Where is shoulder tip

Ectopic Pregnancy Signs And Symptoms

Medically Reviewed by:Jackie Ross BSc MB.BS MRCOG

Last Reviewed:01/06/2021

Next review date:01/06/2024

Written by: The Ectopic Pregnancy Trust

Ectopic pregnancy is a common, occasionally life-threatening, condition that affects around 1 in 80 pregnancies. This page provides detailed general information on potential ectopic pregnancy symptoms and, if a person is experiencing any or all of these signs, they should seek medical attention. Please remember that online medical information is no substitute for expert medical care from your own healthcare professional team.

Lower tummy/abdominal pain and/or bleeding during pregnancy may be due to a number of causes. It is however very important that an ectopic pregnancy as the cause is excluded. If not diagnosed and treated quickly an ectopic pregnancy can lead to internal bleeding and a medical emergency.
Some experience symptoms that are similar to other conditions such as gastroenteritis (tummy bug), urinary tract infection (UTI), pelvic inflammatory disease (PID) and miscarriage, which are the most common ways to misdiagnose an ectopic pregnancy. Not all experience symptoms.
When ectopic pregnancy symptoms start
The diagnosis of ectopic pregnancy may sometimes be difficult, and symptoms may occur from as early as 4 weeks pregnant and up to 12 weeks or even later. In addition, although there are a number of recognised risk factors, in over 50% of women diagnosed with an ectopic pregnancy, there are no identifiable risk factors. See the reasons for an ectopic pregnancy page for more information.
If your instincts are screaming at you that something does not feel right, it is OK to trust them and ask for reassessment at any time. Please do be vigilant and take any pain that concerns you seriously until absolutely proven otherwise.
If you are experiencing any of the following ectopic pregnancy symptoms, please contact your doctor/GP or your local Early Pregnancy Unit. You can also call the NHS Direct 111 service by dialling 111 or access the NHS GP at Hand service. You can contact your out-of-hours doctor/GP service if your normal surgery is closed or go to your local Accident and Emergency department (A&E) or Urgent Care Centre.
You can also view all the options for gaining professional help here.

Detailed general information can be found here on our website. Please remember that online medical information is no substitute for expert medical care from your own healthcare team.

A missed or late period

If you have missed one or more periods, the most likely reason is that you have become pregnant, and it is progressing as it should. However, if you experience typical pregnancy symptoms, such as nausea, painful breasts or a swollen abdomen but no bleeding or pain, this does not completely rule out an ectopic pregnancy, although this is rare. A true period should be normal flow and duration for you. A light period may be abnormal bleeding in pregnancy and should be investigated with a pregnancy test.

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Vaginal bleeding

Ongoing bleeding that is sometimes red or brown/black and watery (like “prune juice”) should be investigated. The bleeding may be heavier or lighter than usual. Prolonged off/on light and sometimes heavy bleeding are quite often seen in ectopic pregnancy and should always prompt a pregnancy test and if positive should be urgently investigated with an Early Pregnancy Unit (EPU) referral.

When seeking medical attention, you will be asked for your last menstrual period which should be your last episode of a normal flow and duration bleeding. It is important that abnormal bleeding does not get confused with a normal period as healthcare professionals may think you are much less pregnant than you are.

Find your nearest EPU

Pregnancy test

Pregnancy test kits that are available now are very sensitive. They can be positive before you have missed your period. It is sensible to perform the test in the morning when urine contains the most pregnancy hormone (Human Chorionic Gonadotropin or hCG). Very rarely a pregnancy test can give a falsely negative result. This is usually because the hormone level is low. If you do a pregnancy test and are surprised by a negative result, repeat the test perhaps with a different pregnancy test kit. If it is still negative and you still think you are pregnant, your doctor can do a blood test to measure the hCG (pregnancy hormone) levels accurately.

If you are in pain and/or bleeding and your home pregnancy test is negative, but you think it should be positive, ensure you are seen by a doctor urgently by attending your local Accident & Emergency department or by contacting your specialist Early Pregnancy Unit.

The blood test that doctors would perform is for hCG which is a hormone produced in pregnancy. HCG is commonly detected in urine by using a urinary pregnancy test, which can show as positive or negative. Blood tests can identify the exact hCG level in the blood. Your GP can do this test, but it will take a few days to get the result, while the hospital and EPU will have the result in a few hours. This is why, if you have symptoms and a surprisingly negative urine pregnancy test, it is better to be seen at the hospital.

