What is chest pain?
This applies to all bodily systems, such as sore throats or pain in the musculoskeletal system. Pains in upper legs, ankles, eyes. Vasovagal reactions can have many triggers - such as hot weather, prolonged standing, lack of food, emotion, head movement - or no apparent trigger at all. Invite medical Students to join with us!!!! Just grasping at straws! Or you can use a formulation that contains at least licorice, peppermint and chamomile. For example, it's unlikely but possible that your shoulder pain is a sign of something insidious happening in your liver , gall bladder , stomach , spleen , lungs , or pericardial sac the connective tissue bag containing the heart.
These are called functioning tumors. Each one is named for the type of hormone the tumor cells make. They are more likely to be cancer than are functioning tumors.
These NETs are much more common in other parts of the digestive system, although rarely they can start in the pancreas. The treatment and outlook for pancreatic NETs depend on the specific tumor type and the stage extent of the tumor , but the outlook is generally better than that of pancreatic exocrine cancers. Some growths in the pancreas are simply benign not cancer , while others might become cancer over time if left untreated known as precancers.
Because people are getting imaging tests such as CT scans more often than in the past for a number of reasons , these types of pancreatic growths are now being found more often.
Serous cystic neoplasms SCNs also known as serous cystadenomas are tumors that have sacs cysts filled with watery fluid. Mucinous cystic neoplasms MCNs also known as mucinous cystadenomas are slow-growing tumors that have cysts filled with a jelly-like substance called mucin.
These tumors almost always occur in women. While they are not cancer, some of them can progress to cancer over time if not treated, so these tumors are typically removed with surgery. Intraductal papillary mucinous neoplasms IPMNs are benign tumors that grow in the pancreatic ducts.
Like MCNs, these tumors make mucin, and over time they sometimes become cancer if not treated. Some IPMNs can just be followed closely over time, but some might need to be removed with surgery if they have certain features, such as if they are in the main pancreatic duct. Solid pseudopapillary neoplasms SPNs are rare, slow-growing tumors that almost always develop in young women. Even though these tumors tend to grow slowly, they can sometimes spread to other parts of the body, so they are best treated with surgery.
The outlook for people with these tumors is usually very good. The American Cancer Society medical and editorial content team Our team is made up of doctors and master's-prepared nurses with deep knowledge of cancer care as well as journalists, editors, and translators with extensive experience in medical writing.
March 14, Last Revised: For reprint requests, please see our Content Usage Policy. Pancreatic Cancer About Pancreatic Cancer. What Is Pancreatic Cancer? The pancreas has 2 main types of cells: Most of the cells in the pancreas form the exocrine glands and ducts. The exocrine glands make pancreatic enzymes that are released into the intestines to help you digest foods especially fats.
The enzymes are first released into tiny tubes called ducts. These merge to form larger ducts, which empty into the pancreatic duct. The pancreatic duct merges with the common bile duct the duct that carries bile from the liver , and empties into the duodenum the first part of the small intestine at the ampulla of Vater. Endocrine cells make up a much smaller percentage of the cells in the pancreas. These cells are in small clusters called islets or islets of Langerhans.
These islets make important hormones like insulin and glucagon which help control blood sugar levels , and release them directly into the blood. Types of pancreatic cancer The exocrine cells and endocrine cells of the pancreas form different types of tumors.
Exocrine pancreatic cancers Exocrine cancers are by far the most common type of pancreas cancer. There are many types of pancreatic NETs. Gastrinomas come from cells that make gastrin. About half of gastrinomas are cancers. Insulinomas come from cells that make insulin. Most insulinomas are benign not cancer.
Doctors say it isn't referred pain. Yet he has no symptoms on the left side. Do you think this is referred pain? Interesting case - I'd love to see the images of the herniated disc e.
Sounds like your friend has a compressed cervical nerve root on the right side, not the left. The pain seems to fit a dermatomal distribution, i. Or maybe there's another problem that is unlikely to show up on an imaging study.
I doubt it's referred pain but it's hard to say without more information. Neat blog and very helpful information! We were studying this in vet school too but your page gives a lot of extra, good information, thanks! I'm definately bookmarking his page: This happened to me in the days preciding a laprocopic appendicectemy. The doctors couldnt figre out what was wrong with me for 36 hours.
It was only when an X-ray was carried out did they realise that there had been a small pocket of carbon dioxide left inside my abdomen. The gas was pushing up against my diaphram causing agony when ever i trie to move eat or breath. I found the whole experience very interesting as i am an occupational therapy student and have been studying anatomy. Same thing for my own and family members' experience of other miscellaneous, occasional not-otherwise-explained aches and pains in joints.
