Pain in the left shoulder usually comes from the shoulder or the neck, not the heart. But the heart can send pain to the left shoulder, so check for heart warning signs first. If the pain comes with chest pressure, breathlessness, sweating or nausea, if exertion brings it on, or if it spreads to the jaw or arm, call your local emergency number now. Do not drive yourself.
If none of those apply, the rest of this page describes the common shoulder and neck causes and what tends to set them apart. It narrows things down. It does not diagnose. A doctor or physical therapist who examines you can do that.
First: the signs that skip the line
Signs that it could be your heart
Call your local emergency number now if left shoulder pain comes with any of these:
- Chest discomfort: pressure, squeezing, tightness, heaviness or fullness in the center of the chest, lasting more than a few minutes or coming and going.
- Breathlessness: shortness of breath with or without chest discomfort.
- Sweating, nausea or lightheadedness: a cold sweat, feeling sick or vomiting, or feeling faint.
- Brought on by exertion: pain that starts with walking, climbing stairs, effort or stress and eases with rest.
- Spreading pain: pain or discomfort spreading to the jaw, neck, back, one or both arms or the upper belly.
Women, older adults and people with diabetes are more likely to have subtler signs. These can include unusual tiredness, breathlessness, nausea, indigestion-like discomfort or back, jaw or shoulder pain without obvious chest pain. If you are unsure, call. Emergency teams would rather check and find nothing.
Other urgent signs
- Call your local emergency number: sudden sharp pain worse on breathing in with breathlessness, or sudden tearing pain into the back.
- Go to the emergency department: a misshapen shoulder after a fall, or an arm that is cold, pale or numb.
- See a doctor today: a hot, red, swollen shoulder with fever. Or left shoulder tip pain after a blow to the left side of the belly or ribs, which can come from an injured spleen and needs emergency care.
What usually sets heart pain apart
These are tendencies, not rules. If there is any doubt, treat it as the heart until a doctor says otherwise.
| Feature | More typical of a heart problem | More typical of a shoulder or neck problem |
|---|---|---|
| Trigger | Walking, stairs, effort or stress | Moving the arm or turning the head |
| Feel | Pressure, heaviness, squeezing, hard to pin down | Ache or sharp pain at a spot you can point to |
| Effect of moving the arm | Little or no change | Certain movements reproduce it |
| Effect of pressing on the area | No tenderness | Often tender to press |
| Other symptoms | Breathlessness, sweating, nausea, lightheadedness | Stiffness, weakness or tingling in the arm |
A sore spot that hurts to press does not rule out the heart. Both can be present at once.
Outer shoulder and upper arm: rotator cuff
The most common shoulder cause on either side. An ache on the outside of the upper arm, worse lifting the arm out to the side or overhead, putting on a jacket or reaching into a high cabinet. Lying on the left side at night often hurts.
- Rotator cuff pain (tendinopathy) and bursitis: pain often in a band of the lifting range, about shoulder height. Many people improve over about 6 to 12 weeks with the right exercise, and some take longer.
- Rotator cuff tear: pain plus weakness. Sudden weakness after a fall or a heavy pull deserves a prompt check.
Deep pain and stiffness: frozen shoulder
Frozen shoulder (adhesive capsulitis) brings deep pain, often worse at night, followed by stiffness in every direction. Reaching behind your back, fastening a bra or seatbelt and turning the arm outward become hard. It is most common between about 40 and 60, and more common with diabetes. It often runs one to three years. The stiffness is what sets it apart from heart pain: the arm cannot move, whoever moves it.
Top of the shoulder: AC joint
Pain at one point on top of the shoulder where the collarbone ends. Worse reaching across the body, sleeping on that side and pressing exercises. Often follows a fall onto the shoulder, or comes on gradually with age or years of lifting.
Shoulder pain answers to arm movement. Heart pain answers to effort.
Pain coming from the neck
The lower neck can send pain to the left shoulder, the top of the shoulder and the left shoulder blade.
- Referred neck pain: turning, tilting or looking up changes it. Arm movement may not.
- Pinched nerve in the neck (cervical radiculopathy): pain running down the arm past the elbow, with tingling or numbness in particular fingers. Tingling in the left arm from the neck usually follows a narrow line and changes with neck position. Heart-related arm symptoms usually do not.
- Muscle tension: the upper trapezius and levator scapulae, from desk work or carrying a bag on the left, cause a broad ache that is tender to press.
Where else this could be coming from
- Lining around the heart (pericarditis): sharp chest pain, often felt at the left shoulder ridge, worse lying flat and easing when leaning forward. See a doctor today.
- Lungs and diaphragm: pain at the shoulder tip that is worse breathing in.
- Spleen and stomach: left shoulder tip pain with upper left belly pain, especially after an injury to the belly or ribs.
- Upper back: stiff joints and strained muscles can send pain to the back of the left shoulder.
Still not sure
If any heart warning sign is present, call your local emergency number. Otherwise, get assessed by a doctor or physical therapist if your left shoulder pain is not clearly easing after about one to two weeks, or sooner if you have heart risk factors (high blood pressure, diabetes, high cholesterol, smoking, a family history of heart disease) and the pain is new and hard to explain.
Note what brings the pain on, whether arm or neck movement changes it, whether effort or rest changes it, and any other symptoms.
More on this area: the pain map.
Rule out the heart first, then look to the shoulder and neck, where most left shoulder pain lives.
Written by Louise Yow, Neck & Shoulder Physio.