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Abdominal pain

During pregnancy, it is not uncommon to experience a period-like ache in your lower tummy and back. However, the following should be investigated:

One-sided pain in your tummy which may be persistent (which means it continues) or intermittent (which means it comes and goes). The pain may have begun suddenly or been gradual.
Discomfort with bloating and a feeling of fullness (not associated with eating) when lying down, particularly if you have already had a child.
Significant lower abdominal and/or back pain.

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Shoulder tip pain

Shoulder tip pain is exactly where it says – not the neck or the back but the tip of your shoulder. If you look to the left over your shoulder and then cast your eyes down, the tip of your shoulder is where your shoulder ends and your arm starts. Shoulder tip pain is very distinctive. You know when you have it because it is a very weird pain you have probably never experienced before. The pain may have begun suddenly.

Shoulders cause pain when we are stressed because we hold ourselves more rigidly and muscles in the back and neck go in to spasm or you may have slept in an awkward position – this is most likely not shoulder tip pain related to an ectopic pregnancy.

Shoulder tip pain tends to develop with other symptoms such as feeling unwell, abdominal pain or vaginal bleeding, faintness, abdominal bloating and fullness, or pain when opening your bowels (poo).

It is caused by internal bleeding irritating the diaphragm (the muscle in your chest which helps you to breathe) when you breathe in and out.

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Bladder or bowel problems

Diarrhoea
Pain when you have your bowels open (go for a poo)
Pain when you pass water (have a wee)
Shooting/sharp vaginal pain

Some pain and a change in your normal bladder and bowel pattern are features of a typical pregnancy for some. All the same, if you present at your doctor/GP or Early Pregnancy Unit with such symptoms, it would be reasonable to have an early pregnancy assessment.

Find your nearest EPU

Collapse

Feeling light-headed, or faint, or actually fainting
Often accompanied by sickness and looking pale
Increasing or slowing pulse rate or falling blood pressure may also be present

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Get help immediately

If you are experiencing these signs of an ectopic pregnancy, with or without tip of the shoulder pain present, please seek medical emergency attention urgently. This may be by calling an ambulance.

What does ectopic pregnancy pain feel like?
Ectopic pregnancy pain can be on one side of the tummy, or lower abdomen, or in the pelvic area. Experiencing these pains during early pregnancy may mean that you could be experiencing ectopic pregnancy. Consult an emergency healthcare professional immediately.

What are the chances of a woman or pregnant person having an ectopic pregnancy?
The risk of ectopic pregnancy is not uncommon – around 1 in 80 pregnancies are ectopic. This is when the fertilised egg implants itself outside of the womb, most commonly in a Fallopian tube, but other sites can be on an ovary, within a Caesarean section scar, or in the cervix.

Deciding whether your symptoms are getting worse
It can be difficult to know which symptoms are concerning. Are they symptoms of an ectopic pregnancy or normal pregnancy sensations? If you are at worried, you should seek medical advice. Contact your doctor/GP or local Early Pregnancy Unit for advice. Your GP will likely refer you to your local Early Pregnancy Unit for an assessment by a healthcare professional. This may involve a blood test to check hormone levels and/or an ultrasound scan depending on how many weeks pregnant you are and your symptoms.
It is important to remember that normal pregnancy symptoms are common and that not everyone experiencing such symptoms will have an ectopic pregnancy. It could still be a viable, healthy pregnancy. However, it is important to be vigilant. If in doubt, seek medical attention and advice from healthcare professionals.

Ectopic Pregnancy Symptoms Checker

What do you need to do if you think you have an ectopic pregnancy?

If you are experiencing any of the following ectopic pregnancy symptoms, please contact your doctor/GP or your local Early Pregnancy Unit immediately.

Other pages you might find helpful

Diagnosis

Learn more about the diagnosis of an ectopic pregnancy

Gold Standard Statement

Learn about the Gold Standard for Care

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Ectopic pregnancy - Symptoms - NHS

Symptoms of an ectopic pregnancy usually develop between the 4th and 12th weeks of pregnancy.

Some women don't have any symptoms at first. They may not find out they have an ectopic pregnancy until an early scan shows the problem or they develop more serious symptoms later on.

Main symptoms

You may have an ectopic pregnancy if you miss a period, have a positive pregnancy test, and have other signs of pregnancy.

Contact your GP or call NHS 111 if you have a combination of any of these symptoms and you think you might be pregnant – even if you haven't had a positive pregnancy test.

Vaginal bleeding

Vaginal bleeding tends to be a bit different to your regular period. It often starts and stops, and may be watery and dark brown in colour.

Some women mistake this bleeding for a regular period and don't realise they're pregnant.

