Shoulder muscle chest area 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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The neck, chest, and shoulder share a common nerve supply. A problem that affects one area may cause referred pain to another.
Most shoulder and neck pain results from injury to muscles and ligaments. The spinal cord, heart, lungs, and some abdominal organs also can cause neck and shoulder pain. Here are some examples:
Fractured clavicle (broken collarbone). This will cause pain in the collarbone but also in the shoulder and sometimes in the upper chest.
Bursitis: A bursa is a sac that provides a cushion to joints and muscles. Bursae can become swollen and painful after injuries. Bursitis of the shoulder may cause pain to radiate to the chest. Sometimes the smaller bursae in the chest wall can become inflamed and cause pain.
Heart attacks: Although the problem is the heart, heart attacks can cause referred pain to the shoulder or neck.
Excessive coughing can also cause chest wall pain due to muscle spasm that may be referred to the shoulder.
Fractured scapula (broken shoulder blade). Pain is localized to the posterior chest wall.
Rotator cuff injuries: The rotator cuff is a group of muscles and tendons in the shoulder. Rotator cuff tendonitis occasionally causes pain referral to the upper chest.
Shoulder separation: The collarbone and shoulder blade are connected by a tough ligament. With trauma to the shoulder, this ligament can be stretched or torn. The upper chest near the collarbone will be the site of pain.
Whiplash injury: Injury to the ligamentous and muscular structures of the neck and shoulder can be caused by sudden acceleration or deceleration, as in a car accident. Any neck injury can cause pain referral to the chest and shoulder.
Gallbladder disease: This can cause a pain referred to the right shoulder and to the right side of the chest.
To reiterate...any part of the chest can cause pain in the chest, including the heart, lungs, esophagus, muscle, bone, and skin. Because of the complex nerve distribution in the body, chest pain may come from another part of the body. The stomach or other organs in the belly (abdomen), for example, can cause chest pain. And anything that causes chest pain can be referred to the shoulder. Examples:
A heart attack occurs when blood flow to the arteries that supply the heart (coronary arteries) becomes blocked. This causes damage and deterioration of the heart muscle.
Angina is caused by blockage or narrowing of the blood vessels that supply blood to the heart. Angina is different from a heart attack in that the arteries are not completely blocked. Also, angina causes little or no permanent damage to the heart.
Both angina and a heart attack can cause referred pain to the shoulder and arm.
The aorta is the main artery that supplies blood to the vital organs of the body, such as the brain, heart, kidneys, lungs, and intestines. Dissection is a tear in the inner lining of the aorta. This can cause massive internal bleeding and interrupt blood flow to the vital organs. Sharp searing intense pain in the upper back and chest is a classic symptom.
A pulmonary embolus is a blood clot in one of the major blood vessels that supplies the lungs. It is a potentially life-threatening cause of chest pain.
Spontaneous pneumothorax occurs when air enters the space between the chest wall and the lung. Normally, negative pressure in the chest cavity allows the lungs to expand. When a spontaneous pneumothorax occurs, air enters the chest cavity and causes the lung to collapse.
A perforated bowel allows air to enter the abdominal cavity. Air in the abdominal cavity irritates the diaphragm, which can cause chest pain. Because the diaphragm is irritated, pain in the shoulder may also occur.
Acute pericarditis is an inflammation of the pericardium, which is the sac that covers the heart. Pericarditis pain is sharp and relieved by leaning over when seated. It may- if there is irritation of the diaphragm cause shoulder pain.
Mitral valve prolapse is an abnormality of one of the heart valves where the valve bulges during contraction. Fleeting chest pains can occur with this disorder. Since mitral valve prolapse is a common finding in patients with fibromyalgia, accompanying shoulder pain is sometimes seen.
Fibromyalgia is another cause of chest muscle pain. Costochondritis is a particularly common cause of chest wall muscle pain. Costochondritis is an inflammation of the cartilage between the ribs. Pain is typically located in the mid chest, with intermittently dull and sharp pain that may be increased with deep breaths, movement, and deep touch. It can mimic a heart attack.
Pneumonia is infection of the lung tissue. Chest pain occurs because of inflammation of the lining of the lungs. Referred pain to the shoulder is relatively common.
Chest pain from esophageal disorders can be alarming symptom because it often mimics chest pain from a heart attack.
Gastroesophageal reflux disease, or GERD occurs when acid flows up from the stomach into the esophagus. The resulting heartburn is sometimes experienced as chest pain. Likewise, esophagitis which is inflammation of the esophagus may also cause chest pain. Another esophageal cause of chest pain is esophageal spasm.
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