If you have shoulder pain, it’s often caused by problems with your shoulder joint or with the muscles, ligaments, or tendons, around your shoulder. But sometimes the source of your pain can be your heart, belly, or
something else. That’s called referred shoulder pain. Usually, if you have a shoulder problem like a pulled muscle or osteoarthritis, moving your shoulder may make the pain better or worse. But if you have referred shoulder pain, you won’t feel any difference if
you move your shoulder. You might notice several different kinds of pain: Referred shoulder pain is often constant, which means your shoulder will hurt even when you’re resting or not using your arm or shoulder. But it may come and go, too. Several health problems can be behind your referred pain, including: Heart problems, like a
heart attack or angina (chest pain that happens when your
heart isn’t getting enough oxygen). If you’re having a heart attack, you might also have chest pains, which you might mistake for heartburn or an
upset stomach. You might also feel short of breath, or feel pain in your arm, back, jaw, neck, or other areas of your body. If that happens, call 911 right away. Neck problems. A pinched nerve in your neck or other neck problems
can cause shoulder pain. Belly surgery. If you have laparoscopic surgery, which is done through a small cut, on your belly to remove your gallbladder, make your stomach smaller for
weight loss, or for other reasons, you might get shoulder pain afterward. That happens to up to two-thirds of people who have the surgery. Laparoscopic surgery can make your body hang on to carbon dioxide in your belly area. That can irritate your spine and nerves, which can trigger
shoulder pain. Lung problems, like pneumonia or lung cancer. Tumors or swelling in your
lungs may cause shoulder pain. Blood clot in your lungs. This is called a
pulmonary embolism. It can feel like a pulled shoulder muscle at first. But the pain is usually so bad that you might have a hard time lying down or sleeping. If that happens to you, call your doctor right away. Belly problems. These include
gallstones, pancreatitis (inflammation of the
pancreas), an ovarian cyst, and ectopic pregnancy (a
pregnancy that happens in one of your fallopian tubes). The pain caused from problems in or near your belly can move up to and between your shoulders. Usually, you’ll also notice other symptoms, like nausea and severe pain in your belly or pelvic area. The
shoulder pain and pain in other areas may come on suddenly and feel severe. If you notice these issues, call a doctor or go to the hospital. Your doctor will need to find out the source of your pain so they can decide how best to deal with it. If you’ve had pain in your shoulder for more than a couple of days without an obvious reason, call your doctor. That’s especially important if you’re in a lot of
pain or if you have other symptoms, like shortness of breath. Your doctor will ask about: Ultrasound, which can give doctors a quick look at your shoulder muscles, joints, and tendons to reveal problems like rotator cuff tears. X-rays, which can show bone problems. MRI, which can reveal problems with your muscles, tendons, ligaments, and other tissues. CT scan, which can show issues with your bones and some of your tendons. Blood or other tests, especially if your doctor suspects your shoulder pain is caused by a different health problem.Symptoms
Causes
Treatments
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Pain below the right shoulder blade has many potential causes, some of which are more serious than others. They range from muscle strain to infections, fractures and tumors. See your doctor to determine the cause, especially if the pain persists, gets worse or occurs repeatedly. Treatment depends on the underlying reason for the pain.
Muscle and Bone Pain
The most common sources of pain near the shoulder blade are the muscles and bones that lie under and around it. Muscle pain is often caused by straining during exercise or sports, although any sudden movement -- such as a cough -- may bring on the pain. This type of pain is usually worse when repeating the action that caused it. Fibromyalgia is another reason for muscle pain below the shoulder blade. This chronic condition of unknown cause typically produces pain in multiple parts of the body, as well as fatigue.
Fractures of the spine or ribs may produce pain below the shoulder blade. They are usually caused by significant trauma to the area resulting from a fall or direct blow. Rarely, muscle or bone tumors begin in the area below the shoulder blade. Tumors may also spread to muscles and bones in this area from other organs, such as the skin, breasts and lungs.
Lung Pain
Pneumonia and blood clots in the right lung may cause pain below the shoulder blade, which usually worsens when taking deep breaths. Coughing and shortness of breath may accompany the pain in both conditions and a fever is often present with pneumonia. Lung cancer may also produce pain below the shoulder blade. This pain is generally not affected by movement and may actually be worse while resting. Unexplained weight loss and a cough are other warning signs of lung cancer. Inflammation of the membrane surrounding the lung -- called pleuritis or pleurisy -- may also cause pain below the right shoulder blade that worsens with breathing. Pleuritis is often caused by an infection.
Kidney Pain
The top of the right kidney lies near the lower tip of the right shoulder blade, so kidney pain can produce pain in this area. Kidney pain may be due to a stone, infection or tumor. Kidney stone pain is typically severe and occurs as intermittent spasms. Movement does not affect kidney stone pain. Pain from a kidney infection -- known as pyelonephritis -- is generally constant. Nausea, vomiting and a fever often accompany the pain, and urine changes, such as dark or bloody urine, may be seen as well. Kidney tumor pain is usually constant but may become more severe over time.
Pain From Abdominal Sources
The brain may interpret pain from organs in the right upper abdomen -- such as the gallbladder or liver -- as coming from the right shoulder blade area because nerves for sensation in these organs enter the spinal cord at the same level. In addition to pain, gallbladder disease often produces nausea, vomiting and intolerance of fatty foods. Tumors, cysts and infections in the liver are all possible causes of pain below the right shoulder blade. A subphrenic abscess -- localized collection of pus above the liver but below the diaphragm -- can also produce pain below the right shoulder blade. Another possible reason for pain at this location is inflammation of the head of the pancreas, the part of the pancreas located on the right side of the upper abdomen.
Shingles
If you've had the chickenpox, you are at risk for developing shingles. The virus that causes chickenpox lives in your nerves and can be reactivated, causing moderate to severe pain that usually appears before the development of a typical shingles rash. Shingles can occur virtually anywhere in the body, including below and around the shoulder blade. The vaccine called Zostavax reduces your chances of getting shingles.
Reviewed by Mary D. Daley, MD.