Referred or radiating pain

What is a referred or radiating shoulder pain?

If you have shoulder pain, it is usually caused by problems with your shoulder joint or the muscles, ligaments, or tendons around your shoulder. However, in rare cases, the origin of your pain may be in your internal organs such as the heart or abdomen. This is called referred pain. Usually, if you have a musculoskeletal shoulder problem, moving your shoulder may improve or worsen the pain. However, if you have referred pain coming from internal structures, the pain won’t change with any movements.

Radiating pain describes radiation of shoulder pain to the arms and hands due to pinching of the nerve. Radiating pain follows specific nerves, whereas referred pain is more general and can occur in many places around injured tissue.

Symptoms

There are different types of referred or radiating pain:

Sharp pain under your shoulder blade
Dull ache in your shoulder
Pain from your neck to your shoulder blade, or vice versa.
Stabbing, burning, tingling feeling in your shoulder

Referred and radiating shoulder pain is often constant and may be present even if you are resting.

Radiating pain

Radiating pain happens when a nerve root in your neck (cervical spine) becomes compressed (pinched) and inflamed. It causes pain that radiates into the shoulder and arm, as well as muscle weakness, numbness and abnormal sensations such as tingling and ‘pins and needles’.

The compression happens mainly due to the two following causes:

Degenerative changes in your spine as you age (cervical spondylosis)
Herniated (bulging) disc in your neck presses on the nerves

Referred pain

Some severe conditions related to referred shoulder pain may include:

Abdominal problems. These include gallstones, cholecystitis (inflammation of the gallbladder), pancreatitis (inflammation of the pancreas), ovarian cyst and ectopic pregnancy (a pregnancy outside of the womb). The pain caused by these problems can refer to your shoulders. Usually, you will also notice other symptoms, like nausea and severe pain in your belly or pelvic area. The shoulder pain may come on suddenly and feel severe. Call a doctor or go to hospital if you notice any of these issues.

Heart problems. When you suffer from a heart attack, your heart muscles are not receiving enough oxygen supply. A heart attack causes chest pain, which could radiate towards your shoulder, causing shoulder pain. Other symptoms include shortness of breath, sweating and lightheadedness. If you are experiencing these symptoms, call 999 immediately without delay.

Diagnosis

To diagnose the genuine cause of your shoulder pain, your doctor will take your case history and past medical history. They will move your shoulder and perform special tests to differentiate the source of the pain to check if the pain is arising from your shoulder or any other structures.

Other tests which may help your doctor confirm your diagnosis include blood tests, ultrasounds, X-rays and other diagnostic tests. X-rays can show if there is any fracture or dislocation of the shoulder. Ultrasound is a quick way to see any muscle, ligament or tendon injury. Blood tests and other diagnostic tests help diagnose other health problems that may cause your shoulder pain.

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