Is Shoulder Pain a Sign of Cancer? Understanding Referred Pain

Medically reviewed by Laila Babar, M.D.

Most of the time, an aching shoulder is just the result of a tough workout or sleeping in an awkward position. You might wake up feeling stiff and assume you simply tweaked a muscle. In rare cases, persistent shoulder pain may be referred from another part of the body and could signal a more serious condition, including lung cancer. We want to help you understand when a joint ache is normal and when it requires medical attention.

“Shoulder pain by itself is more often related to common musculoskeletal issues than cancer,” says Laila Babar, M.D., a medical oncologist at INTEGRIS Health Cancer Institute Southwest.

“But in some cases, pain can be ‘referred,’ meaning the body feels discomfort in the shoulder even though the underlying problem is elsewhere. The key is to pay attention to persistent pain, worsening symptoms or shoulder pain that occurs alongside unexplained weight loss, fatigue or shortness of breath.”

Is shoulder pain a sign of cancer? 

What to know: Many people worry about serious illness when they experience persistent discomfort, but joint aches usually stem from localized issues. However, specific types of discomfort can sometimes signal problems elsewhere in the body.

• Most shoulder aches result from muscle strains or joint wear and tear.
• Pain that originates in one area but is felt in another is called referred pain.
• Certain lung or abdominal conditions can cause referred pain in the upper back or arm.
• Some physicians use numbing and radiofrequency to diagnose referred pain, according to a recent study in Frontiers in Neurology.

The shoulder is a highly mobile joint prone to various mechanical injuries. It relies on a complex web of tendons and muscles that easily become inflamed or torn.

• Rotator cuff tears are a leading cause of localized discomfort.
• Bursitis involves inflammation of the fluid-filled sacs cushioning the joint.
• Frozen shoulder causes stiffness and restricted movement over time.
• Osteoarthritis wears down the cartilage, creating friction and pain.

The chest and lungs sit right next to the shoulder nerves, meaning issues here can radiate outward. Conditions affecting the respiratory system often send warning signals to the upper back or shoulder blades.

• Pleurisy involves inflammation of the lung lining, causing sharp chest and shoulder pain.
• Pneumonia can create respiratory distress that radiates to the upper body.
• A pulmonary embolism might cause sudden, sharp discomfort in the shoulder region.
• Certain lung tumors can press on nerves that run directly to the arm.

The organs and nerves share pathways that can confuse the brain about where an ache actually originates. When an internal organ is distressed, the brain might interpret the signal as coming from a nearby joint.

• Gallbladder issues often cause referred discomfort in the right shoulder blade.
• Heart conditions can radiate pain down the left arm or shoulder.
• Diaphragm irritation sends nerve signals straight to the top of the shoulder.
• Liver problems may also create a dull ache in the upper right back.

When shoulder pain could be related to cancer

Key points: While most joint issues are benign, certain red flags can indicate a more systemic problem. It is important to monitor how the ache behaves and whether it responds to typical rest and recovery methods.

“Pancoast tumors, which are cancers arising in cells in the apex of the lungs, often present with shoulder pain, arm swelling, neck pain and limited mobility,” Babar adds. “Timely diagnosis and treatment are essential and often lifesaving in these situations; patients often need aggressive treatment in the form of chemotherapy and radiation and may need surgical resection as well.”

For Dr. Babar’s patient, Marco Reyes, that was the case. After gritting through severe shoulder and back pain for quite some time – hoping the pain would resolve on its own – Marco went to the emergency room when his friend encouraged him to speak to a doctor. He later learned he had stage IV lung cancer and needed immediate treatment. 

“I was surprised to learn it was cancer,” Marco says. “I kept putting it off and not going to the doctor. But Dr. Babar cured me. She saved my life.” A laborer used to daily aches and pains from a lifetime of building, repairing and remodeling houses, Marco adds that he’s never felt this type of pain before. Now, a few years following his diagnosis and treatment, Marco is thriving and grateful that his cancer remains in remission. 

“When I met Marco, he was very weak, had been losing weight for some months and could not tolerate chemotherapy,” Babar says. “We performed radiation treatment for pain relief and then started him on immunotherapy for residual disease. He had an excellent response to treatment and has no FDG-avid disease left.”

