Referred Shoulder Pain

What is Referred Shoulder Pain?

Referred pain occurs when pain is experienced away from the actual injury or origin of pain. It is more common than most people think, and there are several well-known varieties - Heart Attacks can refer pain to the shoulder, arms and neck, for example. The condition known as 'Brain Freeze' is referred pain from the Vagus nerve. It is not yet understood why referred pain occurs.

What causes Referred Pain in the Shoulder?

Referred pain from the cervical and thoracic spine is usually due to compression of a nerve or a nerve root. There are many reasons that this could occur; including vertebral disc problems, muscle spasms, osteo-arthritic conditions, spinal fractures or tumours. For this reason, referred pain is more common among adults.

When a nerve is compressed, it can cease to send information to the brain. Some nerves carry sensory information, and when these nerves are compressed we experience 'pins and needles' or other strange sensations. Other nerves carry motor information - compression of these nerves can cause muscle weakness and coordination problems.

Symptoms of Pain Referred to the Shoulder

• Radiating pain into the arm, neck, chest and/or shoulders
• Numbness or tingling in the fingers or hands
• Muscle weakness
• Poor coordination, particularly in the hands

Depending on what level the problem is occurring (meaning at which cervical vertebra), the pain and weakness will be experienced in different areas.
Damage to the nerve root between the C4 and C5 vertebrae (C5 root) will result in
Pain at the base of the neck that radiates to the shoulder and upper arm
Weakness in the biceps, with some numbness over the shoulder.

Damage to the nerve root at the C5 – C6 level (C6 root) will result in
Pain that radiates from the neck to shoulder and scapula, down the outside (lateral) surface of the arm.
Weakness in the biceps, with numbness along the thumb and index finger.

Damage to the nerve root at C6 – 7 (C7 root) will result in
Pain from the neck and shoulder down the outside (lateral) surface of the arm, to the middle finger.
Weakness in the triceps, with decreased sensation along the back of the hand and middle finger.

The symptoms may be reduced if you put your hands on the top of your head, which may relieve pressure on the nerve by increasing the space between the cervical vertebrae.
Referral from the Thoracic spine is very uncommon and is usually the result of degenerative disc disease or metabolic conditions such as diabetes mellitus. Due to the fact that these symptoms can often mimic cardiac pains, it is vital to have this investigated urgently, particularly if it is of sudden onset.

If you think you are experiencing Referred Shoulder Pain, seek medical attention to ensure there are no serious problems causing the effects.

Please see the Virtual Sports Injury Clinic for more information on how to treat Referred Shoulder Pain and other causes of shoulder pain.