Which conditions often refer pain to the shoulder?

• A. All of the above
• B. Ulcer
• C. Myocardial ischemia
• D. Gallbladder/Liver disease

Answer: (A)

Pain felt in the shoulder can come from problems inside the chest or abdomen because the nerves carrying visceral sensations share pathways with the nerves that supply the shoulder area. When the heart experiences ischemia, the brain can interpret that sensory input as pain in the left shoulder or arm. Gallbladder or liver issues can irritate the diaphragm, and diaphragmatic irritation often refers pain to the shoulder, typically on the right side. Even ulcers can irritate the diaphragmatic surface, producing diaphragmatic referred pain that the brain perceives as shoulder pain. Since all of these conditions can produce shoulder-referred pain, the best answer is that all of the above explain why shoulder pain can be a clue to non-shoulder pathology.