Finally, an MD confirmed I wasn't nuts. Sometimes heating pad to the belly area helped. For the past two weeks I've been having somewhat diffuse lower back ache and suspect it's the same cause, but getting worried it might be symptomatic of more serious trouble. Thanks for article and any insights. Brads- great blog really helpfull. Im just starting a medical field and currently taking APII. We were discussing referred pain and I was amazed that neck pain could be a referred pain for liver or gallbladder problems.
I've had neck pain for six months. I've also had a pain in my URQ and can palpate that area to create it. Should I mention this referred pain suspision to my Nuero? Thanks for you help.
Hi Dawn, If you can actually create pain in your neck by palpating your right upper quadrant, that certainly sounds like a case of referred pain, and yes, I'd bring it up with the neurologist. I'm guessing that a lot of potential problems have already been ruled out by the imaging studies, but who knows, your doc may want to take another look I have 2 questions at the end.
But, I thought I'd contribute some additional examples of referred pain My mother had shoulder pain for a while - her GP diagnosed an encapsulated shoulder and sent her for physical therapy. It turned out she had lung cancer. I've had referred pain in my right upper back from right upper abdominal pain which only recurs if I've eaten too many cashews or have Starbucks a couple of days in a row. I also have a pain in my left shoulder that I assume is from a couple of herniated discs I have between C5,C6,C7.
When this flares up, I also have the numbness and tingling in 2 of my left fingers. They call this radiculopathy - but, is this different from referred pain? I've been having more frequent pelvic pains and thought if the abdominal pain is related that I might should get my dr to hurry along with scheduling the surgery since there is a concern the cyst could lead to ovarian torsion or rupture.
Hi Tanya, Interesting examples of referred pain, especially the upper back pain from eating cashews! I'm not totally convinced that all of the cases you mention are referred pain.
For example, the severe hip pain could be due to prostate cancer that metastasized to a hip bone sacrum, pelvic bone, etc. Radiculopathy isn't considered referred pain, because the direct injury of nerve roots that carry sensation from the affected body parts in your case, the upper limb can explain the pain and numbness and tingling.
Regarding your last question, unfortunately I'm not qualified to give medical advice, but I can say that when pain increases in frequency or intensity, it's reasonable to be concerned and express those concerns to your doctor. Talking about referred pain,for the last 4 days I could not sleep at all because of a back pain that would extend all the way to my testicules, could not sit or lay down on my back even in the ER.
Turns out to be peptic ulcer. I am so impressed by your responses to such various posts. I found this by searching google for referred shoulder pain, based on my own intense shoulder pain that is unexplained by bursitis or anything else logical.
I am 28 years old and i am otherwise healthy, but at this point i am out of my mind, i would take anything to make it stop. This morning upon being woke up by the pain it gets worse when i sleep, no matter how or where i sleep my right side became so painfull, it reminded me of when i was in labor for 13 hours. I finnaly drug myself out of bed and went running for the bathroom.
I think i may have gallbladder issues, and your blog was very helpful and even a little reassuring, if nothing else, that i am not crazy. This shoulder right side hurts in such a deep unexplainable way. Hot showers seem to help, but not much. It is just so deep. My husband offered to rub my shoulder but i refused fearing any touch, but it turns out, it doesn't cause more pain to touch it.
I can't tell you how deep this pain is, it's all i can think about. I feel like a crazy person. I don't use any medications, and i try to live healthfully, yet i could crawl into the ER right now and beg for drugs.
I feel like they would laugh at me. I am desperate, and was going to go to a chiro, except i don't want my neck manipulated, too much risk there.
Anyway, sorry for the long post, just wanted to say thank you for shedding light on this for me. To the poster above, typically referred right shoulder pain from the abdomen is caused by irration of the diaphragm by the gall-bladder, liver, or duodenum first part of the small intestine , although anything that lies in the right side of the abdomen can cause it.
I would ask your doctor about referred pain, and about what tests might be applicable. The sooner you get to the bottom of it, the better. Thanks for the article Brad; it was very helpful in clarifying some things. I came across it when trying to find out why referred pain from the diaphragm is always shown over the right shoulder in the textbooks and never the left.
Cheers, Tim First year med. I have been dealing with a pain in my upper left shoulder blade area which began almost one month ago.
Both hips at the joints have now began to experience pain with the right side being more significant. Any advice would be so appreciated. Deb, I'd recommend seeing a neurologist, ideally one that specializes in pain management. Very interesting, very useful -- thank you! You might be interested to note that referred shoulder pain often afflicts women with OHSS, Ovarian Hyperstimulation Syndrome, a common but often unrecognized complication of fertility treatments.
Hurts like the dickens. Best wishes with your med school career! Found your site on a google search for phrenic nerve referred pain. I had this happen this weekend, so bad I thought I had a pinched nerve and called my doc who sent me to the ER. Turned out I had pneumonia which quickly turned into a pleural effusion. Several days in the hospital, I am back home and still very ill and the pain is horrendous. Today it moved to my fingers as well and was just trying to find out if that is typical, its the top of my hand and my fingers that are tingly and painful.
