Arthritis chest and 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



Pain in the shoulder and neck is common. Driving a golf ball, cleaning windows, or reaching for a jar can strain and injure shoulder muscles and tendons, especially in people who are out of condition.

Fortunately, this discomfort rarely suggests a serious condition. Causes of shoulder and neck pain include:

• Poor posture and/or unnatural sleeping positions. Sleeping on a soft mattress can give you a stiff neck the next morning.
• Tension and stress. When you feel tense, the muscles around your neck can go into spasms.
• Tendinitis, inflammation of a tendon, the cordlike tissue that connects muscles to bone. Left untreated, tendinitis can turn into "frozen shoulder," a stiff, painful condition that may limit your ability to use your shoulder. "Wry" neck is a similar condition.
• Bursitis, an inflammation of the sac (bursa) that encases the shoulder joint. Bursitis can be caused by injury, infection, overuse, arthritis, or gout.
• Osteoarthritis. Unlike rheumatoid arthritis, osteoarthritis develops from normal wear-and-tear of the joints as we age or from repeated injuries. Aging can cause the joints to wear out, producing bony spurs that can press on nerves and cause pain.
• Accidents and falls. Collarbones can break during falls or auto accidents.
• Motor vehicle accidents. You can develop a whiplash injury when your vehicle is hit from behind.
• Pinched nerve. Arthritis or an injury to your neck can pinch a nerve in your neck. Pain from a pinched nerve usually runs down the arm on one side only.


Sometimes shoulder and neck pain signal serious medical problems, especially with other symptoms such as stiff neck, sudden and severe headache, dizziness, chest pain or pressure, and/or loss of consciousness. Here, the list is a bit different…

• Myocardial infarction – heart attack. Associated with nausea, sweating, flushing, and dyspnea.
• Angina pectoris – Chest pain due to insufficient blood flow to the heart. Associated with activity; repeated episodes; relief with rest; family history; obesity; tachycardia; and increased blood pressure.
• Cholecystitis – gallbladder inflammation may cause chest wall pain.
• Other abdominal considerations that may cause chest wall pain and could possibly confused with arthritis affecting the chest wall are: peptic ulcers, gastroesophageal reflux, gas pockets, irritable bowel syndrome, esophageal spasm, achalasia, or a tear or ulcer in the esophagus, and pancreatitis.
• Gastroesophageal reflux (hiatal hernia) - associated with eating; may be triggered by exercise.
• Musculoskeletal strain or spasms - episode associated with activity and is persistent.
• Pulmonary embolism – a blood clot in the lung.
• Pericarditis – inflammation of the sack that holds the heart typically causes chest wall pain that may be confused for arthritis.
• Myocarditis, inflammation of the heart wall, can also cause chest pain that may be mistaken for chest wall pain.
• Psychogenic - unexplained chest pain and hyperventilation; inability to recall past episodes.
• Pleurisy- inflammation of the lining of the lung- may cause chest wall pain. Other lung problems that may be associated with chest pain and be confused with arthritis are bronchitis, oneumonia, lung cancer, or pneumothorax (punctured lung).
• Aortic dissection – The aorta- the main artery leading away from the heart- ruptures. The pain is “tearing” in nature and radiates to the back.
• Viruses such as herpes zoster may also cause chest wall pain.
If all chest pains are not caused by heart disease, what are their origins and how can we tell the difference? This question is the basis for the physician’s system of diagnosing the cause of chest pain. If the chest wall is tender to the touch, or if the pain occurs with movement of the shoulder, arm, etc, then a musculoskeletal cause is suspected. The junction of the sternum and rib is often tender and inflamed. This is called costochondritis.

Arthritic conditions affecting the cervical spine may caused referred pain to the shoulders. In particular, disc bulging and disc degeneration are often associated with this kind of referred pain. If the chest discomfort is related to eating, then gall bladder disease is suggested. If an empty stomach causes symptoms, then reflux of stomach acid or ulcer disease can be the culprit. It may seem strange that these examples of gastrointestinal disease can be experienced as chest discomfort, but it is not at all unusual. Other causes of chest pain are referred nerve pain from conditions such as arthritis of the cervical spine.

The key distinctive point in diagnosing chest pain caused by atherosclerotic blockages in the blood vessels of the heart (coronary artery disease) is in its relation to physical exertion.

Stretching and strengthening routines, especially before exercising, help prevent injuries to the shoulder and chest. So can using the right equipment and following the proper technique.

Avoid injuries to the shoulder by wearing seat belts in cars and trucks and using protective gear during sporting events.

Avoid vigorous exercise unless you are fit. If you are out of condition, start to strengthen your muscles gradually and slowly increase exercise intensity.

Don't sleep on your stomach. You are likely to twist your neck in this position.

Sleep on a firm mattress. Use a feather, polyester, or special neck (cervical) pillow. Use a thinner pillow or none at all if you have pain when you wake up.

Keep the muscles in your shoulders strong and flexible to prevent injury. These exercises can help:

Stretch the back of your shoulder by reaching with one arm under your chin and place that hand across the opposite shoulder. Place the palm side of your other hand gently on the forearm and push the arm back. Hold for 15 seconds. Repeat 5 times, then switch sides.

Raise one arm and bend it behind your head to touch the opposite shoulder. Use the other hand to gently pull the elbow toward the opposite shoulder. Hold for 15 seconds. Repeat 5 times, then switch sides.

Holding light weights, lift your arms out horizontally and slightly forward. Keeping your thumbs toward the floor, slowly lower your arms halfway, then return to shoulder level. Repeat 10 times.

Sit straight in a chair. Flex your neck slowly forward and try to touch your chin to your chest. Hold for 10 seconds and go back to the starting position. Repeat 5 times.

Sit straight in a chair. Look straight ahead. Slowly tilt your head to the right, trying to touch your right ear to your right shoulder. Do not raise your shoulder to meet your ear. Hold for 10 seconds and straighten your head. Repeat five times on this side and then on your left side.

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