What is the relationship between dorsal (back) and shoulder pain and cholecystitis (gallbladder inflammation)?

From the Guidelines

Gallbladder problems, such as cholecystitis, can indeed cause referred pain in the back and shoulder, particularly in the right shoulder blade area, due to shared nerve pathways with the diaphragm. This type of pain is a result of the gallbladder and diaphragm sharing common nerve roots, which can lead to pain signals being referred to the shoulder and upper back regions. If you're experiencing back and shoulder pain that might be related to your gallbladder, it's essential to seek medical evaluation promptly, especially if accompanied by other symptoms like abdominal pain, nausea, vomiting, or yellowing of the skin 1.

Key Considerations

• The diagnosis of acute cholecystitis is made based on clinical features such as right upper quadrant pain, fever, and leukocytosis, supported by findings from relevant imaging studies, with ultrasound being the investigation of choice 1.
• Ultrasound typically shows pericholecystic fluid, distended gallbladder, oedematous gallbladder wall, and gallstones, and Murphy’s sign can be elicited on ultrasound examination 1.
• For temporary relief of pain, over-the-counter pain medications like acetaminophen (Tylenol) at 500-1000mg every 6 hours (not exceeding 4000mg daily) may help manage discomfort, along with applying a heating pad to the painful area for 15-20 minutes several times daily 1.
• Dietary modifications are crucial, including avoiding fatty, fried foods, and heavy meals, and instead eating smaller, more frequent meals that are low in fat, staying well-hydrated with water, and considering gentle movement like walking to help with pain management.

Management and Treatment

• Early cholecystectomy is a safe treatment for acute cholecystitis and generally results in shorter recovery time and hospitalization compared to delayed cholecystectomies 1.
• Laparoscopic cholecystectomy is a safe and effective treatment for acute cholecystitis and is the first choice for patients with acute cholecystitis where adequate resources and skill are available 1.
• Cholecystostomy is a safe and effective treatment for acute cholecystitis in critically ill and/or patients with multiple comorbidities and unfit for surgery 1.

Importance of Prompt Medical Evaluation

Given the potential for gallbladder problems to cause significant morbidity and mortality, especially if complications such as perforation occur, prompt medical evaluation is crucial. Early diagnosis and treatment can substantially decrease morbidity and mortality rates associated with gallbladder disease 1.

From the Research

Relationship between Dorsal (Back) and Shoulder Pain and Cholecystitis (Gallbladder Inflammation)

• The relationship between dorsal (back) and shoulder pain and cholecystitis (gallbladder inflammation) is supported by several studies 2, 3, 4.
• A study published in the Scandinavian journal of gastroenterology in 2006 found that 63% of patients with gallstone disease experienced pain referred to the back 2.
• Another study published in The American journal of medicine in 1990 found that patients with gallstones more often reported pain radiating to the upper back compared to control subjects 3.
• A study published in Hepatology (Baltimore, Md.) in 1999 found that pain radiated to the right shoulder was significantly associated with gallstones 4.

Characteristics of Pain in Gallstone Disease

• The pain associated with gallstone disease is typically characterized as steady, moderate to severe in intensity, and located in the epigastrium or right upper quadrant of the abdomen 5.
• The pain can radiate to the back or right shoulder, and is often accompanied by other symptoms such as nausea, vomiting, and fever 2, 3, 4.
• The pain can be triggered by eating fatty or greasy foods, and can occur at any time of day, but is often worse at night 2, 3.

Diagnosis and Treatment of Gallstone Disease

• The diagnosis of gallstone disease is typically made using ultrasonography, which can detect gallstones and other abnormalities in the gallbladder 5, 6.
• The treatment of gallstone disease depends on the severity of symptoms and the presence of complications such as acute cholecystitis or gallstone pancreatitis 5, 6.
• Laparoscopic cholecystectomy is a common treatment for symptomatic gallstones, and is often performed electively to prevent future complications 5, 6.