Severe Shoulder and Chest Pain in Pregnant Women: Causes and Solutions

Severe pain in the shoulder blades and chest during the 36th week of pregnancy?

My wife has been experiencing back pain since about the 34th week of her pregnancy.
Starting this Wednesday (1/18), the discomfort has intensified, making it painful to sit, lie down, or perform tasks.
Upon further inquiry, the pain is primarily located near the right scapula and radiates to the spine and buttocks, especially at night until early morning, making it nearly impossible for her to sleep.
She has informed the nearby obstetrician and the attending physician, both of whom believe this is just a normal phenomenon in late pregnancy and suggested heat therapy or more rest.
However, the pain has become so severe that she can hardly move, and with the due date still some time away, the attending physician is reluctant to consider a cesarean section and has not provided relief for her symptoms (I feel this is rather dismissive).
I would like to ask the physician: (1) Are there any pain relievers that pregnant women can take orally or apply topically that would not harm the fetus? (2) Could this be due to a spinal misalignment, pelvic instability, or osteoporosis? (3) Is there a possibility of a tumor? (4) Is acupuncture or local massage from traditional Chinese medicine a viable option for pain relief? (5) Does Western medicine have any immediate recommendations?

Ben Xiansheng, 30~39 year old female. Ask Date: 2005/01/22

Dr. Lü Lizheng reply Obstetrics and Gynecology

The response may indicate that the enlarged uterus is pressing upward against the diaphragm and ribs, causing chest pain, which in turn may compress the thoracic and lumbar spine, leading to pain in the chest, lower back, and shoulder blades.
It is also important to consider potential issues with the placenta.
As the pregnancy progresses and the fetal head descends, the pressure and pain may improve.
Heat therapy, increased rest, topical ointments, and prenatal exercises can help alleviate the discomfort.

Reply Date: 2005/01/22

More Info

Severe shoulder and chest pain during pregnancy can be a distressing experience, particularly as the pregnancy progresses. Your wife's symptoms, which began around the 34th week, are not uncommon, but they can be concerning, especially when they interfere with daily activities and sleep. Here’s a comprehensive overview of potential causes and solutions for her condition.

Potential Causes
1. Musculoskeletal Changes: As pregnancy progresses, the body undergoes significant changes. The growing uterus can exert pressure on the diaphragm and rib cage, leading to discomfort in the chest and shoulder areas. Additionally, hormonal changes cause ligaments to relax, which can lead to postural changes and musculoskeletal pain, particularly in the back and shoulders.

2. Nerve Compression: The expanding uterus can also compress nerves, leading to pain that radiates from the back to the shoulders and down the spine. This is often referred to as referred pain, where the source of the pain is not at the site of discomfort.

3. Preeclampsia: Although less common, severe shoulder and chest pain can sometimes be associated with preeclampsia, a condition characterized by high blood pressure and potential organ dysfunction. It’s crucial to monitor for other symptoms such as headaches, visual changes, or swelling.

4. Other Medical Conditions: While less likely, conditions such as gallbladder disease or even pulmonary issues can manifest as shoulder or chest pain. It’s essential to rule out these possibilities, especially if the pain is severe or accompanied by other concerning symptoms.

Solutions and Recommendations
1. Pain Management: For pain relief, acetaminophen (Tylenol) is generally considered safe during pregnancy and can be used to alleviate discomfort. However, it’s essential to consult with her healthcare provider before starting any medication.

2. Physical Therapy: Engaging in physical therapy can help address musculoskeletal pain. A physical therapist can provide exercises to strengthen the back and shoulder muscles, improve posture, and alleviate pain.

3. Heat Therapy: Applying heat to the affected areas can help relax tense muscles and improve blood flow, which may provide relief. Warm baths or heating pads can be beneficial.

4. Rest and Positioning: Encouraging your wife to rest and find comfortable positions can help alleviate pain. Using pillows for support while sitting or lying down may reduce pressure on the back and shoulders.

5. Alternative Therapies: Acupuncture and chiropractic care may provide relief for some pregnant women. However, it’s crucial to seek practitioners who specialize in treating pregnant patients to ensure safety.

6. Monitoring Symptoms: Keep a close watch on her symptoms. If the pain worsens, or if she experiences additional symptoms such as swelling, headaches, or visual disturbances, it’s essential to seek immediate medical attention.

7. Consulting Specialists: If the pain persists despite conservative measures, it may be beneficial to consult with a specialist, such as an obstetrician or a pain management specialist, who can provide further evaluation and treatment options.

Conclusion
While shoulder and chest pain during pregnancy can often be attributed to normal physiological changes, it’s essential to approach the situation with caution. Ensuring that your wife receives appropriate care and monitoring is crucial. If her pain is severe and debilitating, advocating for further evaluation and treatment is important. Open communication with her healthcare providers will help ensure that both her and the baby’s health are prioritized during this critical time.

Similar Q&A

Understanding Chest Pain with Right Shoulder Discomfort: Causes and Concerns

Hello, Doctor! This morning I noticed a feeling of pressure and pain in my right chest accompanied by shoulder pain. The pressure sensation started today, and I haven't experienced this before. Sometimes the shoulder pain is more intense than the chest pain, and sometimes it...

Dr. Xiao Yongxun reply Family Medicine
Dear Miss Hsiao: 1. When a clinician addresses the issue of chest pain, the first four critical conditions to rule out are myocardial infarction, pulmonary embolism, pneumothorax, and aortic dissection. If none of these conditions are present, the differential diagnosis should c...

Chest Pain While Breathing During Pregnancy: Causes and Solutions

Hello Doctor: I am currently 9 months pregnant, with a due date of March 31. However, for the past two days, I have been experiencing chest pain when I breathe. This occurs even while I am sleeping, whether I am lying flat or on my side. If I take a deep breath, it becomes very p...

Dr. Dai Qihan reply Obstetrics and Gynecology
Your description is insufficient for a diagnosis; it is recommended to consult your regular obstetrician for advice.

Understanding Chest Pain and Rapid Heartbeat During Pregnancy

Hello, I would like to ask... I often feel my heart racing (my pulse is around 80-100 bpm). Sometimes I also experience shortness of breath and chest pain that radiates to my back. What could be the issue? I am currently pregnant and cannot undergo X-rays. How can I prevent this?...

Dr. Lin Liangyu reply Cardiology
Hello: During pregnancy, the workload on the heart increases significantly, often resulting in an elevated heart rate. Some heart conditions may indeed arise during pregnancy. If X-rays cannot be performed, a cardiac ultrasound can be considered. Cardiac ultrasound does not affec...

Managing Pregnancy Complications: Insights for Expecting Mothers

Currently at 34 weeks, this is my third pregnancy, and since mid-pregnancy, my abdomen has frequently been hard. My first child was born in 2000, with premature rupture of membranes leading to a five-hour labor; my second child had a bloody show, and the labor lasted three hours,...

Dr. Zhan Deqin reply Obstetrics and Gynecology
Breech presentation refers to a fetus positioned with the buttocks or feet down instead of the head. While breech births can occur vaginally, the risks are higher compared to cesarean delivery. In the case of transverse lie, a cesarean section is necessary. Intrauterine devices (...