The shoulder blade, or scapula, is a triangular bone in the mid-back. Causes of shoulder blade pain range from common problems such as neck strains and muscle disorders to rare, more serious causes involving the lungs or heart. So what causes scapular pain, and when do you need to see a doctor?
Anatomy of the shoulder blade
The scapula forms the socket of the shoulder joint, with the head of the upper arm bone forming the ball. It also attaches to the collarbone. Various ligaments and muscles connect the scapula to the arm, so arm movement moves the scapula too, keeping the ball-and-socket joint aligned.
When shoulder blade pain needs urgent attention
Most scapular pain is mild and musculoskeletal in origin. But because the scapula can be a site of referred pain from the chest and abdomen, a few warning signs matter.
Seek emergency help if shoulder blade pain comes with chest tightness or pressure, breathlessness, sweating, or nausea (possible heart or lung causes) — call 999. Also see a doctor promptly for shoulder blade pain with a persistent cough, coughing up blood, unexplained weight loss, or severe upper-abdominal pain. These are uncommon, but important. Musculoskeletal scapular pain, by contrast, is usually reproduced by moving the neck, shoulder, or arm.
Common causes of shoulder blade pain
Referred pain from the neck or shoulder
The commonest cause of scapular pain is referral from the neck or shoulder. Inflammation of the discs or facet joints in the lower neck often refers to the inner shoulder blade, near the upper rhomboid muscles. Problems at the back of the shoulder — rotator cuff tendonitis or frozen shoulder — can refer to the outer scapula. Referred pain also causes the surrounding muscles to spasm, intensifying the pain. It’s diagnosed by examining the neck and shoulder, where moving or pressing on the inflamed area reproduces the shoulder blade pain.
Local muscle strain
Overusing the arm and shoulder — a new gym programme, or excessive sport — can strain the muscles around the scapula. Commonly strained muscles include the rhomboids (attaching to the inner blade), latissimus dorsi (the bottom), and teres minor and major (the outer blade).
Snapping scapula and other bone causes
The scapula is rarely affected by disease itself. A fracture from a fall is extremely rare. Snapping scapula syndrome causes the inner blade to snap or crack, and many people with it also have shoulder pain and instability.
Less common causes of shoulder blade pain
Chest wall pain
The chest wall connects the ribs to the spine and breastbone. Injury — from trauma or explosive sporting movements — to the structures at the back of the chest wall (the muscles, ribs, and joints to the spine) can refer pain to the scapula.
Dorsal scapular nerve entrapment
The dorsal scapular nerve runs between the muscles inside the shoulder blade. Traction from heavy lifting or repetitive overhead activity can cause sharp, shooting pain in the scapula. It’s worth considering once the commoner causes have been excluded.
Referred pain from the chest and abdomen
Problems elsewhere can be felt in the scapula. Abdominal conditions such as heartburn, peptic ulcers, and gallbladder or liver disease often cause right-sided scapular pain, while pancreatic disease can cause left-sided pain. Rare lung conditions, such as a pulmonary embolism or a Pancoast tumour, can affect the shoulder blade, and heart conditions such as angina or a heart attack can be felt there too. These are the causes behind the warning signs above.
Simple self-help for scapular pain
For most (musculoskeletal) causes of shoulder blade pain, these simple measures help:
- Stretching and conditioning — shoulder and chest-wall stretches and strengthening exercises, plus aerobic exercise such as swimming or cycling; a physiotherapist can supervise a programme
- Heat packs — on the shoulder blade, to increase blood flow and relax the muscles
- Ibuprofen and other anti-inflammatories, for pain (mind the side effects)
- Massage — from a therapist, or self-massage with a foam roller or massage ball on the tender spots
- Acupuncture — which can relax the tight muscles around the shoulder blade
If these don’t help, see a Sport and Exercise Medicine doctor for a diagnosis.
Frequently asked questions about shoulder blade pain.
What is the most common cause of shoulder blade pain?
Referred pain from the neck or shoulder is the commonest — inflammation in the lower neck or the back of the shoulder is felt over the shoulder blade, often with muscle spasm. Local muscle strain from overuse is another frequent, benign cause.
When should I worry about shoulder blade pain?
Seek emergency help if it is accompanied by chest tightness, breathlessness, sweating, or nausea. See a doctor promptly for scapular pain with a persistent cough, coughing up blood, unexplained weight loss, or severe abdominal pain. Otherwise, see a doctor if the pain follows an injury, comes with nerve symptoms, or doesn’t settle within a few weeks.
Can shoulder blade pain come from the heart or lungs?
Rarely, yes. Heart conditions (such as angina or a heart attack) and lung conditions (such as a pulmonary embolism or a Pancoast tumour) can be felt in the shoulder blade — which is why the warning signs matter. The great majority of scapular pain, though, is musculoskeletal.
Why does the pain sit between my shoulder blade and spine?
Pain over the inner shoulder blade, near the spine, is classically referred from the lower neck (the discs or facet joints) and is often accompanied by rhomboid muscle spasm. It can also come from a local rhomboid strain. An examination of the neck usually identifies the source.
How is the cause of shoulder blade pain diagnosed?
Through a history and examination of the neck, shoulder, and chest wall, which reproduces musculoskeletal pain and points to the source. Where a non-musculoskeletal cause is suspected, or the pain doesn’t fit, further tests exclude the chest, lung, and abdominal causes.
Final word from Sport Doctor London about shoulder blade pain
Shoulder blade pain is common, and most causes are musculoskeletal— such as referred neck pain or muscle tightness. Simple treatment helps the majority. But because the scapula can reflect problems in the chest or abdomen, it’s worth seeing a doctor to confirm the diagnosis and exclude the less common, more serious causes.
If you have persistent shoulder blade pain, Dr Masci can assess you in London, including ultrasound in clinic. Contact the team here or call +44 (0) 203 488 0350.
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