Shoulder pain occurring with a cough can be a puzzling and uncomfortable experience. While it often signals a minor issue, understanding potential causes helps determine when to seek medical attention. This article explores common explanations for why coughing can lead to shoulder pain.
The Mechanics of Coughing and Pain
Coughing is a forceful physiological process designed to clear airways. It involves a rapid, coordinated contraction of numerous muscles throughout the body, including those in the abdomen, chest, neck, and back. During a cough, the diaphragm, intercostal muscles, and abdominal muscles work together to generate significant pressure, expelling air quickly.
This sudden, intense muscular effort can strain or irritate these tissues. The force generated can also transmit to surrounding structures, including the shoulder girdle. Repeated or forceful coughing can lead to overuse or injury of these muscles and their attachments, resulting in pain felt directly in the chest or radiating to the shoulders.
Understanding the Causes
Several conditions can manifest as shoulder pain when coughing, ranging from common musculoskeletal strains to more complex medical issues.
Musculoskeletal Issues
Forceful coughing can directly affect the muscles and bones of the chest and shoulder. Muscle strains are a frequent cause, as intense contractions can overstretch or tear muscles in the chest, back, or even the shoulder blade area, such as the intercostal muscles or those supporting the shoulder. This results in localized pain that may extend to the shoulder. Severe coughing can also lead to bruising or stress fractures of the ribs, with pain referred to the shoulder.
Another musculoskeletal cause is costochondritis, an inflammation of the cartilage connecting the ribs to the breastbone. Coughing exacerbates this pain, which feels sharp or pressure-like and can radiate to the shoulder. Severe coughing is a recognized trigger.
Respiratory Conditions
Inflammation or infection within the respiratory system can also lead to shoulder pain with coughing. Pleurisy, an inflammation of the lining surrounding the lungs and chest cavity, causes sharp chest pain that worsens with deep breaths, sneezing, or coughing. This pain radiates to the shoulder or back.
Conditions like pneumonia or bronchitis, which cause persistent and severe coughing, can indirectly lead to shoulder pain through muscle strain and inflammation. In pneumonia, lung inflammation can also cause referred pain to the shoulder. Prolonged, intense coughing fits associated with conditions such as asthma or Chronic Obstructive Pulmonary Disease (COPD) exacerbations can also strain musculoskeletal structures, leading to pain in the chest and radiating to the shoulder.
Nerve-Related Issues
Nerve compression in the neck, known as cervical radiculopathy or a “pinched nerve,” can cause pain that radiates down the arm and into the shoulder. The sudden jarring motion of a cough can temporarily worsen this nerve pain. This pain is described as sharp or electric-like, sometimes accompanied by numbness or tingling in the arm or hand.
Less Common Causes
While less frequent, certain serious conditions can also present with shoulder pain exacerbated by coughing. Pancoast tumors, a rare type of lung cancer located at the top of the lung, cause severe shoulder pain that radiates down the arm. Unlike most lung cancers, Pancoast tumors often do not cause a persistent cough or chest pain, making shoulder pain a prominent symptom. Pericarditis, an inflammation of the sac surrounding the heart, can also cause chest pain that worsens with coughing and spread to the shoulders.
When to Consult a Doctor
While many instances of shoulder pain with coughing are due to minor muscle strains that resolve on their own, certain symptoms warrant medical evaluation. It is advisable to consult a healthcare provider if the pain is severe or progressively worsening. Seek medical attention if the pain is accompanied by other concerning symptoms such as fever, chills, or difficulty breathing.
Other red flags include chest pain that does not improve with rest or over-the-counter remedies, or if it is accompanied by numbness, tingling, or weakness in the arm or hand. Unexplained weight loss, night sweats, or a significant change in cough pattern are also reasons to see a doctor. Any pain following a significant injury or trauma, or a persistent cough lasting for an extended period, should also prompt medical consultation.
Diagnosis and Management
Diagnosing the cause of shoulder pain with coughing begins with a thorough medical history and physical examination. Your doctor will inquire about your symptoms, medical background, and any recent illnesses or injuries. During the physical exam, they listen to your heart and lungs, and assess the range of motion and tenderness in your shoulders and chest.
Depending on initial findings, diagnostic tests are recommended to identify the underlying cause. These include imaging studies such as a chest X-ray, CT scan, or MRI to visualize the lungs, bones, and soft tissues. Blood tests are also performed to check for signs of infection or inflammation.
Management approaches are tailored to the specific diagnosis. For musculoskeletal strains, rest, pain relievers like ibuprofen, and physical therapy are recommended. If an infection is present, antibiotics are prescribed for bacterial infections. For conditions like pleurisy or pericarditis, anti-inflammatory medications help reduce pain and inflammation. Addressing underlying conditions like asthma or COPD is also an important part of treatment. The goal is to manage symptoms and treat the root cause to provide effective relief.