What organ gives shoulder pain? Surprising causes of referred pain

October 2, 2025 •

5 min read

Approximately 20% of all adults experience shoulder pain, but a significant number of cases are not caused by the shoulder itself. Referred pain from an internal organ is a lesser-known but critical possibility to consider when investigating the cause of your discomfort. It's important to understand what organ gives shoulder pain to seek the right treatment and avoid misdiagnosis.

Quick Summary

Several internal organs can cause referred pain felt in the shoulder, including the gallbladder, heart, diaphragm, and pancreas, due to complex nerve pathways. This type of pain often presents without any movement-related triggers and requires attention to underlying organ issues rather than musculoskeletal problems.

Key Points

Referred Pain Explained: Internal organ issues can manifest as shoulder pain because sensory nerves from organs and the shoulder converge at the same spinal cord segments.
Gallbladder and Right Shoulder: Gallstones or cholecystitis can cause referred pain in the right shoulder, often worsened by fatty foods.
Heart Attack Warning: Left shoulder and arm pain, especially if sudden and accompanied by other symptoms like chest pressure or shortness of breath, can signal a heart attack.
Diaphragm Irritation: The diaphragm's nerve pathway is linked to the shoulder, so irritation from surgery, gas, or lung issues can cause pain in the shoulder tip.
Pancreas and Left Side: Pancreatitis can cause deep abdominal pain that radiates to the back and left shoulder or shoulder blade.
How to Differentiate: Unlike musculoskeletal pain, referred pain from an organ is typically not affected by arm or shoulder movement and is often accompanied by systemic symptoms related to the organ.

Understanding Referred Pain and the Nerves Involved

Referred pain is a phenomenon where pain is perceived at a location other than the site of the painful stimulus. This happens because the sensory nerves from various internal organs and the musculoskeletal system converge at the same segments of the spinal cord. The brain can sometimes confuse the origin of the pain signal, leading you to feel it in a different part of the body, such as the shoulder.

The phrenic nerve, originating from the neck (C3, C4, C5), is a key player in referred shoulder pain. It innervates the diaphragm, the large muscle responsible for breathing located just below the lungs. Because the phrenic nerve shares a spinal root with nerves that innervate the shoulder, irritation of the diaphragm—often from an inflamed organ—can be interpreted by the brain as shoulder pain.

Internal Organs That Can Cause Shoulder Pain

The Gallbladder and Liver

The gallbladder is a small, pear-shaped organ on the right side of the abdomen, just below the liver. Inflammation of the gallbladder (cholecystitis) or gallstones can cause referred pain in the right shoulder and shoulder blade. This occurs because the gallbladder's nerve pathways travel near the diaphragm and phrenic nerve. Pain related to gallbladder issues is often triggered or worsened by eating fatty foods and can be accompanied by nausea and abdominal discomfort. The liver can also cause right shoulder pain if it becomes inflamed or enlarged.

The Heart

A heart attack is one of the most critical causes of referred shoulder pain and requires immediate medical attention. While often associated with chest pain, heart attacks can cause referred pain in the left shoulder, arm, back, and neck. This is particularly common in women, who may experience less typical symptoms. The pain may feel like an ache or pressure and does not improve with changes in position. The pain is referred via the nerve fibers that serve the heart and the chest, which share pathways that lead to the left shoulder and arm.

The Diaphragm

The diaphragm can be irritated by several conditions, leading to pain in the shoulder. One common cause is the presence of gas, especially after laparoscopic abdominal surgery. During this procedure, the abdomen is inflated with gas to create space for the surgeon to work. This gas can irritate the diaphragm, causing temporary, but sometimes intense, shoulder tip pain, which typically resolves as the gas is absorbed by the body. A collapsed lung (pneumothorax) or pneumonia can also irritate the diaphragm and cause referred pain in the shoulder on the affected side.

The Pancreas

The pancreas is located deep in the abdomen, behind the stomach. Inflammation of the pancreas (pancreatitis) can cause severe upper abdominal pain that radiates to the back and sometimes the left shoulder or shoulder blade. Pancreatitis often presents with other symptoms, including nausea, vomiting, and a tender abdomen. This referred pain is a result of the pancreas's proximity to the diaphragm and the complex web of abdominal nerves.

The Spleen

The spleen is located in the upper left part of the abdomen. A ruptured spleen, often due to abdominal trauma, can cause what is known as Kehr's sign: severe left shoulder pain. The pain is caused by blood pooling under the diaphragm, which irritates the phrenic nerve. This is a medical emergency requiring immediate attention.

