Shoulder impingement syndrome is a condition where the tendons of the rotator cuff or the bursa become compressed, or “pinched,” as they pass through the narrow space beneath the acromion, the bony roof of the shoulder. This impingement causes pain and weakness in the shoulder, especially during overhead activities. While shoulder pain is the primary symptom, the unexpected experience of chest pain alongside it can be alarming. Discomfort originating in the shoulder can sometimes be felt elsewhere due to the body’s intricate nerve network. This sensation is a recognized phenomenon, but any new chest discomfort should always be treated with caution.
The Core Answer: Referred Pain from Shoulder Impingement
Shoulder impingement can indeed cause pain that a person perceives in the chest, a phenomenon known as referred pain. This occurs because the nerves supplying the shoulder joint and the nerves supplying the chest wall and rib cage share common pathways that lead back to the spinal cord. When the brain receives pain signals from the irritated nerves in the shoulder, it can misinterpret the source and project the discomfort to an area along the same neural highway, such as the anterior chest.
Specifically, the nerve roots C5, C6, and C7 exit the cervical spine and contribute to the nerves that innervate the shoulder girdle structures, including the rotator cuff and the subacromial bursa. Chronic inflammation or mechanical pressure on these structures due to impingement can irritate these nerve roots. This irritation can then travel along the neural pathways that also supply the upper chest and pectoral region.
The resulting sensation is often felt as a deep, aching pain in the front of the shoulder that radiates forward toward the chest, sometimes mimicking pain from other, more serious conditions. The constant mechanical irritation from the pinched tendons and bursa creates a persistent signal that the central nervous system may struggle to localize correctly. This referred pain is purely a sensory misinterpretation and does not indicate an issue with the heart or lungs themselves.
Differential Diagnosis: Distinguishing Musculoskeletal vs. Cardiac Pain
Distinguishing between musculoskeletal pain from the shoulder and potentially life-threatening cardiac pain is important. Musculoskeletal chest pain originating from the shoulder or chest wall has distinct characteristics that differentiate it from cardiac pain. This pain is described as sharp, localized, and is usually reproducible by specific movements, such as lifting the arm or pressing directly on the tender area of the shoulder or rib cage. The discomfort may increase with activity involving the arm and often improves with rest or when certain positions are avoided.
In contrast, pain that signals a serious cardiac event presents with a different set of symptoms, often described as a pressure, squeezing, or crushing sensation in the center of the chest. This pain is typically diffuse, meaning it is hard to pinpoint a single location, and it does not change with movement or position. Cardiac pain may also radiate to the jaw, neck, back, or down the arm, frequently the left one.
Accompanying symptoms are a major differentiator, as cardiac pain is often paired with systemic issues like shortness of breath, cold sweats, nausea, or dizziness. These associated symptoms are generally absent in cases of referred pain from a shoulder problem. If the chest pain is accompanied by any of these “red flag” symptoms, or if the pain is severe and unremitting, one must seek immediate emergency medical attention.
Confirmation and Treatment of Shoulder Impingement
Once serious causes have been ruled out, a medical professional focuses on confirming the diagnosis of shoulder impingement. The diagnostic process begins with a thorough physical examination, which includes specific orthopedic tests designed to reproduce the impingement pain. The Hawkins-Kennedy test and Neer’s test are two common maneuvers where the physician moves the arm in a way that temporarily narrows the space under the acromion, eliciting pain if impingement is present.
Imaging studies are often used to support the clinical diagnosis and rule out other shoulder pathology. An X-ray can reveal bone abnormalities, such as bone spurs on the acromion, which contribute to the pinching of the soft tissues. Magnetic Resonance Imaging (MRI) provides a detailed view of the soft tissues, allowing the physician to assess the extent of inflammation in the bursa or any associated damage to the rotator cuff tendons.
Initial treatment for shoulder impingement focuses on conservative, non-operative management to reduce inflammation and restore function. This typically involves a period of rest and activity modification, avoiding movements that aggravate the pain, particularly reaching overhead. Non-steroidal anti-inflammatory drugs (NSAIDs) may be prescribed to manage pain and reduce swelling.
Physical therapy is a fundamental part of recovery, concentrating on strengthening the rotator cuff muscles and the muscles that stabilize the shoulder blade. A targeted exercise program helps to improve shoulder mechanics and create more space for the tendons to move freely. In cases where symptoms persist despite physical therapy, a corticosteroid injection into the subacromial space can provide powerful, localized anti-inflammatory relief, allowing the patient to progress with their rehabilitation.