Asthma Shoulder Pain

Overview

Asthma is caused by an over-reactive response from the immune system that causes inflammation in the lungs. While asthma is not typically the primary cause of shoulder pain, inflammation in the lungs can lead to referred pain, which occurs when the source of the discomfort is in the area of the respiratory organs and muscles and then spreads to the shoulder. 

Asthma may also contribute to postural misalignment, or poor posture, that changes the alignment of the spine and puts strain on muscles in the neck, shoulders, back and even cervix.  According to a study in the British Medical Journal¹ the four most common causes of shoulder pain are: damage to the rotator cuff in the shoulder; arthritic conditions (glenohumeral conditions); damage to the joint where the two bones meet (acromioclavicular conditions); and referred pain that originates in the neck. Asthma is not considered to be a common cause of shoulder pain.

What is asthma?

Asthma is a condition that causes airways to swell, become inflamed, narrow, and fill with mucus. This makes it difficult to breathe. Asthma is described as an ‘atopic’ condition which is another word for allergies caused by the immune system having an overactive response causing the individual to be allergic to things that are often harmless to others. The immune system reacts to ‘triggers’ in the environment such as dust mites, pollution, pollen or animal fur. The inflammation in the lungs can cause pain or discomfort in this area.

Causes/Triggers

There is no singular direct cause or reason why some individuals have asthma but many factors increase the risk of developing asthma. For example, it is usually caused by genetics (having a parent and siblings with the condition) or exposure to smoke or pollutants during pregnancy or childhood. The condition can be exacerbated (also called an ‘attack’) by reactions with triggers in the environment such as dust, house mites, pollen, cigarette smoke and animal fur amongst other things. However, some asthma attacks can be unpredictable and what ‘triggers’ an attack is often specific to each person.

What is the connection between asthma and shoulder pain?

Causes of asthma related shoulder pain

Asthma makes it difficult for an individual to breathe. This causes the heart, lungs, spine, diaphragm and other muscles to work harder, hence leading to pain in the back and in the shoulder. It is possible that shoulder pain is caused by the tendency to hunch the shoulders and, as a result, strain the shoulder muscles when coughing. 

This tendency was investigated by a study found in the Journal of Asthma² which aimed to find a correlation between asthma and musculoskeletal dysfunction in adults. The study found that as asthma causes an increased stress on respiratory muscles, it also causes a change in posture. This change in posture led to a decrease in the internal rotation of the shoulder resulting in pain. The study found that when comparing asthmatics with non-asthmatics patients, shoulder pain was significantly increased in those with asthma.  

However, aside from overuse of the muscles in this way, if an individual experiences shoulder pain, it is unlikely to be caused by asthma but another lung condition or cause.

Other causes of shoulder pain

There are other reasons why an individual might experience shoulder pain which are more likely to be the cause rather than asthma. One of the most common causes is a chest infection which causes inflammation of the tissue between the lungs and ribcage. This inflammation often causes pain in the back and chest (called pleurisy) but can also cause pain in the shoulder.  Pain that is felt in one area originates elsewhere is known as referred pain. Typically, pain originating in the lungs, heart or other nearby organs can cause referred pain in the shoulder.

Symptoms of asthma related shoulder pain

Some of the symptoms of asthma-related shoulder pain include:

• Hunched shoulders due to constriction of muscles in the neck and shoulders
• Abdominal muscles may also tighten causing you to lean forward, reducing internal rotation of the shoulder and causing pain
• Feeling the need to sit up and forward or stand up to be able to breathe

What does asthma related shoulder pain might feel like?

The shoulder pain caused by overuse of the respiratory muscles can cause the individual to feel fatigued and short of breath. This pain may be felt between the shoulder blades or felt more on one shoulder blade than another. It can be possible to feel stiffness, a dull ache or stabbing pain  in the shoulder.

Treatment for asthma related shoulder pain

The first treatment for asthma-related shoulder pain is to ensure that asthma is well controlled with consistent use of the prescribed preventer inhaler or medication. This, along with avoiding triggers should help to prevent asthma symptoms and therefore, referred shoulder pain from occurring. However, once symptoms begin, a reliever inhaler or medication will help to reduce the inflammation of the airways and help to relax the muscles in the shoulder so that it does not cause strain and referred pain in the shoulders. 

Other over-the-counter medications such as paracetamol or non-steroidal anti-inflammatory drugs (NSAIDs) can be taken to reduce pain and inflammation in the lungs or in the tissue between the lungs and ribcage. Finding ways to relax the muscles in the shoulders and back can also help to relieve pain. For example, simple exercises such as arm rotation, stretches or physical therapy, may help to reduce pain and improve stiffness and flexibility. It is also important to improve posture and thoracic alignment by ensuring the correct pillow is used when sleeping and sitting upright as much as possible.  

Other symptoms of asthma

Aside from shoulder pain, other symptoms typically experienced can include:

• Breathlessness
• A whistling sound when breathing called wheezing
• Chest pain
• Back pain
• Coughing

When asthma is exacerbated so that it is acute (an asthma attack), other symptoms can include:

• The chest feeling tight
• Difficult breathing
• Increase in heart rate and breathing rate
• Feeling dizzy or drowsy
• Losing consciousness
• Blue lips and fingernails

Other causes of shoulder pain 

Although some individuals may experience shoulder pain as a result of asthma causing postural changes and overloading respiratory muscles, there are other more likely causes of shoulder pain. Pleurisy (a chest infection) is one of the common causes of shoulder pain, and other common causes are injuries to the rotator cuff in the shoulder. The rotator cuff is made up of muscles and tendons and these can easily be trapped or damaged through poor sleeping position or injury during sports. If the pain is sudden and very bad, and there is difficulty moving the arm or shoulder, then the shoulder may be dislocated or the collarbone (clavicle) may be broken. Arthritis (both osteoarthritis and rheumatoid arthritis), are likely causes if the shoulder is stiff and painful over an extended period of time.  

When to seek medical care

According to a study in the British Medical Journal¹ which summarised findings from other systematic reviews, every year approximately 1% of adults will visit their doctor for a consultation about shoulder pain. If an individual has pain or stiffness that is long-lasting (longer than a period of 6 months) and pain is severe then according to the NHS it would be advisable to visit a GP.  They should also visit a GP if they believe they have: damaged their shoulder through impact or accident; lost feeling in their arms; is hot or cold to touch; misshapen ;or if accompanied by fever.

Summary

It is unlikely that shoulder pain is caused by asthma unless it is caused by poor posture. With changes to posture, better breathing techniques, control of symptoms and proper use of medication, it should be well-controlled and unlikely to affect the shoulder. In most cases, shoulder pain can be successfully treated at home with some simple interventions.