Shoulder Blade Pain: Causes, symptoms, Diagnosis and Treatment

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A woman with a Shoulder Blade Pain

1Overview

Shoulder blade pain, also known as interscapular pain, is very common with the cause of pain ranging from simple strains to serious conditions like liver problems, lung cancer, and heart attacks. Sometimes, the causes of shoulder blade pain are not always that obvious or are really difficult to determine. It’s important to take note of where the pain is exactly located, whether the pain is felt on the left or right shoulder blade, and describe how the pain feels in the shoulder blade area.

The shoulder blades are also known as the scapulae in medical terms. They are bones that are triangular in shape which can be found on the back of the shoulders. Every shoulder blade connects the bone of the upper arm to the collarbone. It has three groups of muscles attached to it. These attached muscles help move the shoulder joint.

The shoulder can move in many ways. The muscles connecting the shoulder blade is responsible for the shoulder’s movements such as rotating, moving in a circle, moving side to side, and moving up and down. Since the shoulder has a wide range of movement, it is easy to injure and can result in shoulder blade pain.

Not all shoulder blade pains are caused by injuries. In some cases of shoulder blade pain, the pain is caused by an underlying illness or condition or a nearby organ in distress.

Here are some of the body structures that are connected to the shoulder blades:

  • Skin
  • Part of the heart
  • Part of the esophagus
  • A portion of the lungs
  • Thoracic Spine
  • Thoracic aorta
  • Muscles: The muscles in this area include the middle and lower trapezius muscles and the rhomboids. These muscles play a major role in keeping the shoulder blades down and back.

Pains occurring in the shoulder blades may begin in any of these body parts and structures or may also occur in other areas that are quite close to these structures because of the way that nerves transmit pain signals.

2Possible Causes of Shoulder Blade Pain

There a lot of possible causes for experiencing shoulder blade pain. It may be caused by an inflammation of the shoulder blades or scapula or referred pain felt from other regions or areas of the body such as the abdomen and chest.

Musculoskeletal Causes

Muscle strain

An injury or strain to the tendon or muscle is the most common and frequent cause of pain in the shoulder blade.  An overuse of the upper torso and arms can be felt in the shoulder blades but the pain may also occur with pain in other areas like the back and the shoulder but the pain can only be felt in the shoulder blade. There is a difference between shoulder pain and shoulder blade pain but sometimes, pain in the shoulders can be felt or experienced on the shoulder blades.

Muscle strains feel like the muscles are being pulled. This may be caused by the following:

  • Sleeping in an odd or uncomfortable position (sleeping on one side for a long time)
  • Sleeping in a new bed or a poor mattress
  • Excess heavy lifting
  • Improper posture when exercising or starting a new program for exercise
  • Long hours in front of a computer
  • Poor posture (especially with prolonged standing or sitting and when leaning forward)
  • Activities involving a lot of twisting like tennis or golf

There are other muscular problems or conditions that can also cause pain in the shoulder blade such as rotator cuff tears, spine fractures, and snapping scapula syndrome.

Emotional stress

Depression, anxiety or chronic emotional stress can lead to an increased tension in the upper back muscles with stabbing or burning pain in the shoulder blades. The pain can be triggered by deep breathing, stretching the back muscles, or touching the chest with the chin.

Muscle contusion

Hematoma or the collection of blood in a muscle due to a fall or a direct blow.
Symptoms include pain, tenderness, bruising, and localized swelling.

Myofascial pain syndrome

This is a chronic condition where the palpable knots in the fascia or muscle sheaths act as trigger points. The muscle knots on the shoulder blades triggers muscle twitches when snapped on and you will feel deep aches on the back side of the hand, arm, and little and ring finger, and the shoulder.

Snapping scapula syndrome

This condition refers to the popping, grinding, or snapping sound during the lifting or shrugging of an arm sideways because of the rubbing of the shoulder blade against the rib cage. Some other symptoms of this condition include pain felt along the medial border of the shoulder blade when lifting the arm above the shoulder level and palpable crepitus over the medial side of the scapula.

