Referred Shoulder Pain
What is referred shoulder pain?
Referred shoulder pain is a term given to pain that is felt in the shoulder although it originates from another region of the body. This is commonly seen in clinical practice.
There are several structures in the body that, when injured, may cause the patient to experience pain in the shoulder. This can occur even though there may be nothing wrong with the shoulder itself.
Causes of referred shoulder pain
The neck and upper back are the most common areas of the body that, when injured, may cause referred pain to the shoulder (figure 1). In addition, increased neural tension (tight nerves) may also contribute to the development of symptoms.
Some of the more common conditions which may cause these symptoms include:
- Cervical Disc Bulge
- Cervical Facet Joint Sprain
- Cervical Postural Syndrome
- Cervical Spine Degeneration (Neck Arthritis)
- Thoracic Disc Bulge
- Thoracic Facet Joint Sprain
- Thoracic Postural Syndrome
- Costovertebral Joint Sprain
- Spinal Degeneration (Thoracic)
Signs and symptoms of referred shoulder pain
Patients with shoulder pain that is referred from another source may or may not experience symptoms from the originating source. Patients typically experience a dull ache in the shoulder that is poorly localized and may vary in severity or location. They may also experience pain or stiffness in other locations in the body such as the neck, upper back, shoulder, arm or forearm. Occasionally pain may also be felt in the wrist or hand. These symptoms are usually experienced on the same side of the body as the shoulder pain, although sometimes, the opposite side or both sides may be affected. Occasionally patients may also experience pins and needles or numbness in the affected arm. This most commonly affects the hand and can sometimes affect the other arm or both arms.
Patients with referred shoulder pain normally experience restricted movement and abnormalities on assessment (such as tenderness on palpation) in the specific region of the body causing the pain. Local assessment of the shoulder may demonstrate no significant abnormalities although patients may experience tenderness on firmly touching the shoulder region. In long standing cases of shoulder pain that is referred form another source, patients may develop muscle tightness in the muscles of the shoulder.
Diagnosis of referred shoulder pain
A thorough subjective and objective examination from a physiotherapist is usually sufficient to diagnose referred pain to the shoulder and the underlying cause of symptoms. Further investigations such as X-rays, MRI or CT scans are often required to assist with diagnosis.
Treatment for referred shoulder pain
Treatment for patients with shoulder pain that is referred from another source varies greatly depending on the cause. Accurate diagnosis from a physiotherapist or doctor is therefore required to determine the most appropriate treatment. Treatment of the underlying cause of symptoms should result in improvement in the shoulder pain.
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