Comparison Table: Referred Shoulder Pain Causes


Organ Cause	Typical Shoulder Location	Accompanying Symptoms	Pain Characteristics
Gallbladder	Right shoulder, shoulder blade	Nausea, vomiting, indigestion after fatty meals	Varies from mild to severe; constant or intermittent
Heart	Left shoulder, arm, back, jaw	Chest pressure/pain, shortness of breath, sweating	Pressure, squeezing, or a heavy sensation
Diaphragm	Either shoulder (tips)	Can follow surgery; shortness of breath	Usually temporary; sometimes sharp
Pancreas	Left shoulder, shoulder blade, back	Upper abdominal pain, nausea, vomiting	Often described as dull, deep, and steady
Spleen	Left shoulder (Kehr's sign)	Signs of trauma, rapid heart rate, lightheadedness	Can be very intense and appear suddenly

How to Distinguish Referred Pain from Musculoskeletal Issues

If you're experiencing shoulder pain, it's crucial to differentiate between a muscular or joint problem and a referred pain from an organ. Here are some key differences:

Movement: Musculoskeletal shoulder pain is almost always affected by moving the arm, rotating the shoulder joint, or lifting objects. Referred pain from an organ will typically not change or worsen with shoulder movement. In some cases, it might be persistent even when the arm is completely at rest.
Associated Symptoms: Pay close attention to other symptoms. Gallbladder-related pain might coincide with nausea after eating. Heart-related pain can come with shortness of breath. Pain from the pancreas will be accompanied by abdominal issues. Musculoskeletal pain is usually isolated to the shoulder region and lacks these systemic symptoms.
Location: While referred pain can be vague, certain patterns are common. Left shoulder pain is more likely to be cardiac or pancreatic, while right shoulder pain is a classic sign of gallbladder or liver issues.
Timing: The onset and nature of the pain can offer clues. A sudden, sharp pain could indicate an urgent issue like a ruptured spleen, whereas a persistent, dull ache could point to chronic inflammation.

When to Seek Medical Attention

While this article provides valuable information, it is not a substitute for professional medical advice. You should seek immediate medical help if your shoulder pain is sudden and severe, accompanied by chest pressure, difficulty breathing, dizziness, sweating, or abdominal pain, as these could be signs of a life-threatening emergency like a heart attack or ruptured spleen.

For less severe but persistent shoulder pain that isn't clearly musculoskeletal, a doctor can perform tests and a thorough examination to determine the root cause. This might include a physical exam, blood tests, or imaging. Don't simply assume your pain is from a simple muscle strain. Ignoring referred pain could allow a serious underlying condition to go undiagnosed and untreated.

For more detailed information on specific causes, such as gallstones, a reliable resource can be found on the National Institute of Diabetes and Digestive and Kidney Diseases website.

Frequently Asked Questions

Yes, absolutely. A heart attack is a prime example where pain can radiate to the left shoulder and arm. This is a result of referred pain, where the brain misinterprets nerve signals from the heart as originating from the shoulder region. It's especially important to consider this if the pain is sudden and accompanied by chest pressure or other heart-related symptoms.

The gallbladder and diaphragm share nerve connections with the same spinal cord level as the nerves from the shoulder. When the gallbladder becomes inflamed or is blocked by gallstones, it irritates these shared pathways, and the pain is referred to your right shoulder or shoulder blade.

A key differentiator is movement. Muscular or joint-related pain typically changes with shoulder movement. If your pain persists even when your arm is at rest and does not worsen with specific movements, it is more likely to be referred pain from an internal organ. Accompanying symptoms like nausea or chest tightness are also important clues.

Pancreatitis, or inflammation of the pancreas, can cause pain in the left shoulder or shoulder blade. This pain is often described as deep, steady, and dull, and it typically occurs alongside severe pain in the upper abdomen that may radiate to the back.

Yes, it is quite common. Laparoscopic surgery involves inflating the abdomen with carbon dioxide gas to create space. This gas can irritate the diaphragm, and since the diaphragm's nerves connect to the shoulder area, many patients experience temporary shoulder tip pain. It is usually short-lived and resolves as the body absorbs the gas.

You should seek immediate medical attention if the shoulder pain is sudden, severe, and is accompanied by symptoms such as chest pain, shortness of breath, dizziness, cold sweats, or abdominal tenderness. These could indicate a life-threatening condition like a heart attack, ruptured spleen, or other serious internal issue.

While stress can cause muscle tension and contribute to general pain, it does not directly cause an organ to refer pain to the shoulder. However, chronic stress can exacerbate existing conditions like irritable bowel syndrome or acid reflux, which might have referred pain as a symptom. The underlying cause of organ-referred pain is a physical issue with the organ itself.