Docs keeping a close eye on me, just hate to be a constant complainer if its just part of the whole thing! Great site, thanks for the info. Would like to know if you have come across gouty like R. Thank you for the illustration.
I have a book that my school gave me to learn about "red flags", but it didn't give a good description of the referred pain patterns. The illustration you posted is incredibly helpful and I will use it throughout my career in physical therapy. If only my doctors or I had read this three years and several thousands of dollars later. I had a right rotator cuff injury. Extreme pain has dogged me ever since. I never put it together with eating. Just yesterday I had my stone filled gall bladder removed.
The doctor was amazed that I was not feeling the pain in my gall bladder area. Sorry your knowledge came late for me. Brad, I was diagnosed with Chronic Myofascial Pain 8 years ago. I see an amazing physiatrist for pain management and have read as much as I could over the years. It is always stated, in anything I have read, that the pain I have is referred pain, but it is never fully explained.
I understand what referred pain means, in a general sort of way, but I am curious as to the how and why. Could you explain further please? I am a 24 yr old female. My pulse is strong and can be felt in my abdomen. Sometimes I have constipation or diarrhea and severe lower back pain worst when I try to sit up from lying postion - get about 45 degrees before collapsing. Rarely I have sharp not crushing chest pain. These symptoms do not occur in conjuction with or without food intake.
Hmm, this isn't a lot to go on, especially for someone with very limited clinical experience like me , but I wonder about an inflammatory bowel disease like Crohn's disease or maybe ulcerative colitis. Other possibilities are irritable bowel syndrome, celiac disease, infection Probably your best bet is a visit to a doctor.
The detailed Human Anatomy study , for example, of the bronchial tree as seen through the bronchoscope is now of great importance. The introduction of laparoscopic and thoracoscopic instruments to explore and operate in the abdomen and thorax respectively has also opened new vistas as surgeons require to learn their anatomical landmarks through these approaches.
Hi Brad, I just had my gallbladder removed 3 weeks ago. My gallbladder was very inflammed and I also had a stone. A few days ago my old original pain came back. The pain is just below my rib on my right side and extends into my right side and back area. My doctor ordered another URQ ultrasound and also a hepatic screening. Got the results today and everything is normal.
Doctor says that my pain cannot still be from my gallbladder or from my common bile duct as the ultrasound showed nothing there. To say the least, I'm very frustrated and concerned. I was told that the pain i was having was because I needed to have my gallbladder removed, and now I have the same pain back! Any words of wisdom or advice? Thanks so much Brad!
I posted earlier about shoulder pain etc. Yesterday I awoke with weird pain laterally under bottom right rib. I massaged area to ease pain and, once again, it triggered burping and some relief. Sometimes pain tends to stick around for a few days even after what I believe is entrapped gas has been eliminated. Still achy today, but less. I've experienced intermittent pain and it is excruciating since I was about 15 years old 20 years now.
It lasts for anywhere between 15 and 45 minutes and completely incapacitates me. The pain usually starts in the jaw and quickly moves to my chest to where it feels like someone is pushing knives into my chest and back I can sometimes predict the pain based on my posture. It always occurs after I've been slouching in my seat or on the couch. Since its only monthly I've largely just ignored it. Frequency has not increased over this time period.
I'm the one who had my gallbladder removed and am still experiencing pain in my RUQ under my rib cage and into my side and back. Do you have any thoughts or comments? I had a bower resection 5 wks ago and for the past 10 days have experienced referred pain in the shoulder.
I can find lots of info on what causes this but almost nothing on what to do about it. Tylenol doesn't touch it, nor does ibuprofen, and I'm going nuts! It's keeping me awake which can't be good for healing. If I were talking to you in a clinic, I'd want to know more about the history and nature of your pain, both before and after the cholecystectomy - you know, when did it start, quality and severity, is it associated with any activities, what makes it feel better or worse, continuous or intermittent, etc.
Although it seems unlikely in your case, it's possible that the RUQ pain is unrelated to your gall bladder or liver. For example, I'd wonder about a kidney stone, or maybe retrocecal appendicitis. Depending on what you told me about your history, I'd consider more imaging studies and labs. As always, the best advice I can give is talk to your doctor, and get a second opinion if you're not satisfied.
You should definitely talk to the doctor who performed your procedure. Other options such as certain antidepressants and anticonvulsants are available for chronic pain, but hopefully your pain won't hang around that long. If you're not satisfied with your current doctor, you might consider getting a referral to a pain specialist. Of all the hits for referred pain, yours is definitely the best site.
