Unexplained shoulder pain could signal dangerous health condition, doctor warns

Unexplained shoulder pain could signal a more serious problem, experts warn.

While shoulder pain is often the result of rotator cuff problems, injuries, arthritis, nerve problems, or other orthopedic and muscular issues, it can also be a phenomenon called "referred pain" stemming from liver cancer. 

Pain in the right shoulder blade has been linked to early signs of the disease, according to the American Cancer Society.

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Published case reports have shown that shoulder pain can be a symptom of hepatocellular carcinoma (HCC), the most common type of primary liver cancer.

Mark Ashamalla, MD, chief of radiation oncology at Episcopal Health Services in New York, confirmed that liver cancer can sometimes cause pain that is felt in the right shoulder, even though the shoulder itself is completely normal.

"The liver sits high in the right upper abdomen, just under the diaphragm, which is the muscle that helps us breathe," he told Fox News Digital. "If a liver tumor grows large enough or is positioned in a way that stretches the liver’s outer covering or irritates the diaphragm, it can trigger nerves in that area."

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The brain can then misinterpret those signals and "feel" the pain in the right shoulder or right shoulder blade, even though the problem lies in the liver. "It’s a real symptom, but it is not because anything is wrong with the shoulder joint itself," Ashamalla noted.

This is not true "phantom pain," which usually refers to pain felt in a body part that has been amputated or removed, the doctor clarified. 

"The problem is in the liver, but the body’s nerve wiring makes the pain show up in the shoulder."

Various types of shoulder pain

"Most shoulder pain is caused by far more ordinary things, like muscle strain, arthritis, tendon problems or poor posture," Ashamalla said.

Typical orthopedic shoulder pain usually occurs after an injury, overuse, sleeping awkwardly, lifting something heavy or repetitive motion, according to the doctor.

"It tends to worsen with certain arm movements, and the shoulder may feel tender, stiff, weak or have a limited range of motion," he said. "By contrast, referred pain from the liver often does not behave like a shoulder problem."

The doctor listed the following clues that may indicate referred shoulder pain linked to liver cancer. 

• Pain on the right side, often near the top of the shoulder or around the right shoulder blade
• Pain that’s not clearly triggered by moving the arm
• Pain when the shoulder exam itself seems relatively normal
• Pain that feels more like a deep, dull ache than a sharp mechanical pain
• Pain that keeps going despite rest or routine treatment
• Pain that comes with other symptoms like weight loss, poor appetite, nausea, fatigue, abdominal fullness, abdominal swelling or jaundice (yellowing of the skin and eyes).

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"That said, these are warning signs, not proof. There’s no single pain pattern that automatically means cancer," Ashamalla emphasized. 

"What matters most is when the pain does not fit the usual orthopedic pattern or is accompanied by other concerning symptoms."

Other liver cancer symptoms

One of the challenges with liver cancer is that it often causes no early symptoms at all, or only very vague ones, according to Ashamalla.

"Liver cancer often does not present with one obvious, dramatic symptom," he said. "Instead, it may show up as a cluster of vague changes that are easy to brush off one by one."

Ashamalla shared the following liver cancer symptoms that can be subtle and easy to overlook.

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• Feelings of fullness after only a small amount of food
• Loss of appetite and lack of desire to eat, especially when it's persistent and unexplained
• Unintentional weight loss
• Persistent fatigue or weakness that doesn’t seem to improve
• Upper abdominal discomfort, pressure or heaviness, or a sense of fullness under the right ribs
• Abdominal swelling, which can happen if fluid builds up in the abdomen
• Jaundice (yellowing of the skin or eyes), which can be subtle at first
• Dark urine or pale stools, indicating that the liver or bile system is not functioning normally
• Itching, even without a visible rash
• Low-grade fevers or flu-like feelings without a clear infection.

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When to see a doctor

Ashamalla stressed that people shouldn’t be frightened by every ache or pain.

"Shoulder pain is extremely common, and in most cases the cause is benign," he said. "Don’t panic about ordinary shoulder pain, but don’t ignore it if it's persistent, unexplained, or comes with other red-flag symptoms."

For those who already have liver disease or risk factors for liver cancer, such as cirrhosis or chronic hepatitis, unexplained symptoms may warrant a greater concern.

People should seek medical attention if their pain meets any of the following criteria, according to the doctor.

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• Lasts more than a few weeks
• Has no clear injury or trigger
• Doesn’t improve with rest or standard treatment
• Is present even when the shoulder is not being used
• Is worse at night or when at rest
• Continues even when the shoulder itself seems normal
• Is accompanied by other liver cancer symptoms.