Shoulder Pain During Pregnancy: Causes & How to Relieve Pain 2023

Your body goes through lots of changes in pregnancy. Pain and aches are commonly experienced during this period. Knowing if the pain is normal or something you should check up on would be helpful. Read more to learn the causes of shoulder pain during pregnancy and ways to relieve it.

You may experience left and/or right shoulder pain, shoulder blade pain, shoulder joint pain, and so on. Not every pain^[3] is a sign of a health problem.

Every shoulder pain in pregnancy is not probably a sign of severe disease. A lot of pregnant women experience discomfort and pain in their neck, back, abdomen, legs, and other body parts because the uterus has started to expand. 

First Trimester

The first trimester is when the pregnancy becomes invisible. Emotional and physical changes are part of your amazing journey to having your baby. You may feel fatigued and experience musculoskeletal problems because of the hormonal, vascular, and biomechanical changes that come with pregnancy.  

The hormone^[4] progesterone increases during pregnancy. Progesterone relaxes muscles and ligaments in favor of your body adapting to a growing uterus.

Another hormone called relaxin causes ligaments between pelvic muscles to relax so that the baby can pass through the birth canal smoothly.

These two hormones circulate throughout the body and cause loosened joints, creating discomfort and pain, especially in the back and pelvis. 

Second Trimester

In the second trimester^[5], you may feel your baby’s movements. Also, pregnancy becomes more physically comfortable since morning sickness, extreme tiredness, and breast tenderness ease a bit.

In the second trimester, your discomforts, blood pressure, urine tests, and growth of the fetus will be checked by your doctor. Because your baby is growing, the weight you’re carrying will increase, which may cause pains and aches.

Excessive or unbalanced weight can contribute to shoulder pain in the second trimester as well. The pain for this type of problem will originate in the lower back and spread outwards towards the shoulders. 

Sleeping on the left side may cause left shoulder pain, especially in the second and third trimesters.

Third Trimester

It is the final trimester until birth. Your baby’s growth fastens in the third trimester, and your baby will gain weight quickly.

Also, the hormone relaxin levels increase to relax the pelvic muscles’ ligaments, so your baby more easily passes through the birth canal. Thus your joints get looser because of increased hormones making you more susceptible to pain and aches. 

Serious Causes of Shoulder Pain in Pregnancy

Ectopic pregnancy 

Shoulder tip pain can be a sign^[6] of ectopic pregnancy. It is recommended to get urgent medical advice if you experience shoulder tip pain.

Growing ectopic pregnancy^[7] can cause serious symptoms such as severe pain in the abdomen or pelvis, shoulder pain, weakness, dizziness, or fainting. An ectopic pregnancy occurs if the fertilized egg grows in the fallopian tubes or other places outside of the uterus. Other symptoms of ectopic pregnancy:

• Abnormal vaginal bleeding
• Low back pain
• Pain in the abdomen or pelvis
• Cramping on the pelvis

Ectopic pregnancy may be life-threatening if it is left undiagnosed. Left unnoticed, it can cause rupture of the tubes, causing internal bleeding. Ectopic pregnancy can be treated with medication or surgery. 

HELLP Syndrome or Liver-Related Problems

Shoulder pain is “referred pain” because it is felt in body parts other than where the problem actually is. Shoulder pain radiates from the liver under the right ribs. You may experience a deep pinching feeling on your neck or along a bra strap. Abdominal and/or shoulder pain can be a sign of HELLP syndrome^[8].

If you feel pain in the described area, you should call for immediate medical attention. HELLP^[9] (Hemolysis, Elevated Liver enzymes, and Low Platelets) syndrome is a severe pregnancy complication considered a version of preeclampsia.

 In the U.S., 5-8% of pregnant women develop preeclampsia, and 15% of these women develop HELLP syndrome, which is equivalent to 45,000 women per year. Its symptoms can be mistaken for other conditions such as gastritis, gallbladder disease, acute hepatitis, and fatty liver disease.

