Background: The occurrence of gastroesophageal reflux disease (GERD) has increased over the past two decades. It is imperative for physical therapists to perform medical screening to rule out gastrointestinal disease as a source of referred pain. This report is an example of esophageal disease contributing to shoulder pain that required a referral due to symptoms outside the scope of physical therapy practice.

Case Description: A 16-year-old female presented to therapy with a referral for a shoulder sprain. She had a history of esophageal cancer and GERD. Her shoulder ROM was normal, and she exhibited generalized strength deficits. She underwent five visits of therapy consisting of strengthening and proprioceptive training to improve stability.

Outcomes: At her 5th visit, she reported her pain increased in intensity, was constant, and worsened in supine at night. Palpation of the abdomen revealed tenderness in the medial left upper quadrant. Her symptoms demonstrated non-mechanical patterns; so, she was referred from physical therapy to her pediatrician. A gastroenterologist determined she had a hiatal hernia that was most likely referring pain to her shoulder.

Discussion: A major role of a physical therapist is to perform examination and triage to determine if a patient requires a referral to another healthcare professional. Therapists need to be cognizant of symptoms of gastrointestinal disease and perform medical screening procedures, such as system related screening questions and follow up physical examination techniques. Physical therapists should be aware of the link between GERD and hiatal hernia as a source of referred pain.

Keywords: Referred shoulder pain; GERD; Esophageal disease; Differential diagnosis