Alcohol abuse with tremor and right shoulder pain; most likely organ involvement?

• A. Musculoskeletal
• B. Hepatic
• C. Hematological
• D. Psychological

Answer: (B)

Alcohol-related organ damage most often involves the liver. Tremor can come from alcohol withdrawal, and hepatic inflammation or enlargement can irritate the diaphragmatic peritoneum and the phrenic nerve, producing referred pain to the right shoulder. The liver sits under the right diaphragm, so liver disease from alcohol abuse is the most plausible cause linking both tremor and right shoulder pain. Other options don’t account for both signs together: musculoskeletal issues explain shoulder pain but not the tremor related to alcohol, hematologic problems don’t typically produce this shoulder pain pattern, and psychological factors don’t explain the physical symptoms.