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Identifying Non-Musculoskeletal Shoulder Pain

Shoulder Pain Isn’t Always Musculoskeletal: Red Flags, Referral Clues, and Quick Screening Questions In this PT Snacks episode, we walk through how to tell when “shoulder pain” might not actually be coming from the shoulder—and why that matters for safe, intentional screening in the clinic. We compare classic musculoskeletal patterns (pain tied to motion/loading and reproducible on exam) versus non-mechanical presentations like constant, poorly localized, deep/pressure-like pain that doesn’t change with movement and may come with systemic or autonomic symptoms. We cover common non-musculoskeletal sources that can refer to the shoulder—pulmonary/thoracic, cardiovascular, gastrointestinal/hepatic, and malignancy/systemic disease—plus practical questions and quick vitals-based triage you can blend into a normal eval. We also outline situations that warrant urgent or emergent referral, emphasizing the PT’s role in recognizing what we shouldn’t treat and helping patients get to the right provider quickly. 00:00 Welcome to PT Snacks 00:15 Why Non MSK Matters 01:52 MSK vs Non MSK Clues 03:56 Pulmonary Referral Patterns 04:54 Cardiac Red Flags 05:51 GI and Hepatic Sources 06:34 Cancer and Systemic Causes 07:27 Triage Questions and Screen 09:12 When to Refer Urgently 10:32 Wrap Up and Resources