Shoulder and Thoracic Pain From the Heart, Spleen, Lungs and Gut

Left shoulder pain that does not fit a musculoskeletal pattern may come from the heart, pancreas or spleen. Cardiac pain can include anterior throat, neck and clavicular pain, more often in women, and is linked to exercise, breathlessness and cardiovascular risk factors. The spleen is associated with leukemia and lymphoma; signs include fatigue, recurrent infections, early fullness and easy bruising, illustrated by a tennis player whose lymphoma was found after abdominal palpation. A Pancoast tumor at the lung apex can cause C8 and T1 symptoms, weakness and Horner's syndrome. Mid thoracic pain is common because the stomach, pancreas and esophagus receive innervation from that region. The speaker lists questions about appetite, eating, belching, bloating, nausea, dysphagia and weight loss, and describes an older patient whose thoracic pain turned out to be stomach cancer. Pancreatic disease is linked to diabetes, alcohol and gallstones, and esophageal irritation can bring reflux and a persistent dry cough.