A 52-year-old male presents to the emergency department complaining of persistent severe right upper quadrant pain for the past 2 hours. During that period of time he felt nauseated, was sweating profusely, and also experienced pain in the posterior aspect of his right shoulder. The pain began shortly after a lunch consisting of "fast food." Ultrasound examination reveals multiple stones in an inflamed gallbladder with a normal bile duct. Which of the following spinal nerve segments are involved in the shoulder pain, associated with cholecystitis?
Referred pain from cholecystitis is generally referred to the region of the inferior angle of the right scapula. These fibers are generally from T5 to T9. These sensory fibers for pain are stimulated by the gallbladder inflammation because of the proximity of the adjacent structures. C3 to C5 sensory fibers innervate the shoulder area. The distribution of C5 to C8 is primarily to the upper limb, to the level of the hand; T1 to T4 distribution is to the upper thoracic wall and medial upper arm; T10 and T11 distribution is to the thoracic and abdominal wall, T1 to T4 visceral fibers for pain are generally associated with referred pain from the heart.
C3 to C5
C5 to C8
T1 to T4
T5 to T9
Abdomen & Pelvis