I've been curious about whether severe pain in my left teres muscles might have been referred pain from a stromal tumor in my small intestine. Especially on long drives, the shoulder pain was unrelenting and, even tho it didn't help, I took lots of ibuprophen - enough to make the tumor hemorrhage and be found, fortunately. After surgery to remove the tumor, it took more intervention to stop the shoulder pain, but I thought it could be a reflex pain arc, like in reflex sympathetic dystrophy.
Do you think there might be a connection? Vermont's loss is Utah's gain. Best wishes with school, and then please return to VT.
Hi Blue, I'm glad you've enjoyed the site! Upper back pain from a GIST gastrointestinal stromal tumor in the small intestine seems unlikely - abdominal pain is a more typical presentation. However, GISTs are most common in the stomach, which could definitely lead to referred pain in the upper back perceived, perhaps, as teres major pain. I'm curious about the precise location of your GIST, and whether an additional site in the stomach was definitely ruled out The tumor was defintely in my small intestine.
Initial dx was bleeding ulcer, but my stomach was quite healthy. I had a few months of vague symptoms fatigue, diarrhea but I don't remember any abdominal pain. The outer border of my scapula was tender to touch so maybe it really was a coincidental muscle strain.
Great info, many thanks, I have just had my right ovary removed due to a fist sized dermoid cyst, I have had severe but interrmitant right shoulder pain since.
The nurses and docs who treated me all advised in various vague ways that it was referred pain due to either irritation of the diaphragm or due to the gas used - they had tried to remove the cyst by keyhole surgery initially and the gas can sometimes take days to work its way out.
What do you think? It has felt almost like a trapped nerve as at times my whole arm and fingers have tingled with the pain. They have siad it should just last a few days and that walkign around sometimes helps. I was also trying to figure out why the periumbilical pain in appendicitis occurs there anly and not along its roots! After reading ur blog it made sense that somethings cannot be explained why as to that particular site only and not the whole course of the nerve!! Ok, I am so glad that you wrote about referred pain because I learned that in school.
I have an issue where I have a bad headach accompied by gas. I always thought that maybe I was having a migraine. Everytimne I would touch a certain part of my head where the pain was, I would burp.
It is very annoyiny and I worry all the time about the food that I eat. Thanks again for the info. I think your blog is great, and I would like to feature you on the new Wellsphere. We feature only the best health bloggers on our WellPages, which are special pages that our Health Knowledge Engine crafts to give our users answers to their health questions.
We would feature you on all the pages on topics that our knowledge engine finds are related to your blog postings. Because we have over 2 million visitors each month and we are growing rapidly , you would benefit from an expanded audience for your writings. If you would like us to feature you, send me an email to Dr. I have been experiencing shoulder pain for about a month. In the past month I have tried all kinds of pain relief. Last night, I experienced an evening of loose bowels and today my shoulder pain is gone.
I thought that was really curious until I remembered that my friend had a spleen injury that was diagnosed by shoulder pain. I am assuming that whatever was making me have the loose bowels had been building up and now that it has passed, that relieved the pressure on my spleen.
Thanks for the blog, I am going to monitor life and if my shoulder flares up again, it is off to the doctor. I have had a terrible persistant pain in my right shoulder and neck.. Finally I've been diagnosed with celiac and my gallbladder is going to be taken out next week. I hope it goes away. Do you have any suggestions for referred pain from surgery I've had in the past?
I had my head cut and my face peeled back to remove a bone growth from the oribt of my left eye. My scalp and forhead have never been the same. It has been about 7 years. Headaches and nerve pain bounce all over my head. Thank you for this very interesting website. I have had shoulder pain for a few months now and mentioned it to my gyn. He ordered a catscan and found a mass in the upper right quadrant of my abdomen.
I underwent a second CT yesterday and now will wait for further results. Interestly enough, I mentioned the shoulder pain to the surgeon and he said there was no association; The gyn disagreed and I agree with the gyn as I have had no pain the abdomen thus far and was shocked to find the problem in the abdomen. Keep up the good work. Hi Brad, Useful article. Just two questions, what nerve causes referred pain to jaw in myocardial infarction?
And why does pain from angina and MI not manifest in the right side of the body as well as the left? The mechanism of referred pain to the jaw in MI is still unclear, but recent evidence points to involvement of the vagus nerve http: I'm not sure if the heart is more heavily innervated by left-sided pain fibers, or if the left side of the heart is more likely to be affected in a heart attack.
Or maybe there's some other explanation. Another interesting point is that, for reasons unknown, women are less likely than men to report chest pain in an MI http: Thanks for this wonderful website.
By the way, could you please tell me why visceral pain in the spleen is referred to the hypochondriac region as supposed to the epigastric region? Thanks for this wonderful useful article.
