Pain in your chest and shoulder at the same time can have many causes. Your heart, lungs, or other internal organs may be involved.
The pain may also be referred. This means it’s felt in your chest and shoulder but is actually caused by pain in another part of your body.
If your pain is sudden or severe, it’s very important to get immediate medical care.
In this article, we’ll take a look at some of the most common causes of chest and shoulder pain, and the treatment options for these causes.
Pain in the chest and shoulder can have many causes. Some can be more serious than others. The conditions listed below are some of the most common culprits of this kind of pain.
Angina is the name for chest pain that results from clogged and narrowed arteries around your heart. When this happens, your heart muscle isn’t able to get enough oxygen-rich blood.
It’s not a heart attack. Rather, it’s a sign you have a heart condition. Physical activity often triggers the pain, when you need more oxygen. Emotional stress can trigger it, too.
Angina can be stable. This means it follows a predictable pattern and typically occurs when you’re doing something, or when you’re stressed. With stable angina, symptoms usually go away within a few minutes.
Angina can also be unstable. This type of angina tends to occur suddenly or while you’re at rest. With unstable angina, symptoms can last longer than 20 minutes and may return. The pain may also get worse over time.
An unstable angina attack can be life threatening and requires emergency medical attention.
Chest pain is the main symptom of both stable and unstable angina. Pain usually starts behind the breastbone. Pain may be referred to your left shoulder or arms.
Other common symptoms include:
- shortness of breath
- nausea or indigestion
Symptoms can start suddenly or come on slowly. People with gradual symptoms may not seek medical care right away.
If you think you’re having a heart attack, call 911 or get emergency medical help immediately.
Heart attack symptoms can vary in intensity.
Common heart attack symptoms include:
- a feeling of tightness or pressure in your chest
- chest pain that spreads to your neck, shoulders, one or both arms, or back
- faintness or dizziness
- shortness of breath
- cold sweat
- indigestion, stomach pain, or heartburn
While chest pain is the most common symptom for men, women are more likely to have symptoms other than chest pain. Some of the symptoms women often experience that happen less frequently with men include:
- unusual fatigue that lasts for several days or extreme fatigue that comes on suddenly
- sleep disturbances
- indigestion or gas-like pain
- jaw or back pain
- symptoms that come on more gradually
Your gallbladder is a small organ on your right side that sits below your liver. Its purpose is to release bile into the small intestine. Bile helps the digestive process by breaking down the fats in the food you eat.
Gallstones are little masses that form out of hardened digestive fluid in the gallbladder. Gallstones can range in size, from grains of sand to pingpong balls.
Why some people develop gallstones isn’t clear. But risk factors include:
- being female
- being over 40 years old
- having overweight
- being pregnant
Sometimes gallstones don’t cause any symptoms. But gallstones can cause intense pain when they block a bile duct or when you eat fatty foods. Pain can last up to several hours.
Pain may occur on:
- your right side, above the stomach
- in the center of your stomach, below the breastbone
- in your right shoulder
- between your shoulder blades
You may also have fatigue, nausea, or vomiting.
Pericarditis is the inflammation of the pericardium, the thin sac that surrounds your heart. The two-layered pericardium protects your heart and holds it in place. Fluid between the pericardium layers prevents friction when your heart beats.
Pericarditis usually starts suddenly. It can last from a few days to a few weeks. A viral infection is thought to cause most cases.
The main symptom is sharp or dull pain in the center of your chest or on the left side.
Other common symptoms include:
- pain that spreads from your chest to the shoulder blade
- pain that worsens when you lie down or take a deep breath
- pain that decreases when you lean forward
- mild fever
Your pancreas is located behind your stomach near the first part of your small intestine. It releases fluids that help break down the food in your intestine. It also controls your body’s blood sugar by regulating the release of insulin.
Pancreatitis is an inflammation of the pancreas. It can be chronic or acute. Acute pancreatitis can come on suddenly and usually gets better with treatment. Chronic pancreatitis gets worse over time.
The most common cause of acute pancreatitis is gallstones.
Symptoms of pancreatitis can vary, depending on the type of pancreatitis. The main symptom of both acute and chronic pancreatitis is pain in your upper abdomen, as well as pain that radiates to your back.
Acute pancreatitis symptoms include:
- mild or severe pain that lasts for several days
- abdominal pain that gets worse after eating
- nausea and vomiting
- fast pulse
- swollen or tender stomach
Chronic pancreatitis symptoms include:
- pain in your upper abdomen
- nausea or vomiting
- weight loss without trying
- oily stools that smell bad
Pleurisy is an inflammation of the thin layer of tissues, called pleura, that separate your lungs from your chest wall.
The most common cause of pleurisy is a viral infection in the lungs.
