From the Guidelines
Gallstones can indeed cause referred shoulder pain, particularly in the right shoulder, due to the irritation of the phrenic nerve that shares connections with nerve pathways to the shoulder. This phenomenon occurs when gallstones block bile ducts, leading to inflammation and increased pressure in the gallbladder, which in turn irritates the phrenic nerve, causing referred pain in the shoulder 1. The diagnosis of gallstones and related complications can be made using ultrasound (US) of the abdomen, which is the first choice of investigation for biliary symptoms or right upper quadrant abdominal pain, with a reported accuracy of 96% for detection of gallstones 1.
Key Points to Consider
- Referred shoulder pain from gallstones typically accompanies other symptoms like intense upper abdominal pain (biliary colic), nausea, vomiting, and sometimes fever if infection develops.
- The shoulder pain often worsens after fatty meals since fat triggers gallbladder contraction.
- If you experience right shoulder pain along with upper abdominal discomfort, especially after eating, seek medical evaluation promptly.
- Treatment depends on severity, ranging from pain management with medications to surgical removal of the gallbladder (cholecystectomy) for recurrent or severe cases.
- Ignoring these symptoms can lead to serious complications like acute cholecystitis, pancreatitis, or bile duct infection.
Importance of Prompt Medical Evaluation
It is crucial to seek medical attention if symptoms persist or worsen over time, as delayed diagnosis and treatment can lead to increased morbidity and mortality 1. A thorough medical evaluation, including a physical examination, medical history, and diagnostic imaging like US, can help determine the underlying cause of the symptoms and guide appropriate treatment.
From the Research
Gallstones and Referred Shoulder Pain
- Cholelithiasis, or gallstones, can cause referred pain in various parts of the body, including the shoulder 2.
- The presentation of gallstone disease is often asymptomatic, but when symptomatic, it usually presents as sudden onset right upper quadrant or epigastric abdominal pain, which can radiate to the upper back or shoulder 3, 4.
- Studies have shown that patients with gallstones may experience pain radiating to the upper back, which can be mistaken for shoulder pain 4.
- A specific clinical sign, known as Collins' sign, has been validated as an indicator of cholelithiasis, where patients with gallstone pain attempt to demonstrate the pain by placing their hand behind their back and thumb pointing upwards, which can be related to referred shoulder pain 5.
Diagnostic Considerations
- Abdominal ultrasonography is the most useful diagnostic tool for gallstones, showing high sensitivity and specificity 6.
- Other diagnostic tests, such as endoscopic ultrasonography, abdominal CT, MRCP, or ERCP, can help identify complications or other accompanying diseases caused by gallstones 6, 3.
- A careful clinical evaluation, including a thorough medical history and physical examination, is essential to guide patient selection for diagnostic imaging and appropriate management 4.