When pain occurs, particularly after a specific activity such as eating, your body is warning you that something is not right. The most common internal cause of right shoulder pain is biliary colic, an irritation of the gallbladder usually caused by gallstones. However, shoulder pain can also be a sign of a life-threatening condition, such as a heart attack. If you have recurrent shoulder pain, consult your doctor.
The Facts
Your liver produces bile, and the purpose of the gallbladder is to store this bile. Bile helps digestion by breaking down fats, fat-soluble vitamins and cholesterol so the small bowel can more easily absorb these substances. Bile also helps the body to eliminate excess cholesterol, waste products from some medications and bilirubin, the product of normal red blood cell breakdown. When you eat a meal, your body signals the gallbladder to contract, pushing bile through the bile duct and into the intestine to aid digestion.
Causes
Up to 80 percent of gallstones is crystals of cholesterol. Less commonly, the gallstone is made of hardened bilirubin. These gallstones can be as small as a grain of sand or as large as a golf ball. Cholesterol gallstones may result from an inability of the bile to keep up with the amount of cholesterol excreted by the liver. Gallstones that stay in the gallbladder do not cause symptoms. However, when gallstones move out of the gallbladder, they can block the flow of bile to the small bowel, causing biliary colic. Gallstones may lead to another condition called cholecystitis, an inflammation of the gallbladder. The pain from cholecystitis is typically more severe and lasts longer than the pain from gallstones. Both conditions can cause pain in the right shoulder; cholecystitis is often accompanied by nausea and vomiting.
Symptoms
If a gallstone is blocking the bile duct, the patient will feel pain when the gallbladder contracts. Since the gallbladder contraction occurs when you eat, and occurs more frequently the more you eat, you may only feel this pain after a large meal. Gallbladder pain can last from several minutes to hours. Most often, the pain occurs in the upper right abdomen. However, you might also feel pain referred from the gallbladder to the back, between the shoulder blades or in the right shoulder. The pain usually starts suddenly, and typically increases in intensity over 15 to 60 minutes, then remains steady for the next 12 hours. When the pain finally eases, it usually leaves behind a dull ache. Consult your doctor immediately if you experience these symptoms.
Risk Factors
If you have gallstones, eating a large, heavy meal can cause an attack of biliary colic leading to pain in the right shoulder. Gallstones are more common among certain groups, including American Indians and Mexican-Americans. Risk factors for developing gallstones include a diet high in fats and cholesterol, and low in fiber. Some medications, including estrogen therapy and cholesterol-lowering drugs, can increase your risk of developing gallstones. Other risk factors for gallstones include obesity, being female, pregnancy, family history of gallstones and increased age. In the United States, 20 percent of people over age 65 have gallstones, according to the Merck Manuals.
Treatment
Imaging tests such as ultrasound, CT scan or MRI scans can detect gallstones or cholecystitis. The gallbladder is a non-essential organ, so if you suffer frequent attacks, the typical treatment is surgical removal of the gallbladder. Every year more than half a million people in the U.S. have their gallbladder removed. If you have a medical condition that makes surgery risky, there is non-surgical treatment. Drugs made from bile can dissolve small gallstones, although years of treatment might be necessary to dissolve all the stones. This non-surgical option works on gallstones composed of cholesterol crystals, but not on the less common form made of bilirubin.
