When To Go To The ER For Shoulder Pain

Shoulder pain is a common complaint that many people experience. It is the third most common complaint seen in outpatient clinics in the US. 

Whether you've slept in an odd position or lifted something heavy, it's not unusual to feel discomfort in your shoulders. However, there are occasions when that pain is more than just a minor inconvenience. It could be a symptom of something more serious and warrant a trip to the emergency room (ER).

From this article, you'll learn about some common causes of shoulder pain, when to go to the emergency room, and what to expect when you get there. 

When Should I Go to the ER for Shoulder Pain? Can Shoulder Pain Be Life-Threatening?

Shoulder pain can be a symptom of something life-threatening in some cases, but usually when other symptoms are also present. Sole shoulder pain is very rarely a symptom of something serious going on.

Hence, with shoulder pain, it's not only about the severity but also the events leading up to the pain and accompanying symptoms.

So, here's a good rule of thumb: if you have shoulder pain, you should get help right away in two main situations:

1. Accompanying Symptoms:
   
   If you also exhibit other symptoms along with the shoulder pain, such as:
   
   1. Chest Discomfort
   2. Severe Abdominal Pain
   3. Vaginal Bleeding
   4. Fever
      
      
2. Recent Traumatic Injury:
   
   Getting medical help right away is very important if you recently hurt your shoulder or an area around it.

Let’s discuss these in more detail.

1. Reasons To Go To The ER For Shoulder Pain: Accompanying Symptoms 

Shoulder Pain And Chest Discomfort - Heart Attacks

A blockage in your heart's arteries can cause a heart attack or myocardial infarction, the sudden death of heart muscle cells.

Usually, a heart attack feels like a dull, squeezing pressure in your chest and can happen unexpectedly. However, sometimes you might experience pain in your left shoulder and arm that moves into your neck and jaw.

This pain may occur at any time, including at rest, and often doesn't go away on its own. 

The following conditions may put you at increased risk of a heart attack:

• High blood pressure
• Lifestyle habits (lack of regular physical activity, an unhealthy diet, smoking)
• High blood cholesterol
• Diabetes
• Obesity

Call an ambulance immediately if you have pain in your shoulder(s) and one or more of the following symptoms! You might just be having a heart attack:

• dull, squeezing pressure in your chest
• dyspnea (shortness of breath)
• heavy sweating and anxiety
• nausea and vomiting
• feeling faint

Shoulder Pain Along With Ripping Chest Pain - Aortic Dissections

Sharp pain between the shoulder blades that feels like ripping or tearing could be a sign of an aortic dissection. Aortic dissections are rare and usually associated with poorly controlled hypertension, some genetic conditions, and an existing family history.

Does Shoulder Pain Always Mean Heart Trouble? What Part of Your Shoulder Hurts With Heart Problems?

Heart trouble can manifest in many ways, including shoulder pain. However, shoulder pain without any other symptoms rarely indicates heart disease.

When someone has heart disease, shoulder pain is often followed by other common symptoms, such as chest pain and trouble breathing. 

Depending on the underlying heart condition, the severity and type of these symptoms may also be different.

For example, pericarditis presents as sharp, pleuritic chest pain, while a heart attack typically manifests as dull, squeezing pressure.

If we talk about which part of the shoulder hurts, it's typically the entire shoulder. This pain mirrors the chest pain, as it's essentially the chest pain radiating or spreading out.

You should tell your healthcare provider right away about any symptoms that are bothersome, new, or don't go away. 

Shoulder Pain With Fever - Septic Arthritis

Fever, joint pain, swelling, warmth, and reduced range of motion may indicate a joint infection (septic arthritis). Septic arthritis rarely occurs without underlying conditions and can lead to permanent joint damage or, occasionally, death.

Diabetes, artificial joints, joint surgery or infection, and a weakened immune system can all put you at risk.

