Abstract

Background: Referred shoulder pain is a well-recognized clinical symptom that may originate from thoracic, abdominal, diaphragmatic, or musculoskeletal pathology. In elderly patients with underlying spinal disease, atypical presentations can create diagnostic uncertainty and delay definitive management. Pleural-based lesions associated with pleural irritation may occasionally manifest predominantly as shoulder pain due to diaphragmatic and phrenic nerve involvement. Distinguishing infectious or inflammatory aetiologies from malignancy is especially important in such cases.

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