My mother was complaining of Right Illiac Fossa heaviness. All relevant Investigations were negative. Finally diagnosed as referred pain of Sciatica! Now under treatment for Sciatica.
Hope this information is also useful. Back in , I had a fundoplication for gerds, which worked well. In the last year, I have started to suffer from severe back neck pain,esophageal pain, and pain from below the tip of my sternum to mid sternum. I was checked out for gallstones, and liver issues but nothing. A barium swallow was performed, but no incidence of swallowing problems such as reflux were found.
Endoscopy was performed and my fundoplication was found to be loose, and I have a 4 cm hiatal hernia. Could this be putting presure on my phrenic nerve, causing me massive headaches,esophageal pain, and swallowing pain. Oh yes, one more thing, heart disease was also ruled out.
I am just about at the point where I want to call in Doctor Kavorkian. Hi Lily, it sounds like the most likely source of your pain is the new hiatal hernia.
Anatomically, the vagus nerve is more likely to be involved than the phrenic nerve, but either way, I'd recommend talking to a surgeon ASAP about the possibility of repairing your fundoplication. Also, if your pain gets a lot worse and you start feeling really sick, you may have a strangulated hernia, which is a surgical emergency. I was "pimped" by an attending on how many causes of right shoulder pain I could think of and basically mumbled my way through a random sampling of things you've included in this post.
And I'm just a 2nd year med student, so you can imagine how intimidating that was. It's one of the experiences I'll definitely be adding to a blog I've decided to start up at http: I plan on looking back at my first two years as a med student. Any advice on year 3 clinicals? Brad, this is a great blog.
I had a routine colonoscopy 2 weeks ago. Day after the procedure I had incredible left shoulder pain. In the last 2 weeks I have probably had only 2 nights of full rest. The pain makes me get up. Called doctor to let him know of my pain 5 days after the procedure. They basically blew me off. I called again 3 days later. In the meantime, I was experiencing numbness down my left arm and in my outside two fingers. I can't tell you anymore if the pain is linked to the original pain I was experiencing or if it is now something else which causes the numbing.
Tomorrow I will see a nuerologist previous appt. I will be asking if air was injected in the bowel during the procedure which may have caused the original pain but then the numbness has me stumped. Thank you very much. Med Student Experience, probably the best advice you can get is from 3rd and 4th year students at your school. In general, my MO is to show up, have a positive attitude, learn as much as I can, and treat everyone with respect especially the patients.
I'm also completely up-front about my career goals, e. Clinical evaluations are so subjective that I've stopped worrying about them. CJ, I think you're doing the right thing talking to your doctors. I'm not sure what to make of the numbness in your case - it doesn't fit the classic picture of shoulder pain that you might expect after an abdominal procedure I went to a nuerologist and internal med doctor. The nuerologist brought up the referred pain, which I was glad to see. He put me through some stretches, etc.
So he ruled out referred pain. I have been on steriods this week pills only and I still have some pain not piercing as before in the back and numbness down the arm and fingers.
Sleeping is difficult but better. Perhaps I will have to live with this This followup is to help anyone with a similar situation and what was prescibed for me.
Your comments, Brad, are appreciated as to if I need to ask a specific question of the doctors. I'm 28, have a tube in my right ear and it still gets infected quite often. In another example of referred pain, at the very end of my pregnancy on my due date!
I began having incredible pain deep in my chest, abdomen, up to my neck, shoulders, down my arms and into my hands. Was initially diagnosed with "gas" as I was not currently in labor. Five days later, after giving birth, the same horrible pain persisted. The extreme pain I was feeling was my liver I hardly think this is referred pain from anywhere else?? Hi Ro, I'm not sure what you mean by pain in the right iliac fossa - is the patient experiencing pain in the right lower quadrant of the abdomen, or right flank pain, or deep pain that seems to be centered on the iliac fossa, or something else?
My first thought is musculoskeletal pain, since as you know the iliac fossa is filled with the iliacus and psoas major muscles, but there are many other possibilities, including appendicitis, kidney stones, IBS, IBD, herniated disk, abscess, etc I have suffered from referred pain for over 20 years. I have had every type of test done, and all results were negative.
As my doctor once said, "the good news is that we didn't find anything, and the bad news is that we didn't find anything". I have consciously decided that my pain is like a confusing "traffic jam" of brain signals, that I cannot seem to turn off.
I know that some day there will be a simple "reset" button for the nervous system. Until then, thank you for trying to explain the unexplainable. Hi Anonymous, my best guess is that something perhaps related to the inflammation of your biceps is irritating or compressing your musculocutaneous nerve. As its name implies, the musculocutaneous nerve innervates both muscle and skin. The muscles controlled by the musculocutaneous nerve include two major muscles that bend the elbow: The skin innervated by the musculocutaneous nerve is a patch on the lateral forearm from the base of the thumb to the elbow, as you described.
