The shoulder blade, also called the scapula, is a triangular-shaped bone in your mid-back. Causes of shoulder blade pain are variable but include common causes such as neck strains and muscle disorders, and rare causes such as lung or heart disease. So, what causes scapular pain, and when do you need to see a doctor?
Anatomy
The scapula forms the shoulder joint socket, with the upper limb’s head forming the ball. The shoulder blade also attaches to the clavicle or collarbone.
Various ligaments and muscles connect the scapula to the upper arm bone. Therefore, arm movement also moves the scapula to maintain normal ball-and-socket joint alignment.
Causes of Shoulder Blade Pain
Pain in the shoulder blade can come from inflammation or trauma to the local area or referrals from other parts of the chest or abdomen. Most cases of scapular pain are mild and benign, similar to neck pain or a muscle strain; however, it can sometimes be a sign of a more severe condition in the lungs or heart.
Referred pain from the neck or shoulder
The most common cause of scapular pain is often related to the neck or shoulder. Inflammation of the discs or facet joints in the lower cervical spine usually refers to the area inside your shoulder blade, near the upper rhomboid muscles. In addition, pathology in the back of the shoulder, such as rotator cuff tendinitis or frozen shoulder, can sometimes refer to the outside of the scapula.
Generally, referred pain also causes spasms of the muscles surrounding the shoulder blade, leading to more intense pain.
We diagnose referred scapular pain by examining the neck and shoulder. Ususally, movement or palpation of the inflammation in the neck or shoulder will produce shoulder blade pain.
Local muscle strain as a cause of shoulder blade pain
Generally, overuse of the arm and shoulder, often due to a new gym program or an excessive sport, can lead to a local muscle strain of the scapula. Common muscles strained include the upper and lower rhomboid, which attach to the inside of the shoulder blade, the latissimus dorsi, which connects to the bottom, and the teres minor and major, which lie on the outside of the shoulder blade and attach to the back of the upper arm bone.
The scapula is rarely affected by disease. Examples include a fracture from a fall, which is extremely rare. Snapping scapula syndrome causes the inner blade of the scapula to snap or crack. Many people with this condition also have pain and instability in the shoulder.
Chest wall pain
The chest wall surrounds the lungs and heart. It consists of bones, muscles, nerves, and joints, connecting the ribs to the spinal column and sternum. Injury to the chest wall occurs after trauma or explosive movements during sports. Damage to the structures at the back of the chest wall, such as the muscles, ribs, and joints of the spine, can also affect the scapula.
Dorsal scapular nerve entrapment
The dorsal scapular nerve arises from the brachial plexus in the armpit and runs down between the muscles inside the shoulder blade. Sometimes, nerve traction from heavy lifting or repetitive overhead activities can cause sharp, shooting pain in the scapula or shoulder blade. We need to consider dorsal scapular nerve entrapment, especially if other conditions of scapula pain have been excluded.
Long Thoracic Nerve Injury
The Long Thoracic nerve arises from the brachial plexus and supplies the serratus anterior muscle. Injury to the nerve causes weakness of the serratus anterior, leading to pain in the medial border of the scapula associated with winging of the scapula.
Spinal Accessory Nerve Injury
The Spinal Accessory nerve arises from the lower part of the brain and supplies the trapezius muscle. Injury to this nerve leads to weakness of the trapezius and scapula flipping.
Other causes of shoulder blade pain
Problems in other parts of the body can affect the scapula. For example, abdominal conditions such as heartburn, peptic ulcers, and liver disease often cause right-sided scapula pain, whereas pancreatic disease can cause left-sided pain. Rare lung conditions such as pulmonary embolism or Pancoast tumour can affect the shoulder blade. Finally, heart conditions such as ischaemic heart disease or a heart attack can be felt in the scapula.
Simple self-directed treatment strategies for scapular pain
For most causes of shoulder blade pain, you can use the following simple process to help you get back on track:
- Simple exercises, such as shoulder and chest wall stretching, and aerobic conditioning, like swimming and cycling, can help alleviate shoulder blade pain. We often recommend you seek help from a physical therapist who can supervise your exercise program.
- Heat packs on the shoulder blades will help with the pain. Additionally, heat increases blood flow, allowing the muscles to relax.
- NSAIDs, such as ibuprofen, reduce inflammation and pain. Be careful, though, as these medications can cause side effects such as stomach ulcers and increased blood pressure.
- Massage therapy, whether professional or self-administered, can help reduce pain. For example, apply a foam roller or massage ball to the tender spots in your shoulder blades.
- Acupuncture can help alleviate tightness in the shoulder blades. It works by stimulating the reflex that relaxes muscles, releasing muscle tension and reducing pain.
If none of these strategies help, we suggest consulting a professional, such as a Sports and Exercise Medicine consultant, who can assist with a diagnosis and guide treatment.
Final word from Sportdoctorlondon about shoulder blade pain
Shoulder blade pain is common. Most causes are musculoskeletal, such as neck-referred pain or muscle tightness. However, you should see a Sports Doctor to confirm a diagnosis and exclude other non-musculoskeletal causes.
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