Signs of an Infection

Some commonly seen symptoms of a shoulder joint infection include:

• Fever (seen in 40–60% of cases) 
• Pain (in 75% of cases)
• Reduced range of motion

You may notice that these symptoms come on suddenly or, in some cases, slowly over days or weeks.

Joints are usually swollen and warm, with skin redness and, in some cases, associated chills.

You should immediately go to the emergency room if you have these symptoms. Getting quick help can often prevent serious and sometimes fatal complications.

Shoulder Pain After Strep Throat - Rheumatic Fever

If strep throat isn't treated, it can lead to rheumatic fever, which usually causes inflammation and joint pain. This complication is more commonly seen in children but may recur in adulthood.

Rheumatic fever is caused by a bacteria called Group A β-hemolytic streptococcus. It often develops a few weeks after infection, mainly if untreated or poorly treated.

Inflammation often involves several body systems with symptoms such as:

• Fever, chills, and feeling tired

• Pain and swelling in multiple joints, along with difficulty moving them. This condition is known as migratory polyarthritis. "Migratory" means that the symptoms move from one joint to another, while "polyarthritis" refers to inflammation affecting multiple joints.

• Chest pain, fast heartbeats, and other heart-related symptoms. When rheumatic fever affects the heart, it usually involves the heart valves.

• A flat, painless, curly rash (also known as erythema marginatum) located on the limbs and trunks

• Involuntary, irregular, nonrepetitive movements of the limbs, neck, head, and face (Sydenham chorea)

You should go to the ER if you've had a recent strep throat and are now experiencing one or more of the above symptoms.

Shoulder Pain With Abdominal Pain And Vaginal Bleeding - Ectopic Pregnancy

An ectopic pregnancy occurs when the fertilized egg attaches outside the uterus. The fallopian tubes are a common location for these kinds of pregnancies, and unfortunately, the fetus cannot survive there.

A ruptured ectopic pregnancy can cause bleeding from the vagina and within the 

abdomen and can be fatal if not promptly treated.

This condition can also cause shoulder tip pain due to diaphragmatic irritation from the blood in the abdomen. This happens because the nerves in the diaphragm and the shoulder tip share the same pathways.

While vaginal bleeding and abdominal pain are also features of regular menstruation, there are distinguishing factors to be aware of:

• The pain associated with an ectopic pregnancy is generally not crampy and can be more severe.
• The vaginal bleeding is more severe as well.

If you have an ectopic pregnancy, you may also experience:

• lower abdominal pain that may be mistaken for appendicitis (inflammation of the appendix)
• signs of pregnancy, such as nausea and breast tenderness
• Feeling faint or lightheaded

Early recognition and timely intervention are vital to preventing death and other complications. So call 911 if you have any distressing symptoms.

Shoulder Pain After A Mono Infection - Spleen Ruptures

Sudden left-sided abdominal pain, along with shoulder-tip pain, could indicate a spleen rupture. A direct blow to the abdomen, such as in a car accident or a fight, or a viral infection like infectious mononucleosis (mono) are the two leading causes of spleen ruptures. It is very rare to have a spleen rupture otherwise.

2. Reasons To Go To The ER For Shoulder Pain - Traumatic Injuries

If you've sustained a traumatic injury, such as a fall, and experience severe shoulder pain, noticeable deformities, difficulty moving your arm, or loss of function, it's crucial to seek emergency care. Such pain could indicate a dislocation or fracture that needs immediate attention.

On the other hand, if your shoulder pain manifests as a dull ache that intensifies over time, it might stem from overuse or underlying conditions like arthritis or tendonitis. In such scenarios, consulting your primary care provider or physiotherapist might suffice.

Let’s review some of the injuries that merit a visit to the ER.

Traumatic Shoulder Injuries - Shoulder Dislocations 

Shoulder dislocations make up about 50% of all major joint dislocations.

