Experiencing both nausea and pain in the left shoulder can be a concerning combination of symptoms. These symptoms can range from less serious conditions to those requiring immediate medical attention. This article explores common reasons why nausea and left shoulder pain might appear together, providing general information for better awareness.
Understanding the Connection Between Nausea and Left Shoulder Pain
The human body’s nervous system can interpret pain from internal organs as originating in a different, often distant, part of the body, a phenomenon known as referred pain. Specific nerve pathways that transmit sensations from internal organs, such as the heart, spleen, or stomach, converge with nerves that innervate the shoulder region in the spinal cord. Consequently, the brain may misinterpret the origin of the discomfort, perceiving it in the left shoulder even though the problem lies elsewhere.
Referred pain pathways are a primary reason why symptoms like nausea, often associated with internal organ distress, can accompany pain felt in the left shoulder. For instance, the phrenic nerve, which supplies the diaphragm, also has branches that reach the shoulder. Irritation of the diaphragm, perhaps from an issue with an adjacent organ, can then be perceived as shoulder pain.
Less Severe Causes
Acid Reflux (GERD)
Acid reflux, also known as gastroesophageal reflux disease (GERD), can sometimes manifest with symptoms beyond typical heartburn. When stomach acid frequently flows back into the esophagus, it can cause severe chest discomfort that may radiate to the left shoulder or arm. This irritation can also trigger feelings of nausea, particularly after eating or when lying down. The connection between the esophagus and surrounding nerve pathways can lead to this referred pain.
Muscle Strain or Injury
Muscle strain or injury in the left shoulder or neck area is another common cause of localized pain. Activities involving repetitive motions, heavy lifting, or sudden awkward movements can lead to strains or tears in the muscles, tendons, or ligaments. While primarily causing pain in the affected area, significant pain can sometimes be intense enough to induce a stress response in the body, leading to nausea.
Indigestion or Trapped Gas
Indigestion or trapped gas within the digestive system can cause significant abdominal discomfort, bloating, and nausea. In some instances, severe gas or indigestion can irritate the diaphragm, a muscle located beneath the lungs that aids in breathing. Irritation of the diaphragm can lead to referred pain in the left shoulder, as the phrenic nerve supplying the diaphragm also has connections to the shoulder region. This type of pain typically resolves once the digestive issue is addressed.
Nerve Impingement
Nerve impingement, where a nerve in the neck or shoulder region becomes compressed or pinched, can result in radiating pain. This pain might travel down the arm or across the shoulder blade. The pain can be severe enough to cause secondary symptoms like nausea. Conditions such as cervical radiculopathy, stemming from issues in the neck, can lead to such nerve compression and associated symptoms.
Urgent Medical Conditions
Heart Attack
A heart attack, or myocardial infarction, is a critical medical emergency where blood flow to a part of the heart muscle is blocked. Classic symptoms often include chest pain that may spread to the left arm, shoulder, back, neck, jaw, or stomach. Nausea, along with shortness of breath, sweating, and lightheadedness, commonly accompanies this severe chest pain. Women and individuals with certain medical conditions, such as diabetes, might experience less typical symptoms, including more pronounced nausea or pain primarily in the jaw or back without significant chest discomfort.
Spleen Problems
Problems affecting the spleen, an organ located in the upper left abdomen, can also cause referred pain to the left shoulder. Conditions like a ruptured spleen, often due to trauma, or an enlarged spleen (splenomegaly) can cause pain in the upper left abdominal quadrant. Irritation of the diaphragm from these splenic issues can lead to Kehr’s sign, which is referred pain specifically to the left shoulder. Nausea and vomiting are frequently present alongside abdominal pain and tenderness in such cases.
Pancreatitis
Pancreatitis, the inflammation of the pancreas, is a serious condition characterized by severe upper abdominal pain that can radiate to the back. In some instances, this intense pain may extend to the left shoulder, particularly if the inflammation is severe or widespread. Pancreatitis is almost always accompanied by significant nausea and vomiting, often persistent and severe. Other symptoms can include fever, rapid pulse, and tenderness when touching the abdomen.
Ectopic Pregnancy
An ectopic pregnancy occurs when a fertilized egg implants outside the uterus, most commonly in a fallopian tube. If a ruptured ectopic pregnancy occurs, it can lead to internal bleeding, causing severe abdominal pain. While direct left shoulder pain is less common, significant internal bleeding can irritate the diaphragm, leading to referred pain in the shoulder, along with pronounced nausea and vomiting. This condition is a medical emergency requiring immediate attention for reproductive-aged individuals experiencing sudden, severe abdominal pain and associated symptoms.
When to Seek Medical Help
Certain symptoms accompanying nausea and left shoulder pain signal a need for immediate emergency care. If you experience sudden, severe chest pain that radiates to your left arm or shoulder, especially if accompanied by shortness of breath, sweating, lightheadedness, or persistent vomiting, call 911 or your local emergency number immediately. Similarly, severe abdominal pain that suddenly worsens, fainting, or signs of shock (such as clammy skin, rapid pulse, or confusion) warrant urgent medical attention without delay. These “red flag” symptoms could indicate a life-threatening condition.
For new or worsening symptoms that are concerning but not immediately life-threatening, seeking urgent medical attention within 24 hours is advisable. This includes persistent or increasing pain in the left shoulder accompanied by nausea, unexplained weight loss, or changes in bowel habits. If you are unsure about the severity of your symptoms or if they are causing significant distress, a prompt visit to an urgent care clinic or your doctor is appropriate.
Routine medical consultation is recommended for mild, recurring left shoulder pain and nausea that do not present with any of the urgent warning signs. This allows for a thorough evaluation to identify underlying causes, even less severe ones like chronic acid reflux or muscle strain. Consulting a healthcare professional ensures an accurate diagnosis and the development of an appropriate treatment plan for your specific situation.