Joint and Bone Related Causes

Bone problems like fractures are not common in the shoulder blade because the shoulder blades are one of the few bones that are difficult to fracture. Scapular fractures are usually due to trauma from a fall, hit, or a car accident which may cause the shoulder blade pain. Conditions that may cause pain in the shoulder blades following trauma usually include rotator cut-off tears and acromioclavicular joint separation.

The bony part of the scapula may be affected if you have a history of cancer. Cancers of lung cancer, colon cancer, breast cancer, and esophageal cancer may cause metastases to the shoulder blades.

Osteoporosis may also affect the neck, shoulders, and shoulder blades causing pain on the shoulder blades.

Arthritis can lead to shoulder blade pain when the scapulae are directly affected or referred pain due to arthritis in other body parts such as the chest, ribs, shoulder, or spine.

Displaced, collapsed, or slipped discs result in compression of the nerves in the neck which can cause referred pain in the shoulder blades.

Cardiac Causes

Pain in the chest is more commonly experienced than pain in the shoulder blades but there have been documented findings that show some people who felt pain in the shoulder blades and had heart attacks. The pain caused by heart attacks most especially in women can be felt anywhere within the torso. Pain in the left shoulder blade may be felt in conditions such as aortic dissection and pericarditis or the inflammation of the lining of the heart.

Pulmonary Causes

A large percentage of people with lung cancer feel pain in the shoulder blades or shoulders. Pancoast tumors are a type of lung cancer that grows on the top of the lungs that may cause pain on the arms, shoulders, and shoulder blades by pushing on nerves near the top of the lungs. Other possible causes are blood clots found in the legs that travel all the way to the lungs or pulmonary emboli, and a collapsed lung or pneumothorax.

Pelvic and Abdominal Causes

Shoulder blade pain brought about by pelvic and abdominal causes are actually pretty common. The nerves that pass along the base of the diaphragm get irritated causing pain that feels like it’s coming from the shoulders or the shoulder blades. Shoulder blade pain may also be felt after surgery.

Other possible causes of shoulder blade pain are nerve pain, liver disease, gallstones, pancreatitis, and peptic ulcer disease. These diseases usually cause right shoulder blade pain except for pancreatitis which may cause left shoulder blade pain because the pancreas is part of the digestive system.

Other causes of shoulder blade pain may be the referred pain in the back and near the shoulder blades due to Acid Reflux or GERD.

3When to See a Doctor?

Shoulder blade pain caused by harmless incidents such as the wrong position in sleeping or too much lifting will just go away or may be treated with home remedies.

Shoulder blade pain caused by more serious diseases or unexplainable pain felt on the shoulder blades need immediate medical attention.

You may see a doctor if you experience muscle strain to get a recommendation for treatment.

Women who feel pain in the left shoulder blade should be conscious about the pain as it may be a sign of heart attack.

4Associated symptoms that call for immediate medical attention are:

  • Shortness of breath
  • Chest pain
  • Lightheadedness
  • Sudden difficulty in speaking
  • Irregular or rapid heartbeat
  • Coughing up blood
  • Fever
  • Swelling, redness, or pain in the legs
  • Vision problems
  • Loss of consciousness
  • Excessive sweating
  • Paralysis on one side of the body

5Diagnosis

The doctor usually examines the person to determine the cause of the shoulder blade pain. It starts with an interview to check if there might be a simple reason for the pain.

Once the doctor rules out the simple causes, he/she may perform different tests such as:

  • ECG or stress test
  • Abdominal tests like endoscopy
  • MRI or CT Scan
  • Blood test to check liver function

6Treatment

Treatment depends on the underlying cause of the pain on the shoulder blade. For simple causes such as poor sleeping, overuse of muscles, and strain, an individual may try different home remedies such as:

  • Rest
  • Stretching
  • Massages
  • Ice
  • OTC pain medications
  • Ointments or creams
  • Stretching

When there is an underlying cause such as cancer, the treatment depends on the treatment of the underlying cause. Cancer may require chemotherapy, radiation, or other therapies. Heart conditions may require medications to ease the heart problems.

Treatment is usually effective if the individual knows the cause of the shoulder blade pain.

If the treatment recommended by the doctor does not seem to be working, inform the doctor right away to see whether the treatment needs to be adjusted or changed