Abdominal pain accompanied by shoulder pain

by Nathan Wei, MD, FACP, FACR

Nathan Wei is a board-certified rheumatologist and author of the Second Opinion Arthritis Treatment Kit. It's available exclusively at this website... not available in stores.

Click here: Second Opinion Arthritis Treatment Kit


So what are the causes of abdominal pain accompanied by shoulder pain? They are probably more numerous than you think!

Cholecystitis

This is inflammation of the gallbladder.

The gallbladder is a pear-shaped organ that is nestled beneath the liver. Its main function is to store and concentrate bile - a bitter greenish mixture of acids, salts and other substances. Approximately twenty million Americans have gallstones. Gallstones often occur in individuals with liver disease. Other risk factors for gallstones include female gender, obesity, a family history of gallstones, multiple pregnancies, rapid weight loss, and biliary tract narrowing (known as biliary strictures). The typical pain from gallstones is a right upper quadrant discomfort that usually lasts from a half hour to six hours before abating. Pain is usually severe and usually recurs. This pain often radiates to the shoulder or back, and is usually accompanied by nausea and vomiting. Diagnosis of gallstones is typically made by obtaining an abdominal sonogram. People with symptomatic gallstones require surgical removal of the entire gallbladder, not just the gallstones. Constant pain in right upper quadrant, onset often postprandial; nausea and vomiting; tenderness in right upper quadrant and right shoulder; splinting on right side.

Ectopic pregnancy
In women, abdominal discomfort may signal a problem with the reproductive system. Pelvic pain that occurs each month just before a woman’s period suggests endometriosis. Tenderness in the lower abdominal area may mean pelvic inflammatory disease. For women of childbearing age, an ectopic pregnancy can produce a sudden sharp, stabbing abdominal pain along with vaginal bleeding, a history of missed or light periods, or pain radiating to the shoulder. Ovarian cysts and uterine fibroids can also cause abdominal pain in women.

Heart attack
Although the one of the classic signs of an impending or actual heart attack in males is pain in the shoulders, females frequently report pain between the shoulder blades instead.

If you are experiencing pain between the shoulder blades, combined with any of these symptoms, call your Doctor or 911 immediately!

- Squeezing chest pain or pressure
- Shortness of breath
- Sweating
- Tightness in chest
- Recurring chest discomfort
- Pain spreading to shoulders, neck or arms
- Indigestion or gas-like pain
- Dizziness, nausea or vomiting
- Unexplained weakness, fatigue
- Discomfort/pain between shoulder blades
- Sense of impending doom

Pancreatitis

Another rare cause of abdominal pain and shoulder pain was published in this paper describing a 16 year old boy who presented with severe right shoulder pain. The pain was due to a large amount of fluid in the pleural space that developed as a result of pancreatitis (inflammation of the pancreas).

Massive right-sided hemorrhagic pleural effusion due to pancreatitis; a case report
Mohammad Reza Namazi and Ashkan Mowla
Shiraz University of Medical Sciences, Shiraz, Iran

BMC Pulmonary Medicine 2004, 4:1 doi:10.1186/1471-2466-4-1

Fibromyalgia

Fibromyalgia is a condition characterized by chronic, widespread pain in muscles and soft tissues surrounding the joints throughout the body, accompanied by fatigue. The disease is fairly common, affecting approximately 2 percent of the US population.

Although its symptoms are similar to other joint diseases, such as arthritis, fibromyalgia is actually a form of soft tissue or muscular rheumatism that causes pain in the muscles and soft tissues. This condition may cause irritable bowel symptoms and cause widespread musculoskeletal symptoms including shoulder pain. Fibromyalgia is one of several pain syndromes included in the classification of musculoskeletal pain syndrome (MSPS), or pain amplification syndrome.

Now we move onto more serious causes...

Liver Cancer

Liver cancer, an abnormal cell growth in the liver, comes in two types:

Primary cancer means that the cancer started in the liver. of the liver occurs when the cancer starts in the liver.

Secondary cancer of the liver occurs when a cancer starts someplace else and spreads to the liver.

These early warning signs of Liver Cancer:

- A hard lump in the belly, below the rib cage on the right side.
- Discomfort in the upper belly on the right side.
- Pain around the right shoulder blade, or pain between the shoulder blades.
- Yellowish skin color (jaundice)
- Abdominal swelling causing a feeling of fullness

Esophageal Cancer

Esophageal cancer appears as tumors, or an abnormal growth of cells in the esophagus. The esophagus is the food passageway that connects the throat to the stomach.

Esophageal cancer usually does not display any symptoms until the cancer has advanced to a stage that is too late for a cure. The main symptom is difficulty in swallowing food. There is a frequent sensation of food getting stuck in the throat or chest.

Signs of advanced Esophageal cancer include:

- Pain when swallowing.
- Pain in the throat or back, behind the breastbone or pain between the shoulder blades.
- Decreased appetite and weight loss.
- Hiccups with the feeling of food getting stuck in your throat or chest.
- Vomiting and coughing up blood.

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