Right shoulder blade pain rib cage pain



by Nathan Wei, MD, FACP, FACR

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

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Typically, one does not think of pain in the shoulder as originating from the abdomen.

However, a patient who complains of both right shoulder pain as well as right-sided rib pain usually has referred pain from either the abdomen or the chest.

Abdominal sources of pain include peptic ulcer disease, pancreatitis, ectopic pregnancy, and gall bladder disease.

Lung causes include pneumonia, pleuritis, and pulmonary emboli.

Probably, the most likely association is with gall bladder disease. This is termed biliary colic.

Biliary colic is a steady or intermittent ache in the upper abdomen, usually under the right rib cage. It happens when

gallstones interfere with the normal flow of bile from the gallbladder. If a gallstone blocks the ducts leading to the bowel, the normal flow of bile into the intestine is disrupted. The muscle cells in the bile duct contract vigorously to try to move the stone, causing the pain of biliary colic.

A person with biliary colic usually complains of an ache or a feeling of pressure in the upper abdomen. This pain can occur in the upper abdomen just below the breastbone, or in the upper-right part of the abdomen near the gallbladder and liver. In some people, the abdominal pain spreads back toward the right shoulder blade. Many people also experience nausea and vomiting.

Symptoms are especially common after fatty meals. The symptoms also can occur when a person who has been fasting suddenly breaks the fast and eats a very large meal.

Diagnostic ultrasound can be used to detect gallstones. Blood tests also may be ordered.




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