Authors: Zawn Villines and Hana Ames
Shoulder pain often occurs due to inflammation or muscle injuries. Less frequently, shoulder pain can be a symptom of lung cancer.
Although shoulder pain is not a common symptom of lung cancer, any persistent, unexplained pain warrants a visit to a doctor for further investigation.
This article explains the links between different types of lung cancer and shoulder pain. It also identifies other potential causes of this symptom.
Lung cancer can cause referred pain in the shoulder. Referred pain means that pain starts in one area of the body, but a person experiences it in a different area.
Some types of lung cancer are more likely than others to cause referred pain.
Pancoast lung cancer tumors
Pancoast tumors are a relatively rare form of lung cancer. They account for 3–5% of incidences of lung cancer.
These tumors develop in a groove called the superior sulcus at the top of the lungs. They often cause intense shoulder pain on the same side of the body as the affected lung because the superior sulcus is close to the shoulder.
If a Pancoast tumor affects the brachial plexus — which is a network of nerves at the top of the shoulders — it can cause pain in the shoulder and arm.
The pain can radiate to the head, neck, and chest. A person may also experience weakness, pain, or tingling in their hands and fingers.
96% of people with Pancoast lung cancer tumors report shoulder pain as one of the first symptoms.
Some people with a Pancoast tumor may experience a group of symptoms called Horner’s syndrome, which can further contribute to shoulder pain. This syndrome can also cause asymmetrical symptoms such as:
- a droopy eyelid on the affected side
- shrinking in one pupil
- changes in sweating, such as reduced sweating on one side of the face
- the sinking of an eyeball into the bony cavity
While the symptoms of Horner’s syndrome are typically mild, the underlying cause will likely require a timely diagnosis and immediate treatment.
Mesothelioma is a type of lung cancer that usually develops as a result of long-term exposure to asbestos.
The symptoms of mesothelioma are similar to those of other types of lung cancer. Shoulder pain may also be a symptom of mesothelioma, but doctors do not know how common this is.
Other symptoms of mesothelioma include:
- shortness of breath
- pain in one side of the chest
- hoarseness and coughing
- trouble swallowing
- swelling in the face and arms
Typically, mesothelioma symptoms take approximately 40 years before they develop.
Symptoms of mesothelioma can sometimes be mistaken for arthritis. According to the Centers for Disease Control and Prevention (CDC), 49.6% of people aged 65 or older have a diagnosis of arthritis.
Because mesothelioma and arthritis affect people of a similar age, people with shoulder pain due to mesothelioma may dismiss their symptoms as arthritis. This can delay diagnosis and worsen their outlook.
Metastatic lung cancer
Metastatic lung cancer is cancer that has spread to other areas of the body. When lung cancer spreads to nearby regions, such as the bones and lymph nodes, shoulder pain may occur.
Metastatic lung cancer can cause a range of symptoms specific to the body system that it affects. For example, lung cancer that spreads to the liver may cause symptoms of jaundice, such as yellow skin.
Depending on where the cancer has spread, other common symptoms of metastatic lung cancer include:
- coughing up blood
- unexplained weight loss
- fluid around the lungs
There is no specific characteristic that defines the shoulder pain symptoms of lung cancer.
One study of shoulder pain in people with mesothelioma found that the participants ranked the pain intensity as 4 out of 10 on average.
A few people in the study, however, experienced more significant symptoms. These included decreased mobility.
Where is shoulder pain located with lung cancer?
Some cancer-related shoulder pain, such as the pain that Pancoast tumors cause, may start in the shoulder and radiate to the head, neck, and chest.
Some people with cancer-related shoulder pain also experience pain in the arms that radiates down to the hands. Numbness and tingling may sometimes occur in the hand and fingers of the affected side.
Non-small cell lung cancer (NSCLC) is the most common type of lung cancer. Other symptoms of NSCLC include:
- a persistent cough
- coughing up blood or rust-colored mucus
- hoarseness or wheezing
- unexplained weight loss
- fatigue and weakness
- chest discomfort or pain
- repeated respiratory infections, such as bronchitis and pneumonia, that do not go away or keep coming back
Most cases of shoulder pain occur due to poor posture or muscle strains. The most common causes of this pain include:
- Short-term injuries: These may occur due to overextending or overusing muscles in the shoulder. Symptoms typically only present in the injured joint.
