Differential Diagnosis for Right Shoulder Blade Pain and Nausea and Vomiting

Single Most Likely Diagnosis

• Musculoskeletal strain or sprain: This is often the most common cause of shoulder blade pain, which can be exacerbated by physical activity or poor posture. Nausea and vomiting could be secondary to pain or related to a viral gastrointestinal issue coinciding with the musculoskeletal injury.

Other Likely Diagnoses

• Gastroesophageal reflux disease (GERD): GERD can cause referred pain to the back, including the area around the shoulder blades, due to acid reflux. Nausea and vomiting are common symptoms of GERD.
• Peptic ulcer disease: Similar to GERD, peptic ulcers can cause epigastric pain that radiates to the back, including the shoulder blade area, and are often accompanied by nausea and vomiting.
• Pneumonia or pulmonary embolism with referred pain: While less common, pneumonia or a pulmonary embolism can cause pain that is referred to the shoulder blade area, especially if the lungs are involved. Nausea and vomiting can occur due to the severity of the illness or secondary infection.

Do Not Miss Diagnoses

• Myocardial infarction (heart attack): Although less common, myocardial infarction can present with atypical symptoms, including pain in the back or shoulder blade area, especially in women or diabetic patients. Nausea and vomiting can also be present.
• Pancreatitis: Acute pancreatitis can cause severe abdominal pain that radiates to the back, including the shoulder blade area, and is often accompanied by nausea and vomiting.
• Aortic dissection: This is a life-threatening condition where the inner layer of the aorta tears. It can cause severe, tearing pain in the chest or back, which may radiate to the shoulder blades, and can be accompanied by nausea and vomiting.

Rare Diagnoses

• Tumor or metastasis: Rarely, tumors or metastases in the lung, spine, or other areas can cause referred pain to the shoulder blade area. Nausea and vomiting could be related to the tumor itself or to treatment effects.
• Sickle cell crisis: In patients with sickle cell disease, a crisis can cause severe pain episodes, including pain in the back or shoulder area, and may be accompanied by nausea and vomiting.
• Herpes zoster (shingles): Shingles can cause pain in a dermatomal distribution, which could include the area around the shoulder blade. While nausea and vomiting are less common, they can occur, especially if the patient has a significant systemic response to the infection.