Vaginal bleeding during pregnancy is relatively common and isn't necessarily a sign of a serious problem, but you should seek medical advice if you experience it.

Tummy pain

You may experience tummy pain, typically low down on one side. It can develop suddenly or gradually, and may be persistent or come and go.

Tummy pain can have lots of causes, including stomach bugs and trapped wind, so it doesn't necessarily mean you have an ectopic pregnancy.

But you should get medical advice if you have it and think you might be pregnant.

Shoulder tip pain

Shoulder tip pain is an unusual pain felt where your shoulder ends and your arm begins.

It's not known exactly why it occurs, but it can be a sign of an ectopic pregnancy causing some internal bleeding, so you should get medical advice right away if you experience it.

Discomfort when going to the toilet

You may experience pain when going for a pee or poo. You may also have diarrhoea.

Some changes to your normal bladder and bowel patterns are normal during pregnancy, and these symptoms can be caused by urinary tract infections and stomach bugs.

But it's still a good idea to seek medical advice if you experience these symptoms and think you might be pregnant.

Symptoms of a rupture

In a few cases, an ectopic pregnancy can grow large enough to split open the fallopian tube. This is known as a rupture.

Ruptures are very serious, and surgery to repair the fallopian tube needs to be carried out as soon as possible.

Signs of a rupture include a combination of:

a sharp, sudden and intense pain in your tummy
feeling very dizzy or fainting
feeling sick

Call 999 for an ambulance or go to your nearest accident and emergency (A&E) department immediately if you experience these symptoms.

Page last reviewed: 23 August 2022
Next review due: 23 August 2025

Pain in the shoulder joint. Diagnostics. Treatment.

Prolonged pain in the shoulder significantly spoils the quality of your life, besides, if not treated in time, it threatens the health of the shoulder in the future, so you need to seek the help of an experienced orthopedic traumatologist in order to identify and eliminate the cause of pain in time.

Causes of pain in the shoulder joint and methods of its treatment are explained by traumatologist-orthopedist Medicīnas centrs ARS Dr. Janis DOBELNIEKS.

Worried shoulder

The shoulder is a complex biomechanism. The shoulder joint is the only joint in the human body that performs full rotation due to its anatomical structures. As soon as something is broken in this mechanism, even due to a minor injury, the shoulder does not work normally. If it was not a serious injury, then it is difficult to immediately determine the causes of pain, but pain always has a provoking factor that can cause long-term pain and complications in the future.

Don't adapt to pain

Unfortunately, often the pain does not decrease, it becomes more pronounced and makes it difficult to sleep at night. Many people try to adapt to the situation, and if because of pain they cannot raise their arm, they simply try not to do it. Because of this, the shoulder becomes tighter, over time, extensive joint damage and other problems develop, which can result in shoulder joint prosthetics and disability. Self-medication with pain medications, ointments and compresses can reduce inflammation and pain, but it is not possible to eliminate the anatomical damage to the structure. If the shoulder hurts for a long time and does not go away, then you need to go to the doctor. It is important to understand that when treating shoulder pain, time is of the essence.

If your shoulder suddenly starts to hurt, you should start waiting, reduce the load and let the shoulder rest. If the pain does not go away within two weeks and intensifies, this is a signal that the shoulder is seriously damaged.
In order not to waste time on unnecessary examinations , it is recommended to visit an orthopedic traumatologist for a detailed examination of the shoulder-joint and the start of qualified and professional treatment.

Why does my shoulder hurt?

First you need to find out what exactly causes shoulder pain. Often the cause of the pain is not found in the shoulder joint itself, but in the cervical spine, where the intervertebral discs, pinching the nerve roots, cause pain in the shoulder. It spreads along the nerve, through the entire arm to the fingertips. If there is a feeling of numbness and the pain does not depend on the load, then it is recommended to consult a neurologist.

If the cause of pain in the shoulder joint itself is caused by damage to the anatomical structures or inflammation , then it never extends below the middle third of the forearm. The painful area can be covered with the palm of your hand. One of the common causes of pain in the shoulder is partial damage to the tendon of the long head of the biceps - rupture , which often occurs in athletes and physically active people. The tendon can be damaged or torn for no particular reason, as over time it wears out and loses elasticity. This damage is characterized by pain when performing certain movements, even without the application of force. Sports activities are often limited - volleyball, swimming, golf. The second most common cause of shoulder pain is damage to rotator cuffs . The rotator cuff is a combination of many muscle tendons that provide mobility to the arm at the shoulder. When it is damaged, the main complaint is pain, which is expressed not only with the load of the arm, but also at night. The tendon can be completely torn from the bone or partially torn, the function of the hand seems to be preserved, but there are certain movements that cannot be performed. The cause can be either trauma or gradual damage to the tendon. Without moving the arm, the pain gradually decreases, but by resuming movement, the shoulder may again hurt. The third most common cause of shoulder pain is deformity at the junction of the clavicle and scapula . Often there are processes on the bone - osteophytes, which put pressure on the muscles, creating inflammation in the surrounding tissues and pain.