A dislocation occurs when the bones of the shoulder move out of place. This is often the result of a strong force on the shoulder, like in a fall. Other potential causes are:

• Car accidents
• Contact sports
• Direct blows to the shoulder

With a shoulder dislocation, you may notice

• Sudden pain with difficulty moving your arm
• A ‘lax sensation’ in your shoulder as the joint moves out of place
• A visible deformity 
• Swelling or bruising over your shoulder
• Numbness or tingling over the shoulder if there’s a nerve injury

The axillary nerve is often injured in shoulder dislocations. In addition to powering the muscles, it also provides sensation to the external aspect of your shoulder. Luckily, injuries to this nerve often resolve as soon as your shoulder is popped back in.

In the event of a shoulder dislocation, here’s what to do:

• Do not try to pop your shoulder back in; a professional should do this.
• Immobilize your shoulder with a (make-shift) sling.
• Seek medical care immediately.

In conclusion, shoulder dislocations are painful and traumatic injuries. Getting medical help immediately and following aftercare instructions is vital to avoiding complications.

Traumatic Shoulder Injuries - Fractured Humerus

The humerus is the long bone in your upper arm, running from your shoulder to your elbow. A fracture here means a complete or partial break anywhere along the length of your humerus. 

There are several potential causes of a fractured humerus:

• Falls on an outstretched hand (most common cause)
• Car accidents
• Violent fits (seizures)
• A direct blow to the humerus
• Pathologic fractures. These are caused by diseases such as Paget's disease and metastatic bone disease, which make bones weaker and more likely to break. Metastatic bone disease is when cancer from another part of the body spreads to the bones.

Breaks in the humerus can be quite dangerous. The humerus is where several shoulder muscles attach and several nerves, particularly the radial nerve, pass through.

The radial nerve is incredibly vulnerable around the middle of the humerus. A fracture in this area and subsequent injury to this nerve may result in problems with sensation and mobility in your arm. A condition known as "wrist drop" (weakness and inability to extend your hand at the wrist) is a feared complication.

Please get help immediately if you have shoulder pain after a fall or car accident or have a health condition that weakens your bones.

Traumatic Shoulder Injuries - Torn Rotator Cuff

The rotator cuff is a group of tendons and muscles that converge around the top of the upper arm bone (humerus) and hold it within the shoulder socket. It plays a crucial role in shoulder movements and stabilization.

Muscles of the rotator cuff include the supraspinatus, infraspinatus, teres minor, and subscapularis.

A traumatic tear in the rotator cuff is a severe injury, often leading to pain and functional impairment.

While rotator tears can arise from degenerative conditions due to age or overuse, acute injuries can also occur. Rotator cuff tears are usually caused by:

• Lifting heavy objects, particularly with improper form
• Repeatedly throwing a baseball or similar actions in sports
• Chronic shoulder inflammation that weakens the tendon over time.

With a rotator cuff tear, you might experience sudden, intense pain with shoulder weakness and a limited range of motion.

Rotator cuff tears may also increase your risk of a shoulder dislocation.

If you’re concerned that you might have sustained a rotator cuff tear, the ER is equipped to provide immediate and appropriate care. The following section will discuss what you can expect in the emergency room.

What Does the ER Do for a Torn Rotator Cuff?

The primary objective of the ER is to diagnose, manage immediate symptoms, and set up specialty reviews. Here's what you can expect when seeking emergency care for a suspected rotator cuff tear:

• History: The ER doctor will ask about your injury - how it happened, the nature of the pain, and any previous shoulder issues.

• Physical Examination: Your doctor will try to determine where the pain and discomfort are coming from by moving your arm in specific ways and testing its strength.

• Tests and Imaging: The first line of imaging usually involves X-rays to rule out bone fractures and check for other abnormalities. The ER might order an MRI if a torn rotator cuff is highly suspected and more detailed imagery is required. However, the doctor might postpone the appointment due to a tight schedule or recommend seeing a bone specialist.

• Pain Relief: Relieving your pain is a priority in the ER. They might offer pain medications and cold packs and immobilize your shoulder to prevent further damage.