- Referred pain from other areas of the body: Neck and back pain may trigger aching in the shoulder. Weakness in one muscle can cause the shoulder muscles to overcompensate, leading to pain.
- Injuries in the spine: These may include herniated disks, which put pressure on certain nerves. Some of these nerves lead to the shoulder.
- Osteoarthritis: This is a degenerative condition that progresses as the cartilage wears down between the joints.
- Rheumatoid arthritis (RA): RA is a long-term inflammatory condition that can sometimes affect the shoulder. It occurs when the immune system attacks the joints, causing pain and inflammation.
- Tears in the rotator cuff: This shoulder injury impairs a person’s ability to move, rotate, and lift their arm.
- Frozen shoulder: This is an injury that limits mobility in the shoulder. Underuse, RA, and unusual tissue growth in the shoulder may cause frozen shoulder.
- Poor posture: Slumping over a computer, holding the body in an awkward position for extended periods, and craning the neck can all cause tension and pain in the shoulders. The pain may spread to the neck and back.
Less frequently, various diseases can irritate the nerves of the shoulder, triggering pain. Heart disease, gallbladder disease, and liver disease can all cause shoulder pain in this way.
Nerve pain can cause tingling, numbness, or pins and needles in the shoulder. The area of the body that it affects often changes or expands over time.
Treatment for shoulder pain
In many cases, shoulder pain is temporary and occurs due to overuse, strain, and minor injuries. To treat new shoulder pain, people should try:
- resting the injured shoulder, avoiding excessive movement or heavy lifting
- applying an ice pack to reduce pain or a heat pack to reduce stiffness
- compressing the area with a bandage or wrap to reduce swelling
- keeping the painful area elevated
Some people also find that switching between heat and ice packs helps to increase blood flow, promote faster healing, and reduce pain.
Gentle stretching, low-impact exercise, and nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, may also provide relief.
People should visit a doctor if they experience shoulder pain that either lasts more than a few days, goes away and then returns or becomes unbearable. Depending on the cause, a doctor may recommend:
- physical therapy
- exercise therapy
- surgery to address structural issues or damage
- alternative treatments, such as acupuncture or chiropractic care
- pain relievers to reduce shoulder pain and improve mobility
Long-term shoulder pain can range from mild to debilitating. Learning how to cope with shoulder pain that lasts a long time can help make it more bearable.
People should not stop using the affected shoulder as this can prevent it from getting better. Keeping moving can stop the shoulder from freezing up. A person should continue their normal activities, taking regular breaks if needed.
Some people may want to consider their sleeping arrangements and add extra pillows for shoulder support while they sleep.
Lung cancer is one of the most dangerous forms of cancer because it can spread rapidly. Among those in whom a doctor detects and treats lung cancer before it spreads, about 56% will live for 5 years beyond diagnosis.
However, once lung cancer reaches distant sites in the body, the 5-year survival rate reduces to 5%. For the best chance of survival, people who have symptoms of lung cancer should seek prompt medical treatment.
The treatment options for lung cancer depend on the type of cancer and whether it has spread to other areas of the body. Some common treatments include:
- surgery to remove tumors
- chemotherapy and radiation treatment
- drugs that block or interfere with the growth of tumors or treat other symptoms of cancer
- immunotherapy, which is a treatment that supports the immune system to fight cancer cells
These options may improve a person’s outlook if a doctor detects lung cancer before it spreads. Once lung cancer reaches the lymph nodes and distant organs, the outlook becomes worse.
For people with lung cancer who have a poor outlook, treatment can help improve their quality of life.
However, recognizing symptoms early on is critical for improving the life expectancy of a person with lung cancer. It is vital to seek medical attention for any persistent or particularly intense shoulder pain.
Does lung cancer spread quicker than other cancers?
According to the American Cancer Society large cell (undifferentiated) carcinoma is a type of NSCLC lung cancer that tends to grow and spread quickly, which can make it harder to treat. How this compares with other types of cancer is not yet known, however.
Large studies evaluating the spread of lung cancers compared with that of other cancers are necessary to confirm the answer to this question.
Christina Chun, MPHAnswers represent the opinions of our medical experts. All content is strictly informational and should not be considered medical advice.
Shoulder pain is not a common symptom of lung cancer.
However, in rare cases, it can be an early indication of Pancoast tumors or mesothelioma.
In most cases, shoulder pain is temporary and occurs due to overuse, strain, and minor injuries.
However, any persistent, unexplained pain warrants a visit to a doctor for further investigation.