor” information, which may cause muscle weakness and occasionally problems with coordination and movement, other nerves carry sensory information. When the nerve is compressed, it is more challenging to send signals to the areas it supports. When the nerves that carry sensory information are squeezed, it can produce pins and needles, tingling, and other strange sensations. Compression may sometimes affect both types of information.

2) What are the symptoms of referred shoulder pain?

You might experience a variety of painful sensations, including the following:

  • A stabbing ache just below your shoulder blade.
  • Dull aching in the shoulder area.
  • A soreness radiates from your neck down to your shoulder blades (or vice versa).
  • A sharp pain, a burning sensation, tingling, or even an “electric” sensation in your shoulder.

Shoulder pain caused by a referred condition is often unrelenting, which means that you will continue to experience discomfort in your shoulder even when you are resting. 

3) What are the causes of referred shoulder pain?

The causes of referred shoulder pain are:

  • Abdominal conditions like pancreatitis or gallstones.
  • Pelvic issues, including an ovarian cyst that has burst.
  • Cardiac inflammation or blood vessel conditions often cause left arm and shoulder discomfort.
  • An issue with the lungs, such as pneumonia, may cause discomfort in the neck, armpit, upper chest, upper arm, shoulder, and shoulder blade region. 
  • Other disorders, such as thoracic outlet syndrome, Paget’s disease, or shingles (herpes zoster).

Other issues might include gas after laparoscopic abdominal surgery or air leaking into the vagina due to certain gynaecological operations.

4) What are the home remedies for referred shoulder pain?

Without a diagnosis, transferred pain therapy may not be effective.

The neurological system of your body may be calmed and inflammation reduced by using easy home treatments for acute pain.

Among the natural therapies for severe muscular pain are:

  • Using a warm compress relieves cramping and muscular tension.
  • Soaking in an Epsom salt warm water bath alleviates muscle stress.
  • Relaxing your body while taking care not to aggravate the painful region.

However, you shouldn’t attempt to treat yourself at home if you are experiencing any signs of organ damage or a heart attack.

 5)  What are the different types of referred shoulder pain?

Injury to tissues other than the spinal nerves is known as “somatic referred pain.” The pain compounds are released when damaged tissues like ligaments, tendons, muscles, and joints irritate the surrounding sensory neurons. If these nerves innervate other structures elsewhere, the brain may perceive the pain as coming from those structures.

An injured spinal nerve is a source of “radicular referral pain.” The spinal nerve’s supply region is the location of the pain. Along with paraesthesia or alterations in feeling, such as numbness and weakening in the muscles innervated by the severed spinal nerve, results in sharper pain in a much narrower, more defined region.

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