• Referral/Specialist Review: Most people with a suspected rotator cuff tear will be referred to an orthopedic surgeon for further assessment and to discuss potential treatments. Treatment may include physical therapy, surgery, or both. Surgery is usually used in traumatic tears or in patients who do not respond to physical therapy and other conservative measures.

In summary, the emergency room is the first place to go for care after a torn rotator cuff. The focus is diagnosis, pain relief, and referral to a specialist for further review.

What Are Red Flags for Shoulder Pain?

As we discussed earlier, most cases of shoulder pain are not life-threatening. However, you should keep an eye on the following "red flag" symptoms and seek immediate medical attention if they appear:

• a recent history of trauma and pain that appears suddenly (especially if pain restricts all joint movements)
• abnormal joint shape 
• joint swelling or mass
• redness over a 'hot,' painful joint
• severe restriction of movement
• persistent shoulder pain that isn't relieved by rest or over-the-counter medication 

The following symptoms may not need emergency care, but they could be signs of more serious problems that still need to be checked out by a doctor as soon as you can:

• Fever, night sweats, and weight loss with shoulder pain may point to cancer.
  
• Shoulder pain that moves up into your neck or down your arm with numbness or tingling might point to cervical radiculopathy. It occurs when a nerve in your neck is compressed or irritated. Common causes are trauma, disc herniation, and degenerative conditions.

Can the ER Help With Shoulder Pain?

Yes, the ER can definitely help with shoulder pain.

We understand you might be anxious about going to the emergency room for shoulder pain. Knowing what happens during such visits can help you feel more prepared.

• First, a doctor may ask you about the nature, intensity, and duration of your shoulder pain. They may also inquire about any other symptoms you've been experiencing associated with shoulder pain.

• They may then follow up with a quick physical examination. The doctor will evaluate the range of movement in your shoulder and look for tender, swollen, or deformed areas. In an emergency, like if they think someone is having a heart attack, doctors may start treatment while they do these basic checks.

• Your doctor may also request tests depending on what they suspect might be causing your shoulder pain. We'll discuss some of these investigations in the next section.

• In the ER, the primary focus is on immediate relief and stabilization. For shoulder pain, the team will first determine its cause. Initial treatments might involve administering pain-relief medications. If the ER doctors think you have serious injuries like fractures or dislocations, they'll send you to another department. There, you'll get checked further and might have surgery if needed. For treatments like physical therapy or regular injections, they'll most likely advise you to see a specialist after leaving the ER.

ER Procedures for Diagnosing Shoulder Pain

Your medical history and physical exam will guide your doctor on what procedures and tests to choose to figure out what's wrong.

They might use imaging, blood tests, or a combination of these. Let's look at the most commonly used:

• An x-ray to look at your shoulders or other organs. It is particularly helpful in diagnosing fractures and other joint or bone issues.

• A CT scan provides details of the bone and surrounding soft tissues.

• An MRI is useful for assessing the bones, ligaments, muscles, and tendons of your shoulder in greater detail. 

• Ultrasound might be used to evaluate soft tissue injuries such as rotator cuff tears. It can also be used to diagnose other conditions that may cause pain in your shoulder, such as an ectopic pregnancy.

• Blood tests can also be performed to rule out infection or more systemic medical conditions, like an autoimmune disease. It can also be an option if the ER doctor suspects referred pain from a heart or lung condition.

• In joint aspiration or arthrocentesis, a sample of joint fluid is taken with a needle and sent to a lab. Tests are done to check for white blood cells, bacteria, or other microorganisms. This procedure is also therapeutic in some cases. This means it can provide relief by reducing joint swelling and pain when excess fluid is removed during the aspiration.

What Is the Best Painkiller for Shoulder Pain?

For mild shoulder pain, many people find relief with over-the-counter pain relievers.

