Left Shoulder Pain in Pregnancy: Causes and Treatment Options

Common Causes of Left Shoulder Pain in Pregnancy

Musculoskeletal pain is extremely common during pregnancy, with prevalence peaking in months 6 and 7 of gestation, according to Praxis Medical Insights 1
Pregnancy-related hormonal changes cause joint laxity and reduced ligament rigidity, weakening joint stability and increasing demand on stabilizing muscles 1
The European Heart Journal recommends considering cardiovascular issues during pregnancy, including acute coronary syndromes or aortic dissection, which may present with left shoulder pain 3, 4
Pulmonary embolism, which occurs more frequently during pregnancy, can sometimes present with referred shoulder pain, as reported by the European Heart Journal 5, 6

Evaluate for red flags that suggest serious pathology, such as severe pain with hemodynamic instability, associated symptoms like vaginal bleeding, abdominal pain, or syncope, and chest pain, shortness of breath, or palpitations, as suggested by Praxis Medical Insights and the European Heart Journal 2, 3, 5
Assessment of the painful shoulder should include evaluation of range of motion, strength, and tone, changes in length of soft tissues and alignment of joints in the shoulder girdle, and levels of pain and orthopedic changes in the shoulder, according to the International Journal of Stroke 7

Ultrasound is the primary imaging modality for evaluating abdominal and pelvic causes of referred shoulder pain during pregnancy, as recommended by the Journal of the American College of Radiology and Praxis Medical Insights 8, 2
MRI is recommended as the next step following ultrasound when additional imaging is needed for musculoskeletal causes, to avoid radiation exposure, according to the Journal of the American College of Radiology and Praxis Medical Insights 8, 2

Non-pharmacological approaches should be first-line treatment for musculoskeletal causes, including gentle stretching and mobilization techniques, active range of motion exercises, and rest and activity modification, as suggested by the International Journal of Stroke 7
Pharmacological management for musculoskeletal causes may include acetaminophen as a first-line medication, and NSAIDs like ibuprofen should be used with caution and only for short periods, particularly avoiding use in the third trimester, according to the International Journal of Stroke 7
Ectopic pregnancy with intraperitoneal bleeding requires immediate surgical intervention, as recommended by Praxis Medical Insights 2
Cardiovascular conditions like acute coronary syndrome during pregnancy require specialized care, including coronary angiography with the possibility of coronary intervention, and β-Blockers and low-dose acetylsalicylic acid are considered relatively safe during pregnancy, as reported by the European Heart Journal 4

For most women, pregnancy-related musculoskeletal pain resolves spontaneously after delivery, according to Praxis Medical Insights 1
Women at highest risk for persistent postpartum pain include those who had pain prior to pregnancy, experienced early onset of symptoms during pregnancy, or had higher pain severity during pregnancy, as reported by Praxis Medical Insights 1
Prevention of Complex Regional Pain Syndrome through active, active-assisted, or passive range of motion exercises is recommended, according to the International Journal of Stroke 7