The most common symptoms of pleurisy include:
- sharp chest pain that gets worse when you breathe, cough, laugh, or sneeze
- pain in your shoulders or back
- shortness of breath
- muscle or joint pain
Some people may also experience a cough or fever.
Chest pain with shoulder pain isn’t always an emergency, but it can be very hard to tell. That’s why it’s important to pay attention to any other symptoms you may have.
Call 911 or go to an emergency room if you have:
- severe chest and shoulder pain
- have an existing heart condition
- think you’re having a heart attack
Other symptoms that can be a sign you need immediate medical attention are:
- escalating chest and shoulder pain
- difficulty breathing
- fainting or dizziness
- extreme weakness
- 31 percent of the causes were due to acute coronary syndrome, which included angina and other heart problems
- 30 percent of chest pain causes were due to acid reflux
- 28 percent of causes were due to a musculoskeletal condition
See your doctor if you have unexplained chest and shoulder pain. Any time you have chest pain, it’s important to get a proper diagnosis and appropriate treatment.
Because there are many possible causes for chest and shoulder pain, diagnosis can be challenging.
Your doctor will take a full medical history to find out about any other health conditions you may have. They’ll also ask if your family members have heart disease or other types of conditions.
Your doctor will ask about your symptoms, when they started, how long they lasted, and if they changed.
Once your doctor knows more about your symptoms and any other health conditions, they’ll do a physical exam and listen to your heart and lungs.
There are many diagnostic tests your doctor may use to determine what’s causing your shoulder and chest pain. Common diagnostic tests include:
- an X-ray of your lungs, heart, gallbladder, or other organs
- an electrocardiogram (EKG) to look at how your heart is beating
- an echocardiogram to look at your heart muscle and how it’s working
- blood tests to look for signs of a heart attack or specific enzyme levels for certain conditions, like pancreatitis
- a stress test to see how your heart functions when you exercise
- a coronary angiography to find out if you have a blockage in a coronary artery
- a heart CT scan, also known as CT angiography, to look at your heart and blood vessels and to check for blood clots or other problems
- an MRI to look at heart movement and blood flow, or to get a more detailed view of your gallbladder or pancreas
- a biopsy of lung tissue if pleurisy is suspected
- a pancreatic function test to see if your pancreas is responding normally to specific hormones
Treatment for shoulder and chest pain depends on what’s causing the pain.
Because there can be so many variables, treatment plans for the same condition may be different from one person to the next. Some factors that may influence your treatment plan include:
- your age
- other health conditions you may have, including overweight
- whether or not you smoke
For heart problems, your doctor may prescribe:
- blood thinners to prevent clots
- clot-busting drugs (thrombolytics)
- antibiotics for pain caused by an infection
- fluid drainage for pericarditis
Your doctor will likely recommend lifestyle changes, including changes to your diet, physical activity, and stress management.
Depending on the frequency of your gallstone attacks, your doctor may recommend surgery to remove your gallbladder. This is usually done laparoscopically.
For a less serious gallstone condition, your doctor may prescribe a drug called ursodiol. This drug may help dissolve the gallstones over time. Your doctor may also put you on a low fat diet to help prevent further gallstone development.
Some people have success with natural remedies for gallstones. Be sure to talk to your doctor before trying any at-home treatments for gallstones.
Treatment for pleurisy will depend on the cause.
Your doctor may prescribe antibiotics if you have a bacterial infection. Viral infections often clear up without treatment. Over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs) may help relieve chest pain.
If you have a lot of fluid buildup, known as pleural effusion, your doctor may want to drain it. This is done with local or general anesthetic. It may require a hospital stay.
A hospital stay may also be necessary if you have other health conditions that make your pleurisy more difficult to treat.
Your doctor will give you medications to help reduce the pain. You may also have to fast for a couple of days to give your pancreas a rest. You may need intravenous fluids to prevent dehydration.
You may be hospitalized if your pancreatitis is severe.
Other treatment may include surgery to drain your pancreas, or surgery to remove your gallbladder if gallstones caused your pancreatitis.
Longer-term treatments may include:
- diet changes
- limiting alcohol use
- taking pancreatic enzyme supplements to aid digestion
Other chest pain causes
For chest pain conditions that aren’t related to your heart or coronary arteries, you doctor may prescribe:
Pain in your chest and shoulder can have many causes. Some of the most common include angina or other heart conditions, gallstones, pericarditis, pleurisy, or pancreatitis.
Unexplained pain that occurs in both your chest and shoulder should always be checked out by your doctor.
If the pain is severe or lasts longer than a few minutes, immediately go to the emergency room or call 911. For many conditions, the earlier you receive treatment, the better your outcome is likely to be.