These include options like ibuprofen, aspirin, and acetaminophen. Other options include capsaicin (derived from chili peppers) or menthol, which are ingredients in some pain-relieving gels, patches, or sprays.

If these standard remedies aren't effective, your doctor might prescribe stronger medications. These can include:

• Opioid analgesics, like codeine
• Corticosteroids 

Talking to a doctor or nurse before starting or changing any medication routine is essential.

What if Painkillers Are Not Working for Shoulder Pain?

If painkillers aren't alleviating your shoulder pain, it might be a hint that you should visit a doctor. Persistent pain despite medication could indicate a more severe underlying issue or that a different treatment plan is needed. It's essential to get an accurate diagnosis to address the root cause and ensure optimal recovery.

Why Does Shoulder Pain Get Worse?

Various factors can amplify shoulder discomfort. Here are situations where your shoulder pain might worsen:

• Lack of rest and continued strain or use of your shoulder. 
• Osteoarthritis and rheumatoid arthritis can cause pain that worsens if the disease is not treated.
• Severe conditions like septic arthritis may also cause worsening shoulder pain.

You should go to the ER if you're experiencing severe pain, especially if there are other symptoms.

How Long Is Too Long for Shoulder Pain?

Mild shoulder pain might go away after a few days of rest, over-the-counter medicine, and gentle exercise. You should see a doctor if the pain lasts more than a week or two.

If your pain comes on suddenly with other red-flag signs we talked about earlier, call 911.

Who Should I See for Shoulder Pain?

If your shoulder pain is manageable and not too severe, visiting an urgent care center is a good starting point. They can help with issues that aren’t critical but need care, like minor pain or sprains, and usually have shorter wait times.

However, if the pain is intense, constant, or accompanied by other serious symptoms, it’s advisable to head straight to the emergency room. They are equipped to handle more severe cases and can provide immediate treatment if needed.

Ideally, in situations that aren't urgent or life-threatening, you should go to a primary care doctor first. They can treat you or send you to a specialist, like an orthopedic doctor. Orthopedists can diagnose the source of the issue and recommend appropriate treatment options. They may even refer you for physical therapy, which can be valuable for many shoulder conditions.

You can find a ton of information in this article about the different types of doctors you can see if you have shoulder pain. 

Understanding the Difference: Routine Orthopedist Visit vs. ER

You can continue with your regular clinic appointments if you have a shoulder problem. As long as it hasn't changed and you haven't had any sudden or red-flag symptoms.

If your symptoms change or you get new ones without any major warnings, your doctor will check you and decide if more tests are needed.

You should go to the emergency room if your shoulder pain comes on quickly, is very painful, or comes with fever, chest pain, or trouble breathing.

How To Get a Referral for an Orthopedic Specialist

Depending on your health insurance, you may or may not be able to see an orthopedic specialist directly. In many cases, insurance companies require a referral for specialist visits to be covered. 

You'll typically need a referral from your primary care physician to see an orthopedic specialist. This is usually done by talking to your doctor about your symptoms and health history. Your doctor can then decide if you need to see a specialist. They will formally refer you if they agree that a specialist's opinion would be beneficial.

You can get the gist of the different insurance plans and their referral requirements here.

Takeaway

• Seek emergency care if you have shoulder pain along with other symptoms such as chest discomfort, severe abdominal pain, or fever.

• Go to the ER if you have a recent history of trauma to the shoulder, like a fall, car accident, or sports injury. This may cause injuries like
  
  • Fractures,
  • dislocations or
  • rotator cuff tears

• Red flags that warrant an ER visit include sudden severe pain, visible deformity, inability to move the joint, swelling, or redness.

• The ER can provide pain relief, conduct tests like X-rays or MRIs to diagnose the cause, and refer you to specialists for follow-up care.

• For non-emergent shoulder pain, see your primary care physician first. They can refer you to orthopedic specialists or physical therapists as needed.

Knowing when to see a doctor or go to the emergency room for shoulder pain can help you get the right treatment and avoid complications.