Best explanation of left shoulder pain I've ever found.

[ajoneen 0]

If you woke up with a pain in your shoulder, you'd probably think something was wrong with your shoulder, right? Maybe you slept on it the wrong way, maybe you're a weekend warrior who threw the football a few too many times. In most cases, your hunch is probably right. Pain in the shoulder usually indicates an injury or disease that affects a structure in your shoulder, such as, say, your subacromial bursa or a rotator cuff tendon. Makes sense, doesn't it?

But you might be way off. Sometimes the brain gets confused, making you think that one part of the body hurts, when in fact another part of the body, far removed from the pain, is the real source of trouble. This curious (and clinically important) phenomenon is known as referred pain. For example, it's unlikely but possible that your shoulder pain is a sign of something insidious happening in your liver, gall bladder, stomach, spleen, lungs, or pericardial sac (the connective tissue bag containing the heart). Yup - conditions as diverse as liver abscesses, gallstones, gastric ulcers, splenic rupture, pneumonia, and pericarditis can all cause shoulder pain. What's up with that?

Neuroscientists still don't know precisely which anatomical connections are responsible for referred pain, but the prevailing explanation seems to work pretty well. In a nutshell, referred pain happens when nerve fibers from regions of high sensory input (such as the skin) and nerve fibers from regions of normally low sensory input (such as the internal organs) happen to converge on the same levels of the spinal cord. The best known example is pain experienced during a heart attack. Nerves from damaged heart tissue convey pain signals to spinal cord levels T1-T4 on the left side, which happen to be the same levels that receive sensation from the left side of the chest and part of the left arm. The brain isn't used to receiving such strong signals from the heart, so it interprets them as pain in the chest and left arm.

So what about that shoulder pain? All of organs listed above bump up against the diaphragm, the thin, dome-shaped muscle that moves up and down with every breath. The diaphragm is innervated by two phrenic nerves (left and right), which emerge from spinal cord levels C3, C4, and C5 (medical students remember these spinal cord levels using the mnemonic, "C3, 4, 5 keeps the diaphragm alive"). The phrenic nerves carry both motor and sensory impulses, so they make the diaphragm move and they convey sensation from the diaphragm to the central nervous system.

Most of the time there isn't any sensation to convey from the diaphragm, at least at the conscious level. But if a nearby organ gets sick, it may irritate the diaphragm, and the sensory fibers of one of the phrenic nerves are flooded with pain signals that travel to the spinal cord (at C3-C5). It turns out that C3 and C4 don't just keep the diaphragm alive; neurons at these two spinal cord levels also receive sensation from the shoulders (via the supraclavicular nerves). So when pain neurons at C3 and C4 sound the alarm, the brain assumes (quite reasonably) that the shoulder is to blame. Usually that's a good assumption, but sometimes it's wrong.

From:

Anatomy Notes: Referred pain

[TerriDoodle 6]

EXCELLENT post!!! Thank you!

[Lana24 10]

excellent post...great way to explain

[Marimaru 7]

I found this also and it was very interesting. My shoulder hasn't hurt since I've been unfilled for a week, but before that it would hurt if I got overly hungry, and hurt if I got overly full. Other times it seemed to hurt randomly, so I'm really not sure what *exactly* the issue is, but I was pretty sure it was relating to my band.

[ajoneen 0]

there is a new trial going on where they are cutting the nerves to the stomach at banding to see if that has any effect on the recovery/weight loss/pain of banders. Should be interesting.

[sfeiner 2]

They should just cut the nerves than carry the hunger pains in the first place. Then none of us would get hungrey...Oh that's right, there's head hunger. Well there must be some nerves up there somewhere too:biggrin:

[MargenOhio 2]

I am 4 months out from band surgery and have the referred left shoulder phrenic nerve pain you describe every day before Breakfast, lunch and dinner. Only filling my tummy with food makes the pain temporaily go away. It's very bad if I don't get something to eat. My doc is stumped. Can you rationalize this for me?

[Rutiglius 0]

Great post -- lots of information to think about!

[childcareresources 5]

Hi I was banded June 1,2009 and have the same issue.I don't need to be reminded to eat.Iwish it would hurt after and not before eating.Still looking for the answer.

[heartfire 4]

Cool article! Thanks for posting!

[Jachut 487]

DH has had chronic shoulder pain since before he was banded and nobody can find a thing wrong with his shoulder or neck.

I am always saying it might be something else, like a hernia etc, but nobody seems to want to check it out! He's asked, but is always told, no its not that.

[xavier 153]

I LOVE my left shoulder pain..its a warning that if I take two more bites of food I'll REALLY be in the hurt bag!

If the pain is made worse or better by eating, then I think it has to be diaphragm/band (referred) pain!

[Humming Bird 275]

I thought my shoulder pain was lasting longer than most banders because I have fibromyalgia. After reading other's comments, I now know I am not alone.

GOOD NEWS!!!! I have found something that gives me much relief and thought I would post it in case it may help others.

I use equate (walmart's store brand) extra strength menthol pain patch. I cut the patch in half, but if the pain is really bad, you could use the whole patch. I put the patch on my shoulder in the evening and leave it on all night. It really works great and no pills to worry about.

hope this helps :blushing:

[Luu2008 2]

I have pain, not severe, if I get overly hungry. It has been since banding so I have always known it was band related, happy to hear I'm not alone. I feel like its my body telling me "eat!"