If I were examining you, I'd want to figure out what's bugging your biceps and, perhaps, your musculocutaneous nerve I should clarify that I don't know whether it's referred pain or not.
To figure that out, your orthopedist needs to get a detailed history and perform a careful physical exam. An EMG might help. Brad, What a brilliant article. Referred pain is such a hard concept to grasp and diagnose.
I have had left shoulder pain for a year. After clearing my heart angio , neck mri and shoulder injections, xrays ; I am sure it is referred pain.
I also have a lap band with a hiatal hernia on top of the band. I have terrible L shoulder pain and my surgeon who did the lapband refuses to attribute this to referred pain from the phrenic nerve from lapband and hiatal hernia. I am trying to convince him that maybe the band is misplaced. Good Luck finishing up Med School!!! As a nurse we need more good Docs. Have you chosen a specialty?
Erica, thanks for your comments. I'm most likely heading into radiology. Pain just below the umbilicus is certainly consistent with an ovarian cyst - in fact, that would be a nice example of referred pain - but cysts aren't always painful and something else more serious could be the source of pain.
I wrote you back in November of Since the second catscan, I had a huge mesenteric cyst removed and my referred pain has gone away. The Florida Hospital South surgeo was familiar with referred pain. Thanks for your blog I am now in good health. I have abdominal pain, swelling, and burping which can be triggered by my physical therapist working on the lower left quadrant of my back. I am assuming from your diagram that I need to see a Dr. By the way, abdominal CAT scans, xrays, and stomach emptying tests have shown nothing.
This is why I am trying to follow the referred pain to find the answer. Hi anonymous, I haven't heard of abdominal symptoms being triggered by physical therapy. Have you experienced other symptoms that suggest kidney problems, like blood in the urine? Any fever or other symptoms suggesting an infection? The absence of findings on abdominal CT is reassuring, but it's still a good idea to see your doctor if you're concerned.
I was very interested to read this blog post. For months Ive been suffering with pain in my right shoulder area, and lower right back area exactly where you diagram shows the livers referred pain to be. I paid a fortune to see an osteopath thinking it was back trouble. But eventually I got so ill that I went to hospital and tested positive for hepatitis in my liver. So the referred pain was exactly spot on for your diagram. Although by the time I got to the hospital stage I was also experiencing a lot of chest pain too.
Hi, Can you help with an explaination for this type of refered pain Pressure is applied to the region of the peroneous longus and brevis, resulting in localised pain obviously and an "itchy, prickly" type pain in the lateral chest wall in the rough vacinity of the 12 rib, to the lasing extent tat it needs to be scratched by the subject.
Would be evry inteersted in some theries and if possible, some follow up articles. Does it have something to do with embyonic developmnet of the feotus inutero? Just grasping at straws! Hi Alex, interesting observations that I haven't heard before, and I don't have a good explanation for them.
Probably related in some way to embryological development, but I could only speculate. Have you seen this finding in more than one subject? Hi Brad, The subject is me in this case, but I have seen this in other subjects also. Still baffled by this. We discuss dermatomes but agree we may be close, but no prize yet. The only thing I can find courtesy of Google is on a website discussing "Axon Reflex" What is you thought on this though process.
It does not involve a complete reflex arc, and therefore it is not a true reflex. Perhaps a crossed neuron or synapse. Maybe, consider something a little more off base like a reflexology type response. Very interesting and helpful. I had cancer, surgery followed by radiation through the intestines and ended up with celiac disease that was undiagnosed for a long, weak, declining, scary year.
Three years later, energy continues to return, although slowly. If I get tired or eat something that has been gluten contaminated, it's between the shoulder blades that I'll feel it first, and then in the ball or big toe joints of my feet. Three to five days later, things will have settled down, but the last thing to go will be the dull, throbbing pain in my feet and between those shoulder blades. So glad I'm not crazy, and that it's all likely related to the same original difficulties.
Groin pain can actually indicate a problem with the hip: Brad, I have a question for you like everyone else. I am having deep pain on my left side more towards the front than back just below my rib cage for 3 days. I hurts when I breathe. Hard to say without a little more information and probably a physical exam, too. Where is the pain? How would you describe the pain? Does the pain radiate to other parts of the body?
How bad is the pain on a scale of ? When did the pain start? Was the onset sudden or gradual? Does it come and go? Is it getting worse or better? Anything make it better? Anything make it worse? Anything else related to the pain? For now I'll say that left upper quadrant pain i. If you're young and basically healthy, it could just be a simple musculoskeletal problem e. As always, if you're concerned, I'd go see a doctor. Thank you for the blog. I had a lap nissen fundoplication almost 7 weeks ago.