In half a year it may be too late . At the very beginning, the damaged tendon can be sutured, and the hand can fully work. Dragging time only causes harm - after 6 months, scar, fatty tissues grow into the muscle and cause muscle atrophy. These are irreversible changes that cannot be removed during surgery, as the tendon can no longer be pulled back to where it was previously attached. A year later, it is almost impossible to perform a qualified operation with a predictable restoration of hand function.

Feeling of instability in the arm is usually the result of various injuries that are caused by incorrectly executed, rapid movement, falling, etc. Not only during sports activity, but also in everyday life, there may be a feeling that the shoulder, as it were, jumps out of its place and hurts. Around the flat surface of the joint there is a cartilaginous lip, like the edge of a plate. If the “plate has one edge broken off”, then the head of the shoulder has a tendency to slip out and create pain. This is called a bankart injury, which often combines with a shoulder tendon injury, causing shoulder instability, pain, limited mobility, day-to-day movement anxiety, etc. An operation is required to preserve the quality of life, otherwise the consequences can be very serious. The more often the head of the shoulder is displaced from its place, the more the joint capsule is damaged, the stronger the pain, the more limited the mobility. Over time, arthrosis and irreversible damage to the cartilage develops, when a conventional operation will no longer help, since it is necessary to restore bone structures.

Diagnostics of the shoulder joint

Radiologist-diagnostician, Associate Professor, Dr. med. MAJA RADZIņA

Various methods can be used to examine the shoulder joint. The most informative for determining traumatic bone injury is radiography. To determine soft tissue injury, the first and foremost method is ultrasonography (ultrasound) - this is the only method that allows you to examine the shoulder joint in motion to make sure that the tendon is not damaged after the injury, or that the limitation of mobility is caused by swelling of the soft tissues or damage to them. The quality of ultrasound depends on both the specialist and the ultrasound machine itself. For the patient, this is a quick, affordable and acceptable examination.

If ultrasound detects damage to, for example, some element of the rotator cuff, then magnetic resonance imaging (MRI) of the joint should be performed to assess damage to deeply located tendons and cartilage. MRI shows an anatomical image of the shoulder joint, the exact distance to a specific structure. This helps the orthopedic traumatologist accurately plan the course and scope of the operation and perform the treatment better. The sooner you visit a doctor, the easier it is to diagnose the problem, the lower the risk of complications in the future.

Arthroscopic surgery

Most often, the shoulder joint is operated on arthroscopically. 3-6 small incisions 4-5 mm long are made. Through them, a miniature camera is inserted into the shoulder joint, which is connected to a computer, and tools that can be used to assess and eliminate all damage to the joint, restore damaged ligaments and muscle tendons, clean hardened tissues and salt deposits in one go. The traumatologist monitors the progress of the operation on the monitor screen with multiple magnification. This method has significant advantages: it is less traumatic and gentle, the incision sites heal quickly. New technologies make it possible to qualitatively and accurately assess the condition of the joint, even in places where this is not possible when performing a conventional surgical operation. The operation lasts up to 1. 5 hours - it depends on the volume and complexity of the damage. It is performed on an outpatient basis at the ARS Day Hospital under general anesthesia. The next morning the patient can return home. The hand is freely suspended in a kerchief bandage, which protects against accidental movements.

Gentle rehabilitation

To keep the shoulder in a state of rest, it takes 4-6 weeks to wear an arm bandage. Then, under the supervision of a physiotherapist, therapeutic exercises begin. Rehabilitation lasts about 3 months, pain after surgery can last up to 3-4 months. It will take 5-6 months to fully restore the shape. The hand during this period should be especially protected. It is better to keep your hand for 2 months than not to move your whole life.

Medicinas centrs ARS
Skolas iela 5, Riga
Tel. (+371) 67 201 007
www.ars-med.lv

Shoulder pain | Handbook CLRC

Neurological diseases at the initial stage can pass without pronounced signs, but in the advanced stage they can cause irreparable consequences.

Severe pain in the shoulder joint may indicate a pinched shoulder nerve, so you should definitely visit a doctor. If you start a problem or delay a visit to a neurologist, it can develop into vertebrobasilar insufficiency.

