What causes shoulder pain during pregnancy?

From the Guidelines

Shoulder pain during pregnancy should be managed with gentle stretching exercises, good posture, and supportive measures, as it is typically caused by postural changes, hormonal effects on ligaments, and increased weight. To manage shoulder pain during pregnancy, try gentle stretching exercises like shoulder rolls and wall slides, maintain good posture, apply heat or cold packs for 15-20 minutes several times daily, and use supportive pillows while sleeping.

Key Considerations

• Acetaminophen (Tylenol) is generally considered safe during pregnancy at regular doses (up to 3000mg daily divided into doses) for short periods, but always consult your healthcare provider first 1.
• Massage therapy from a prenatal-certified therapist can help, as can prenatal yoga.
• Avoid NSAIDs like ibuprofen during pregnancy. The pain often results from the relaxin hormone loosening ligaments throughout the body, combined with forward-shifted posture due to the growing belly pulling the shoulders forward and increasing strain. If pain is severe, persistent, or accompanied by numbness, tingling, or weakness, consult your healthcare provider promptly as it could indicate a more serious condition requiring specific treatment. While the provided evidence does not directly address shoulder pain in pregnancy, general principles of managing pain and maintaining comfort during pregnancy can be applied, prioritizing the safety and well-being of both the mother and the fetus 1.

From the Research

Shoulder Pain in Pregnancy

• Shoulder pain is a common complaint during pregnancy, and its management is crucial to prevent adverse maternal and fetal outcomes.
• The use of non-steroidal anti-inflammatory drugs (NSAIDs) in pregnancy is associated with increased risks of miscarriage, malformations, and fetal adverse effects, such as premature closure of the fetal ductus arteriosus and oligohydramnios 2.
• However, NSAIDs may be used in pregnancy if the maternal benefits outweigh the potential fetal risks, at the lowest effective dose and for the shortest duration possible 2.
• Acetaminophen is considered a safer alternative to NSAIDs for mild to moderate pain management in pregnancy, although its efficacy may differ from that of NSAIDs 3, 4.

Management of Shoulder Pain

• The diagnosis of shoulder pain is crucial in decision-making, and ultrasound is an important tool in the diagnostic and therapeutic pathway 5.
• Conservative management, including the use of NSAIDs, physiotherapy, and subacromial steroid injections, is a well-established practice for shoulder impingement syndrome 6.
• In cases of rotator cuff-related shoulder pain, ibuprofen may be more effective than acetaminophen in improving pain severity and functional activity 3.
• Ultrasound-guided injection and other techniques, such as steroid injections, hydrodilatation, and extracorporeal shockwave treatment, may be used to treat various shoulder conditions, including subdeltoid subacromial bursitis and calcific tendinosis 5.

Considerations for Pain Management in Pregnancy

• Pain management in pregnancy should be tailored to the lowest therapeutic dose and shortest possible duration, with careful consideration of the risks and benefits of various analgesics 4.
• Short courses of weaker opioids may be safe in pregnancy, but neonatal abstinence syndrome must be monitored following third trimester exposure 4.
• Limited safety data for pregabalin and gabapentin indicate that these are unlikely to be major teratogens, and tricyclic antidepressants and serotonin-norepinephrine reuptake inhibitors have limited but overall reassuring safety data 4.