I had the usual general shoulder pain for a few days from the gas used in inflating the abdomen. That dissipated, but I continue to have pain in my left shoulder actually my upper trapezius in an area that is about the size of of silver dollar. On palpation, the area feels like a muscle spasm in that it is a painful lump.
The surgeon that did the fundoplication doesn't have any kind of answer. Its sort of a "in some people the pain lasts longer" answer, with more pain meds. It has gotten worse over the last 2 weeks, and is affecting my shoulder joint; I had a shot for AC joint bursitis last week. The orthopedist who did that has referred me to a chiropractor to see if he can figure it out, as well as to PT.
I'm not sure why it is my left shoulder, since your illustration said it was the right. All three doctors my GP, too don't seem to register a problem when I say it's my left shoulder. Does all this just sound like referred pain from the diaphragm? Gretchen, what you're describing doesn't sound like a typical case of referred pain, but I can't rule it out.
Certainly the timing and location of the pain make me suspect the pain is related somehow to the Nissen. You might talk to one of your doctors about getting a CT or MRI of the surgical site and maybe the shoulder too to make sure they aren't missing something.
Hello, and thanks for the information. I have had pain in my left shoulder for well over a year. It comes and goes and nothing I do makes it feel better or worse.
I have tried to find some kind of pattern or cause and nothing that I can find makes it start or stop. I went to multiple doctors and got an MRI of my shoulder, and multiple x-rays and there is nothing structurally wrong with my shoulder except some extra mobility or looseness in the joint.
I also tried physical therapy which didn't have any effect on the pain. When the pain hits its peak, it sometimes make my vision go out of focus. It feels like the pain is coming more often, and staying longer, and getting worse, I feel like I am going to lose my mind!! The pain definitely gets to a 10 often, and I have tried heat, ice, icy hot type items, advil, tylenol, and nothing helps.
What should I do next? Any help would be great! Unfortunately there is currently no safe, inexpensive, effective way to screen for all cancers. Screening is only recommended in certain age brackets for a few relatively common, treatable cancers e.
Your pain has several concerning features, including its intensity, resistance to conservative treatment, localization to one region, and trajectory getting worse. Given the lack of findings on shoulder imaging, I would definitely think about referred pain from another site like the base of the left lung or the left upper quadrant of the abdomen.
Have you discussed this possibility with any of your doctors? It appears that my shoulder pain is only indirectly because of the fundoplication surgery. It seems I have had a trigger point in that shoulder for years and yes, I have had some muscle spasms there before, but never this bad. I think that the post surgical shoulder pain activated the trigger point in a way that it has never been before. It has basically been in non-stop contraction for 2 months.
Understandably, this very painful condition has affected my shoulder joint as well. I am finally getting some relief with acupuncture, but I am holding out the possibility of a trigger point injection if I can't get total relief through more conservative means. Thanks for your input. All input helps when you are trying to solve a puzzle.
For the last 3 months I had pain between my shoulder blades now my whole back hurts from my neck to my hips my doctor has sent me physical therapy but no help at all.
Any ideas what this could be? Also my sciatica is getting worse. Hard to say without knowing more about your history. One condition that comes to mind is polymyalgia rheumatica Found your site when doing a quick refresher on referred pain for an MI 1 site that came up on bing search. Your post was very helpful, thanks. Also, from what I have read, angina pectoris doesn't seem to produce referred pain like an infarction. Is this simply because the pain is less severe? Is it because angina pectoris results from lactic acic buildup whereas an infarction is from tissue death?
Do they both result from lactic acid buildup? Interesting question about the pathophysiology of angina pectoris vs. I'm not sure if anyone really knows the answer: I was reading an article online about brain disease. I don't understand the cause of the spinocerebellar degeneration disease. If the cerebellum is slowly decaying, how does that directly correspond to comas? I'm currently considering to enter med school. Do you think this software would be helpful? I am a 56 year old male and for the last 3 months I had pain between my shoulder blades now my whole back hurts from my neck to my hips my doctor has sent me physical therapy but no help at all.
My doctor also sent me to a Hematologist at a cancer center and they found nothing out of the ordinary on my blood work. I have also had a CT Scan of my brain and it was normal. And I have also had nuclear heart stress test while walking on a treadmill and was normal. They have taken x-rays of my back and found arthritis in the upper and lower parts of my back. Also I am seeing a kidney doctor at this time.
I have seen a chiropractor after a few x-rays he adjusted me and I have had some relief from my back pain and have helped my sciatica a little. I have smoked off and on for 30 years. I may cough maybe once or twice a day or on a bad day 3 or 4 times a day. So could COPD be the cause of my back pain or maybe something worse. To the man with pain between your shoulder blades. The vagus nerve, connects from the stomach to the spine.
