Upper left chest and shoulder pain can be a source of significant concern. This discomfort is a common complaint, but its origins are diverse, ranging from benign musculoskeletal issues to potentially life-threatening cardiac events. Understanding the causes helps guide appropriate action. The pain can vary widely in intensity, character, and accompanying symptoms, making diagnosis complex.
Cardiac-Related Causes
Heart conditions are a common cause of upper left chest and shoulder pain. Angina causes chest pain or discomfort when the heart muscle does not receive enough oxygen-rich blood, typically due to narrowed coronary arteries. Angina pain can feel like pressure, tightness, squeezing, or a burning sensation in the chest, and it may radiate to the shoulders, arms, neck, jaw, or back. This discomfort is frequently triggered by physical exertion or stress and usually subsides with rest or medication.
A heart attack occurs when blood flow to a part of the heart muscle is blocked, leading to tissue damage. Symptoms can include chest pain that feels like pressure, squeezing, fullness, or aching, lasting more than a few minutes or recurring. The pain may spread to the shoulder, arm, back, neck, jaw, or even the upper abdomen. Other accompanying symptoms can include shortness of breath, cold sweats, nausea, vomiting, lightheadedness, or unusual fatigue. Women may experience more subtle symptoms like extreme fatigue, nausea, or jaw and back pain without pronounced chest discomfort.
Pericarditis, an inflammation of the sac surrounding the heart, can also cause chest pain, often described as sharp or stabbing. This pain is typically felt behind the breastbone or on the left side of the chest and can radiate to the left shoulder and neck. The pain from pericarditis often worsens when coughing, lying down, or taking a deep breath, and it may improve when sitting up or leaning forward. Aortic dissection, a tear in the inner layer of the aorta, typically presents as sudden, severe, tearing pain in the chest or back.
Musculoskeletal Causes
Musculoskeletal issues are a common cause of upper left chest and shoulder pain. Intercostal muscle strain, affecting the muscles between the ribs, can lead to localized pain and tightness in the chest and ribs. This pain is often described as sharp or stabbing, worsening with movement, deep breathing, coughing, or twisting the torso. Tenderness to the touch in the affected area is also common.
Costochondritis involves inflammation of the cartilage connecting the ribs to the breastbone. The pain is typically sharp, aching, or pressure-like, and it frequently affects the upper ribs on the left side of the body. This discomfort can radiate to the arms and shoulders and often intensifies with deep breaths, coughing, sneezing, or movement of the chest wall. Applying pressure to the affected rib joints usually reproduces the pain, which helps distinguish it from other causes.
Conditions affecting the shoulder itself, such as rotator cuff injuries or bursitis, can also result in pain that extends to the upper chest. Rotator cuff injuries involve damage to the tendons and muscles surrounding the shoulder joint, leading to pain, weakness, and limited range of motion. Bursitis, the inflammation of a bursa in the shoulder, causes pain, swelling, and tenderness, especially with movement. Nerve impingement, such as cervical radiculopathy originating from the neck, can cause pain, numbness, or tingling that travels down the arm and into the shoulder or chest area.
Other Potential Causes
Pain in the upper left chest and shoulder can also originate from other organ systems. Digestive issues are a common source of referred pain, with acid reflux (GERD). GERD can cause a burning sensation in the chest, sometimes mimicking heart pain. Esophageal spasms can produce intense, squeezing chest pain that may spread to the neck, arm, or back, often mistaken for a heart attack.
Respiratory conditions can also lead to discomfort in this region. Pleurisy, an inflammation of the lining around the lungs, causes sharp chest pain that worsens with breathing, coughing, or movement, and it may spread to the shoulders and back. Pneumonia, a lung infection, can result in sharp or stabbing chest pain that intensifies with deep breaths or coughing, and this pain can radiate to the shoulder, upper chest, and neck. A collapsed lung (pneumothorax) occurs when air leaks into the space around the lung, causing sudden, sharp chest or shoulder pain that worsens with deep breathing or coughing.
Neurological conditions like shingles can affect nerves in the chest wall, leading to a painful rash and nerve pain that can be felt in the upper left chest and shoulder. Conditions such as gallstones or pancreatitis can sometimes cause referred pain to the left shoulder or upper chest. Gallstones might cause sudden, intense pain that can radiate to the right shoulder or back. Pancreatitis, an inflammation of the pancreas, usually causes severe upper abdominal pain that can radiate to the back and sometimes the left shoulder.
When to Seek Medical Attention
Recognizing when to seek medical attention for upper left chest and shoulder pain is important. Immediate emergency medical care is necessary if the pain is severe, crushing, or feels like a heavy pressure in the chest. This urgency increases if the pain:
Spreads to the arm, jaw, neck, or back.
Is accompanied by shortness of breath.
Is accompanied by sweating.
Is accompanied by nausea.
Is accompanied by vomiting.
Is accompanied by lightheadedness or sudden weakness.
Pain that lasts more than a few minutes, goes away and comes back, or worsens with exertion also warrants immediate evaluation.
If the pain is persistent but does not present with these urgent symptoms, or if it worsens over a day or two without emergency signs, contacting a doctor within a day or two is appropriate. This includes persistent pain that affects daily activities, pain that is consistently reproduced by movement or pressure, or pain accompanied by a fever without other severe symptoms. Any new or unexplained chest pain should be assessed by a healthcare professional to rule out serious underlying conditions.
Diagnosis and Treatment Approaches
Medical professionals diagnose upper left chest and shoulder pain through evaluation. This begins with a medical history, including pain characteristics, onset, and aggravating or relieving factors. A physical examination assesses for tenderness, swelling, range of motion, and heart and lung sounds.
Diagnostic tools determine the underlying cause. An electrocardiogram (ECG) is used to check for heart activity abnormalities, especially when cardiac causes are suspected. Blood tests can measure cardiac enzymes, inflammation markers, or other indicators of organ function. Imaging studies like chest X-rays can help identify lung issues or rib fractures, while CT scans or MRI may visualize soft tissues, blood vessels, or complex spinal issues. If digestive causes are considered, endoscopy or other gastrointestinal tests might be performed.
Treatment for upper left chest and shoulder pain is tailored to the specific diagnosis. For musculoskeletal conditions, approaches may include rest, over-the-counter pain relievers or anti-inflammatory medications, and physical therapy to improve strength and flexibility. Cardiac conditions often require medication to manage blood pressure, cholesterol, or heart rhythm, and in some cases, procedures like angioplasty or surgery. Digestive issues might be managed with antacids, lifestyle modifications, or specific medications.