A sore shoulder during pregnancy may come from muscles, tendons, an injury or your neck. Sometimes pain felt in the shoulder comes from elsewhere in the body. The first step is to check whether you need urgent care before trying stretches or pain relief.
New, unexplained shoulder-tip pain in early pregnancy needs urgent medical assessment, even if you have no vaginal bleeding. Go to the nearest emergency department, especially if you also have abdominal or pelvic pain, dizziness or faintness. These can be signs of an ectopic pregnancy with internal bleeding.
Call 000 for collapse, severe pain, heavy bleeding, chest pain or sudden significant difficulty breathing. Do not drive yourself if you feel faint or seriously unwell.
What is shoulder-tip pain?
The shoulder tip is around the outer top of the shoulder, where the shoulder meets the arm. In an ectopic pregnancy, blood inside the abdomen can irritate the diaphragm and cause pain that is felt at the shoulder rather than at its source. This is called referred pain.
You cannot rule out an ectopic pregnancy by pressing on the shoulder, moving your arm or deciding that you slept awkwardly. You may not have all the usual warning symptoms. If pregnancy is possible, tell the clinician even if you have not had a positive test.
Our ectopic pregnancy guide has more information, but do not delay assessment to read it if you have symptoms now.
When else should I get urgent help?
Contact your maternity team immediately or go to hospital if shoulder pain occurs with:
- Pain high in the abdomen or under the ribs, a severe headache, vision changes or sudden swelling of your face or hands. Particularly after 20 weeks, these can be signs of pre-eclampsia.
- Fever, feeling very unwell, persistent vomiting or yellowing of the skin or eyes.
- A fall or injury, especially if you cannot use the arm, the shoulder looks out of shape or there is sudden swelling.
New weakness, numbness, a hot or swollen joint, or pain that is worsening or present at rest also needs prompt medical advice. You do not need to wait a set number of days before asking for help.
At any pregnancy stage, reduced or concerningly changed baby movements need immediate maternity advice, regardless of what you think is causing your shoulder pain.
Could it be a muscle or joint problem?
Yes. Shoulder pain may be related to lifting, repetitive work, a strain, tendons around the joint or pain coming from the neck. It can feel worse during particular movements or when lying on the sore side.
These patterns can help a clinician assess you, but they are not a reliable home test to exclude more serious causes. Pregnancy should not be used as a blanket explanation for new pain, and a particular hormone level cannot be diagnosed from how your shoulder feels.
If the pain is mild, has an obvious activity-related trigger and you otherwise feel well, ask your GP or physiotherapist for advice if it persists, recurs, affects sleep or limits what you can do. Seek help sooner if you are unsure.
Can gallbladder problems cause shoulder pain?
Gallbladder pain can sometimes be felt in the upper abdomen, back or right shoulder. It may come with nausea or vomiting. Shoulder pain alone cannot establish that diagnosis, and avoiding particular foods will not rule out a serious problem.
Persistent or severe upper abdominal pain, especially with fever or jaundice, needs urgent assessment. In pregnancy, clinicians may also need to check for pregnancy-specific conditions such as pre-eclampsia rather than assuming the pain is digestive.
What might an assessment involve?
Your clinician will ask about your pregnancy stage, exactly where the pain is, how it started and what makes it worse. Mention bleeding, abdominal pain, headaches, vision symptoms, fever, breathlessness, injury and any medicines you have used.
They may examine your shoulder and neck and check your blood pressure and other observations. Depending on the concern, blood or urine tests and an ultrasound or other imaging may be needed. Ask what a proposed test is looking for and how the benefits and risks apply during pregnancy.
If an early pregnancy scan cannot yet establish the pregnancy’s location, make sure you understand the follow-up and emergency return plan. A booked repeat scan is not a reason to wait through worsening symptoms.
What can help an assessed muscle strain?
Once your clinician is satisfied that the pain is musculoskeletal, a simple plan may include changing aggravating tasks, brief breaks and physiotherapy. Ask which movements are suitable rather than forcing stretches through pain.
Supporting your arm with a pillow or changing your work setup may make rest easier. A wrapped cool pack may help after a strain; protect your skin and stop if it causes discomfort. Avoid prolonged complete rest unless advised, and ask how to return gradually to usual activities.
From 28 weeks, start sleep on either side. If one shoulder is sore, try the other side and adjust pillows for comfort. You do not need to force yourself onto the left side. If you wake on your back, simply return to a side before settling again.
Check medicines before using them
Ask a doctor or pharmacist which pain relief is suitable for your pregnancy and your health. Anti-inflammatory gels and sprays are medicines too; being applied to the skin does not automatically make a product appropriate.
Do not start ibuprofen, diclofenac or other anti-inflammatory treatment without advice. If you have been prescribed a medicine, including low-dose aspirin for a pregnancy indication, do not stop it because of general advice online. Check with your prescriber.
For overlapping lower pain, our pelvic pain guide explains the early-pregnancy assessment pathway. If you are unsure whether your symptoms are urgent, contact your maternity team rather than waiting for them to become severe.
Sources and further reading
- Healthdirect: Ectopic pregnancy
- Healthdirect: Warning signs during pregnancy
- Healthdirect: Shoulder pain
- Healthdirect: Gallstones
- Healthdirect: Medicines during pregnancy
- Safer Baby: Sleep on your side
This is general information for Australian readers. It cannot distinguish a shoulder strain from referred pain in your individual situation.