I had an ulcer hurt in that place, referred pain, no doctor could find out what was wrong and two months later the ulcer perforated, Causing peritonitis. Ask for an indoscopy to find out if you have an ulcer. I had to have explorotory surgery.
Anonymous, do you ever experience that pain after a meal? Your description is consistent with a bad case of gastroesophageal reflux disease GERD. However, it could be something else - I'd strongly recommend seeing your doctor. In general, somatic pain is sharp or burning and easy to localize. Visceral pain is more dull, diffuse, and harder to localize. However, these are just general patterns; there may be exceptions. Also, other types of pain like neuropathic pain may not fit neatly into either category Post-hysterectomy suprapubic area pain that is episodic in nature.
Described as "deep", "dull". Gets worse with stress. What are your thoughts? Referral from lower thoracic segments? As far as I know, deep dull lower abdominal pain after a hysterectomy is most consistent with surgical injury of pelvic tissues including visceral nerve fibers, and perhaps, as you suggest, post-surgical scarring. I doubt the degenerative disc disease is related unless the history is suggestive.
However, I could be wrong. I came across this article while researching referred pain I have a question that I would love if you could answer. For awhile, almost 5 weeks, I've had back pain on my left side right next to my shoulder blade, in between the spine and shoulder blade. It's in a very specific place that I can pinpoint.
And it comes and goes with different levels of severity usually a dull pain that sometimes, not too often, becomes a stabbing pain when I breath in deeply. Occasionaly I have a dull ache in my chest that moves around left side and sternum I've also had a cough for the past 9 weeks. The cough hasn't gone away The antibiotics were each about three weeks apart due to respiratory infections.
I also had a chest x ray which came back negative. I was wondering if you could give me your opinion of what this might be and if I should be worried? Ashlee Premed student btw: P And I just finished anatomy class This was awesome but I have one question.
If the pain in my sholder is in fact referred pain, would pusing on the spot where I feel the pain make it worse? I know pain quite well. Wow, 20 years of it. Cut wide open 3 times and I guess a thoracotomy surgery. There is where my problem lies I believe.
Cut from my back, under left arm ending at my breast. Post thoracotmy syndrome, intercostal nuerolgia, and symphatetic nerve dystrophy. Obviosly, I can't spell medical terms. I have finally laid down that absolute bottle. Hoping to begin again with the doctors. Some days my hair touching my neck or my clothing being on my back raises my pain level. They used me as a text book in the trauma ICU. I believe if they would have been interested enough to follow through with my "long" recovery they perdicted, they may have been the wiser.
My pain doctor told me he would always be there, he would never throw me out in the streets untreated. He lied and I found my medicine at the liquor store. Keep up the studies and I have a feeling you have dreamed the best dream for you.
I appreciate this site and your info. Good Luck with Medical School. Consider yourself invited to Uganda for an elective especially on Family Medicine.
I've had the same shoulder pain for over 10 years and had my gallbladder removed last year, but my pain persists. Now I also have pain in my lower right abdominal area. What is going on? Ashlee, sorry for the delay - I've been out of town. Part of your description sounds like pleuritic chest pain, i.
There are many causes of pleuritic pain - such as pneumonia, rib fracture, lung cancer, pneumothorax, pericarditis, and pulmonary embolism - but most of those would show up on a chest x ray. I can see why your health care provider gave you antibiotics - in a young, otherwise healthy person with your symptoms and a negative CXR, a respiratory infection seems like a good bet pneumonia doesn't always show up on CXR. I would also think about gastroesophageal reflux disease GERD and maybe pericarditis.
See your doctor if things aren't getting better! KHKuhl, hard to say what's going on without more information. Right lower quadrant pain has many possible causes, including appendicitis, gastroenteritis, irritable bowel syndrome, pelvic inflammatory disease, various ovarian conditions, diverticulitis, etc.
I am contacting you today in hopes of developing a relationship with your website; we have seen your site and think your content is great. I hope you show some interest in building relationship, please contact me at annie. My mother has intense left shoulder pain that has persisted for about 3 weeks now without relief. When she stands or sits it hurts the most and she can't sit or stand for prolong periods of time without lying down for awhile. She's been to the doctor but he didn't examine it and said it was Wry neck.
Something I've come to understand that doesn't involve any of her symptoms. She's had problems with her gallbladder gallstones in October and liver problems a few years back which was never diagnosed.
The pain pills only take the edge off. She wants to know if this pain could be referred pain since she had the referred pain briefly with her first child.
Thanks this article was very helpful and easy to understand. I wanted to thank you for your reply! The coughing has stopped. I think it was probably due to stress, but the back pain is still there.
Hi Brad, Was wondering if you could clarify if my pain I had today was referred pain. Today, about 4 hours after I ate breakfast, my abdomen, especially below the rib cage hurt like no other.
It got worse with walking, sitting straight and breathing.