Therefore, at the first pain in the shoulder area, contact the specialists of the Kuntsevo Center. Its diagnostic base allows you to quickly perform an MRI of the shoulder, ultrasound or electroneuromyography, based on the results of which the doctor will select the optimal treatment for the disease.

In addition, by contacting a rehabilitation center, you will save your precious time: here you can undergo diagnostic procedures, get medical advice, and get qualified recommendations for recovery.

Dozens of patients have already seen the individual and effective approach of the treating staff in solving the problem of shoulder pain.

Types and classification

Pain can occur not only due to nerve neuralgia, but also due to problems in other organs, which should be taken into account. If the joint is not dislocated and retains its anatomical capabilities, then this indicates problems with the nerve joint.

Pain by severity

A person can feel pain of different intensity:

Aching (also called somatic) - rarely appear, it is difficult to establish the exact localization, it can last for days. Most often occurs in the bones and joints, giving a person a lot of inconvenience and discomfort.
Acute - occurs suddenly and with high intensity, can just as quickly pass. It is the first sign that neuralgia of the brachial nerve is developing.
Chronic - constant inflammation of the tendons and joints are the cause of the formation of chronic pain.

Pain according to the mechanism of occurrence

Evidence of problems with the cervical vertebrae is pain that is felt from the shoulder to the fingertips. In some patients, the hand may become numb for a while.

Raising the arm and feeling discomfort at the same time can indicate a problem in a person with supraspinal tendons.

There is another type of pain in the shoulder - biceps hurts when doing loads or physical exercises. This means a problem in the forearm.

Causes

Neuralgia of the shoulder joint most often develops due to excessive physical exertion on the hands and hypothermia of the joint.

Often there are situations when a left-hander lifts a heavy load with his right hand, which can cause a pinched nerve in the left hand (on the main working muscle group).

According to neurologists, the right shoulder joint is most often subject to pinching.

It is worth paying attention to the fact that there are factors that affect the acceleration of the development of neurological problems in humans. Among them:

Constant stressful situations are another aggravating factor, since they provoke the development of psychosomatic processes in the body.

Which doctor treats

If pain occurs in the crying joint, we recommend that you immediately contact a neurologist or rheumatologist. A traumatologist and orthopedist can also deal with such requests from patients.

Specialists will perform diagnostic procedures, including:

MRI,
radiography,
CT.

Additionally, patients can be prescribed an ECG and a blood test so that the doctor has a complete picture of the person's health and can consult with doctors of other specializations.

IMPORTANT! Shoulder pain can indicate both neurological problems and injuries of the shoulder joint. In any case, the symptom cannot be ignored, because the consequences of a neglectful attitude can lead to the development of a serious illness.

Therefore, if you have shoulder pain, make an appointment with our specialist - a neurologist, traumatologist or rheumatologist, who will determine the essence of the problem and prescribe the necessary treatment for you. A consultation with a highly qualified doctor at the Kuntsevo Medical and Rehabilitation Center will help you get rid of shoulder pain and restore your former high quality of life!

Make an appointment

Methods of treatment

For the treatment of neuralgia of the shoulder joint, patients are prescribed anti-inflammatory and warming ointments (for example, Finalgon). Be sure to enhance the positive effects of ointments should be taken and strengthening vitamins of group B.

General physiotherapy is not superfluous. For these purposes, a person can be prescribed electrophoresis and ultrasonic exposure, which allow you to remove swelling of the tissues.

Exercise therapy, massaging, and acupuncture are other proven options for treating a pinched shoulder. In extremely severe cases, the patient may be offered a fixation bandage, which completely eliminates the mobility of the arm.

Please note that the treatment is only successful in the initial and moderate severity. Chronic problems with the shoulder joint are not treatable and the patient can only eliminate and minimize pain syndromes.

Rehabilitation and recovery

Physiotherapy exercises are carried out in quality rehabilitation activities. It allows you to restore damaged muscle tissue, reduce pain or completely get rid of them when the shoulder joint is pinched.

Patients should only engage in therapeutic exercises under medical supervision in order to achieve the desired result.

It is worth noting that the recovery will be positive only with the right combination of exercise therapy, medications and the implementation of all the recommendations of the attending physician!

Lifestyle

Patients with neuralgia of the shoulder joint must necessarily lead an active lifestyle, which allows to activate metabolic processes in the body. Eat only natural and healthy foods.

Try to give up bad habits and spend more time outdoors. Stressful situations should be kept to a minimum! This will generally strengthen the immune system and get rid of pain in the shoulder.

You can make an appointment with a neurologist for a fee in one of the following ways: