A Cardiologist Explains: Shoulder Pain

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Hello, and good afternoon to you.  Of course, I know it must be the afternoon because I don’t see patients in the morning or evening or weekend anymore.

shoulder painAt any rate, I shall discuss with you pain of the shoulder. The shoulder is an anatomical area located superior and lateral to the heart.  All other shoulder anatomy is of relative unimportance.


Shoulder pain has a variety of possible etiologies. The cardinal etiology of shoulder pain is of course referred from the mediastinum, I. E. the heart.  All patients with shoulder pain should have an EKG, set of troponins, and a TEE. If those are normal, well, then you start to think about other things.

Chief among those would be the pericardium. Pericarditis can present as shoulder pain.  So can pneumonia. So can hiatal hernia.  These things must be ruled out prior to passing down the diagnostic ladder.

The second other thing to think about is the muscles. But not cardiac muscle, some other type of muscle. Skeletal muscle? Anyway, that could be hurt. It is easily fatigued since it is not quite as durable as cardiac muscle.

There are four muscles of course that comprise the Rotary Cup. One for each chamber of the heart. There’s the left spinatus and right spinatus on top, and the left and right scapularis below. These are you the muscles that move the shoulder up and down, and up and down, and up and down again, in a cyclic manner forever. They can be injured or have a thrombosis I suppose.

The bones can also be damaged or infarcted, but that’s really not very interesting at all.

The workup for Rotary Cup pain involves ultrasound primarily. If the muscle is torn, you need to speak with a surgeon. If the muscle is just strained, however, it will still continue to function, though possibly with a lower ejection fraction. At that point, do a stress test, and you may find that the muscle is damaged. Unfortunately if the muscle is damaged, it cannot be fixed. But there’s a lot of medication that you can take that will sort of help a little bit if you can tolerate the side effects.

Finally, it is important that you always call Orthopedic Surgery when a patient says their shoulder hurts them.  Those scalpel jockeys are never interested in seeing our patients, since they usually cannot be cleared for surgery…  But they have these fancy tests called “xrays” that only they know how to order.

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