Can referred pain from the gallbladder cause muscle tension in patients with a history of gallbladder disease, such as cholecystitis or cholelithiasis?

Gallbladder Referred Pain and Muscle Tension

Yes, referred pain from gallbladder disease causes measurable muscle hyperalgesia and altered tissue characteristics in the referred pain area, which manifests clinically as muscle tension.

Mechanism of Referred Muscle Changes

• Gallbladder pathology induces somatosensory hyperalgesia in 84% of patients with uncomplicated gallstone disease, specifically in the referred pain area where visceral pain is perceived 1
• The muscle tissue in the referred pain area (typically right upper quadrant extending to the right shoulder and scapular region) demonstrates significantly lower pain thresholds to electrical stimulation compared to the contralateral side 2
• Subcutaneous and muscle pain thresholds at the referred site are inversely correlated with the number of painful gallstone attacks—meaning more frequent colics lead to progressively lower pain thresholds and increased muscle sensitivity 2

Clinical Presentation

• Patients with symptomatic gallbladder disease characteristically refer pain to the right supraclavicular region and/or shoulder, which is accompanied by measurable changes in the underlying tissues 3
• The referred pain area shows both sensory hyperalgesia and altered tissue trophism (increased subcutaneous thickness and decreased muscle thickness) in symptomatic patients compared to asymptomatic patients or controls 2
• Collins' sign—where patients place their hand behind their back with thumb pointing upward to demonstrate scapular tip pain—is positive in 51.5% of gallstone patients, reflecting this characteristic referred pain pattern 4

Reversibility After Treatment

• After cholecystectomy, the somatosensory hyperalgesia in the referred pain area normalizes completely within 4-12 weeks, and sensory findings return to normal 1
• Patients who continue experiencing gallstone colics show progressive decreases in subcutaneous and muscle pain thresholds at the referred site, while those whose colics resolve show significant threshold increases back toward normal 2

Pathophysiological Basis

• The muscle tension and hyperalgesia result from central neuroplastic changes in sensory pathways induced by visceral nociceptive inputs from the gallbladder, creating neuronal hyperexcitability in somatic areas sharing central pathways with the gallbladder 1
• These referred sensory and trophic changes only occur in painful gallbladder pathology, not in asymptomatic gallstone disease, and their extent is directly modulated by the amount of perceived visceral pain 2

Clinical Implications

• The presence of muscle hyperalgesia and tension in the right upper quadrant and shoulder region is not simply "guarding" but represents measurable neurophysiological changes secondary to visceral pain 2
• Physical examination findings of muscle tenderness in the referred area (cystic point and right shoulder/scapular region) have diagnostic value and correlate with the severity and frequency of gallbladder symptoms 2, 4