The COVID-19 pandemic introduced a novel respiratory illness that quickly demonstrated its ability to affect far more than just the lungs. Caused by the SARS-CoV-2 virus, this multifaceted disease can impact various body systems, leading to a wide range of symptoms. The virus’s systemic reach means it can influence numerous physiological processes, sometimes resulting in unexpected manifestations.
Understanding Acute COVID-19 Related Shoulder Pain
During the acute phase of a COVID-19 infection, shoulder pain can arise from direct viral effects on the body’s tissues. Myalgia, or muscle aches, are a frequently reported symptom, affecting an estimated 40-60% of individuals with COVID-19. This widespread muscle pain, including in the shoulders, is often attributed to the body’s inflammatory response as it combats the virus. The immune system’s release of cytokines, intended to defend against the infection, can lead to systemic inflammation affecting muscles and joints.
This inflammatory process can result in a rheumatic-like condition, where symptoms such as stiffness, tenderness, and aching are felt in various musculoskeletal areas, including the shoulders. These muscle and joint pains, triggered by the viral infection, often resolve as the acute infection subsides and differ from chronic conditions like rheumatoid arthritis. In some instances, the virus may trigger an overactive immune response, causing the body to inadvertently attack its own muscles or joints, leading to more pronounced inflammation and pain. These direct manifestations typically appear alongside other common acute symptoms like fever and cough.
Shoulder Pain from Indirect Causes and Complications
Shoulder pain associated with a COVID-19 infection can also stem from indirect causes and complications. One common indirect cause is muscle strain from persistent coughing, a hallmark symptom of COVID-19. This can lead to discomfort in the chest or back, radiating to the shoulder.
Lung inflammation, such as pneumonia, can contribute to referred pain in the upper back and shoulder region. The close anatomical proximity of the lungs to the upper spine means that severe lung irritation can cause discomfort that radiates outwards. In severe cases requiring hospitalization, prolonged bed rest or mechanical ventilation can lead to shoulder stiffness, muscle weakness, and pain due to disuse syndrome. This lack of mobility can cause muscle atrophy and reduced joint range of motion, contributing to persistent shoulder discomfort.
Persistent Shoulder Pain and Long COVID
Shoulder pain can extend beyond the acute phase of COVID-19, becoming a persistent symptom of “Long COVID” or Post-Acute Sequelae of SARS-CoV-2 infection (PASC). Musculoskeletal pain, including in the shoulders, is a common feature of Long COVID, with studies reporting its prevalence weeks to months after the initial infection. Over 10% of individuals with Long COVID report ongoing muscle and joint aches.
This prolonged pain may be linked to ongoing inflammation, as the virus can trigger a persistent inflammatory response even after the acute infection resolves. The immune system’s chronic activation may contribute to discomfort in various body parts, including the shoulders. The virus’s effects on the nervous system, including potential neuronal hyperexcitability, could also play a role in persistent musculoskeletal pain. Some individuals also report general fatigue alongside these lingering aches, which can further impact daily activities.
When to Seek Medical Attention
Seek medical evaluation for shoulder pain experienced during or after a COVID-19 infection under certain circumstances. Immediate medical attention is advisable if you experience sudden or severe shoulder pain, or if you cannot move your arm. Other concerning signs include a change in the shape of your arm or shoulder, significant swelling, or persistent numbness or pins and needles.
Consult a healthcare provider if your arm or shoulder feels unusually hot or cold, or if the pain began after an injury or fall. Prompt medical assessment is also recommended if you develop severe pain in both shoulders, or if shoulder pain is accompanied by systemic symptoms like fever or difficulty breathing. These symptoms could indicate a more serious underlying condition requiring diagnosis and care.