 Some of the symptoms of HELLP syndrome include:

• Shoulder pain or pain when deeply breathing
• Abdominal or chest pain, including upper side pain
• Nausea and vomiting
• Bleeding
• Changes in vision
• Difficulty breathing 
• High blood pressure
• Protein in the urine 

In order to get diagnosed timely, you should have regular prenatal visits and inform your doctor if you have any family members diagnosed with HELLP syndrome, preeclampsia, or other hypertensive diseases.

Gallstones

Pain between shoulder blades during pregnancy may be a sign of gallstones. Pregnant women have increased risk factors for gallstones^[10] because of increased hormones and a slower rate of digestion. Gallstones are the second most common non-obstetric emergency affecting pregnant women.

Increased hormones^[11] may cause higher cholesterol levels and changes in the pattern of gallbladder emptying, thus resulting in gallstone formation.

By the third trimester, almost 8% of pregnant women form gallstones, but 7% of them don’t have symptoms. One in ten pregnant women who have symptoms develops complications. Some symptoms of gallstones:

• Pain in the shoulder region such as right shoulder pain or back pain between your shoulder blades^[12]
• Pain in the abdomen or the right upper area
• Ongoing vomiting
• Light-colored stools
• Dark urine 
• Yellowing of the skin and eyes

Pregnant women who have pain in the right upper area or center of the abdomen should avoid eating or drinking until the pain eases up. Your doctor can check gallstone formation by ultrasound which is safe during pregnancy.

If the symptoms do not resolve with pain medications, intravenous fluids, and dietary changes, your doctor may consider the removal of the gallbladder. Surgery can be done regardless of trimester if there is a serious condition.

How to Treat Shoulder Pain During Pregnancy

Daily and work life may get more challenging because of pregnancy’s discomforts and pains. Pains may be sudden and severe or chronic. You may feel the pain in your entire body or local area. If you experience pains while pregnant, you should report to your doctor. They will design a treatment plan^[13] to reveal your pains.

Treatments usually consist of gentle stretching and strengthening and joint mobilization exercises. Education is also an essential part of the treatment. Your physical therapist will teach you how to stand, walk and bend properly while pregnant. 

It is important to know what type of musculoskeletal pain you have. Musculoskeletal pains include pains in bones, joints, ligaments, muscles, and tendons. 

• Bone pain: Injuries may cause bone fractures resulting in bone pain 
• Joint pain: Hormonal changes during pregnancy, increased progesterone, estrogen, relaxin, and cortisol hormone levels^[14] relax the joints; thus, the movements may cause pain. Also, inflammation, swelling, and stiffness are often seen in joint pain. Generally, joint pains get worse with activity and get better with rest.
• Muscle pain: Muscle weakness, spasms, cramps, and injuries cause muscle pain
• Tendon and ligament pain: They connect joints and bones. Damage to tendons and ligaments can create discomfort and pain.

If your pain is not a sign of a serious health problem that comes naturally with pregnancy, there are things to do at home to prevent^[15], reveal or ease the common pain or aches; they may also be helpful to prevent shoulder pain  

• Having scheduled rests
• Using good posture
• Stretching regularly or as often as your doctor advises
• Doing strengthening exercises in a way your medical professional suggested
• Getting the prenatal nutrients you need- follow a healthy and balanced diet rich in anti-inflammatory foods
• Resting the area of pain
• Using ice and heat to decrease inflammation and swelling
• Massage therapy 
• Adjusting good sleeping posture 
• Using a pregnancy pillow may help

When to See a Doctor?

Pregnancy comes with lots of concern because you want the best for your little baby. That’s why it is good to be aware of the signs and symptoms that you’re experiencing. Pain and aches are commonly seen in pregnant women because your body changes with increased hormone levels and biomechanical changes. 

Don’t be overly concerned about every pain. However, it is best to let your doctor know about your discomforts and pain to make sure there is nothing serious.   

Every shoulder pain in pregnancy is not probably a sign of severe disease. However, you should always reach out to a healthcare provider if you experience unusual pain. The American Pregnancy Association (APA)^[2] recommends contacting your doctor if you experience shoulder pain. 

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