Key takeaways:

• Cancer-related aches rarely improve with ice, heat or physical therapy.
• The discomfort might feel deep, relentless and unrelated to physical activity.
• Accompanying respiratory or systemic symptoms are major warning signs.
• Early medical evaluation is crucial for an accurate diagnosis.

Notice shoulder pain that appears without an injury and does not improve over time. A sudden ache that lingers for weeks without any prior trauma is unusual for a simple muscle strain.

• Mechanical injuries typically have a clear starting event, like lifting something heavy.
• A spontaneous ache might indicate pressure building from an internal source.
• Shoulder pain without injury should always be evaluated if it persists.
• Continuous discomfort that ignores anti-inflammatory medication is a warning sign.

Pay attention to pain that worsens at night or at rest, especially near the shoulder blade. Most musculoskeletal issues feel better when you lie down and stop moving the joint.

• Tumors can cause increased pressure when you lie flat in bed.
• The discomfort may throb constantly regardless of how you position your arm.
• Resting should alleviate mechanical strain, so pain at rest is abnormal.

Watch for shoulder pain and symptoms connected to lung cancer, like cough, shortness of breath or weight loss. These systemic signs suggest the respiratory system is actively involved.

• A persistent, hacking cough that produces blood is a major concern.
• Unexplained dropping of pounds points to a systemic illness.
• Feeling breathless after minimal exertion often accompanies lung issues.
• Lung cancer screening should be performed aggressively, especially if you are a smoker.

Know that rare tumors like Pancoast tumors can start with shoulder and arm pain or weakness. These specific growths develop at the very top of the lungs and invade nearby chest wall tissues.

• They often press against the nerve bundle called the brachial plexus.
• This pressure causes severe discomfort radiating down the arm.
• Patients may also experience weakness or tingling in their hands.
• Pancoast tumors frequently disguise themselves as severe orthopedic issues initially.

When shoulder pain is more likely from a musculoskeletal issue

Why it matters: Most of the time, your discomfort is simply a mechanical problem resulting from daily life. Identifying the mechanical nature of your ache can provide peace of mind and guide you toward physical therapy.

• Musculoskeletal pain is the most common reason for doctor visits.
• These issues respond well to targeted stretching and strengthening exercises.
• The discomfort is usually linked directly to specific physical activities.
• Recovery generally follows a predictable timeline with proper care.

Consider recent overuse, sports or lifting injuries that strain the joint or tendons. Repetitive motions are notorious for causing tiny tears in muscle fibers over time.

• Painting a ceiling or pitching a baseball often leads to tendinitis.
• Lifting heavy boxes awkwardly can easily tear a rotator cuff muscle.
• Resting the joint usually brings noticeable relief within a few days.

Look for pain that changes with movement, position or reaching overhead. Mechanical problems rely on joint mechanics, meaning the ache will spike when you use the affected muscles.

• Reaching for a high shelf might trigger a sharp, localized pinch.
• Putting on a jacket can become incredibly difficult and painful.
• Certain specific angles of rotation will consistently reproduce the exact same ache.

Notice swelling, stiffness or loss of range of motion in the shoulder itself. Physical changes directly on the joint are strong indicators of a localized, non-cancerous problem.

• A visibly swollen or red joint usually means acute inflammation or bursitis.
• Feeling a grinding or popping sensation points to cartilage wear.
• If you physically cannot lift your arm, a torn tendon or frozen shoulder is likely.
• These physical limitations are rarely the primary signs of referred internal pain.

Find a doctor at INTEGRIS Health now

Finding help: If you are concerned about your symptoms, reach out to a healthcare professional today. Our experienced team can help diagnose your condition and create a personalized treatment plan. Whether you need physical therapy, advanced imaging or cancer screening, we are here to support your journey to recovery. Find a doctor at INTEGRIS Health today!

Explore cancer care services offered at INTEGRIS Health

From diagnosis through survivorship, our multidisciplinary team provides expert treatment, support services and compassionate care tailored to your unique needs.

SEE MORE