The shoulder blade is a flat, triangular shaped bone located in the upper back. Its function is to stabilize and assist with shoulder movement. The scapular joint in the shoulder allows for movement of the arms and is made up of a group of muscles and tendons called the rotator cuff.
There are injuries and illnesses that can happen in the shoulder blade that cause pain, like muscular injury, fibromyalgia and bursitis.
The causes of these illnesses are not always known, but they may be related to incorrect posture, excessive force and even trauma or fractures. Because of the different possibilities, you should always see a doctor if you have persistent shoulder blade pain. The doctor can assess the area and evaluate your symptoms to determine a diagnosis or a need for further testing. Once an underlying cause is identified, appropriate treatment can be initiated.
What causes pain in the shoulder blade?
Some conditions or clinical findings that can lead to shoulder blade pain are:
1. Bad posture
Shoulder blade pain can be caused by poor posture, sitting for long periods in front of the computer, or excessive use of a cell phone or tablet. These can create tension in the shoulder muscles, reflected in the scapula.
What to do: you should make changes to your lifestyle, changing your posture when working in front of the computer, choosing to keep your back resting on the chair, in addition to reducing the time you use your cell phone or tablet whenever possible. In addition, exercises such as stretching or those recommended by the physiotherapist can be performed to improve posture.
2. Direct blows and accidents
Pain in the shoulder blade can be caused by trauma from a direct blow, fall, car accident or contact sports. All of these situations can lead to fractures or compression of the suprascapular nerve, causing intense pain in the scapula. However, nerve compression may also be due to rotator cuff syndrome.
What to do: If you have intense pain from direct trauma, you should seek urgent medical attention. The doctor will order imaging tests like an X-rays to assess for a fracture. If confirmed, the doctor may prescribe medication to relieve pain, physiotherapy and immobilization with slings and splints, and in more serious cases, surgery.
3. Lifting weights incorrectly
Lifting weights incorrectly or carrying heavy objects can lead to muscle or ligament injuries, resulting in shoulder blade pain.
This type of injury is more common in people who practice physical activities such as weight training or crossfit, or who work in professions that require carrying weight such as construction workers, mechanics or nurses.
What to do: apply a warm compress to the area for 15 minutes, twice a day, followed by an anti-inflammatory ointment. It is also important to avoid lifting weights during this period and to maintain correct posture on a daily basis. You can also stretch to reduce muscle tension and alleviate discomfort.
4. Overuse injury
Overuse injuries of the shoulder joint can lead to shoulder blade pain. This generally occurs due to repetitive movements, and is common in people who play sports such as volleyball or basketball, and in professions such as painting or dentistry.
These repetitive movements can cause muscle or ligament injuries, sprains or bursitis, resulting in shoulder blade pain.
What to do: Avoid excessive use of the joint when possible and apply cold compresses to the area for the first 48 hours to relieve discomfort. If the pain is severe, you should consult an orthopedist to assess the type of injury and recommend the most appropriate treatment.
5. Back problems
Some spinal problems, such as cervical disc herniation, cervical spondylosis or osteoporosis, can cause pain in the scapula. These conditions are also related to other symptoms such as pain that radiates to the arms or fingers, weakness in the arms, a burning sensation or numbness in the fingers, for example.
What to do: you should consult an orthopedic surgeon to identify the condition that is causing pain in the scapula, so that the most appropriate treatment can be indicated.
6. Bursitis
The shoulder blade contains pockets of fluid that help to reduce friction that occurs with arm movements. These fluid-filled sacs are called bursae, and these can become inflamed with over-use or trauma. This inflammation, also known as bursitis, is associated with intense pain that is most felt with movement and on cold days. It often affects the shoulder area and causes shoulder blade pain.
What to do: Bursitis-related pain can be relieved by applying ice to the area for 20 minutes, 2 to 3 times per day. The doctor may also recommend analgesic, anti-inflammatory and corticosteroid medication to improve pain and reduce inflammation. Treatment also involves rest when possible and physiotherapy sessions to maintain range of motion.
7. Winged scapula
A winged scapula occurs is associated with improper protruding of the scapular bone when moving. This incorrect positioning can feel like the bone is “out of place” and can cause discomfort. Although it can affect any side, it is most commonly seen in the right shoulder blade, and can occur with conditions like arthrosis, clavicular fracture, paralysis and thoracic nerve damage.
Diagnosis is confirmed by an orthopedic surgeon through a physical exam followed by further testing with an EMG, to evaluate the functioning of the muscles in the area.
What to do: Once confirmed, the specialist may prescribe medication to relieve pain in the short-term. In most cases, surgery is recommended to repair any damaged nerves behind the chest cavity.
8. Fibromyalgia
Fibromyalgia is a common rheumatologic condition that is is characterized by generalized pain in several areas of the body, including the shoulder blades. It can also cause symptoms like fatigue, muscular rigidity, tingling in the hands, depression, and sleep disturbances, which can all worsen overall quality of life.
These symptoms should be evaluated by a rheumatologist, who can confirm a diagnosis through a thorough assessment of the patient’s health history, taking into account the locations of pain and duration. The doctor may opt to order imaging, like MRIs or EMGs, to rule out other possible pathologies. Learn more about the symptoms of fibromyalgia and how it is diagnosed.
What to do: Fibromyalgia is a chronic disease that does not have a cure. Treatment is aimed at symptom relief and can include muscle relaxants (like cyclobenzaprine) and tricyclic antidepressants (like amitriptyline). TENS machines and ultrasounds, typically used by a physiotherapist, can also help to manage pain.
Check-out the fibromyalgia medications that your doctor may prescribe.
9. Snapping scapula syndrome
Snapping scapula syndrome is a condition that is associated with pain and cracking within the shoulder blade upon movement. It is caused by excessive physical activity and direct trauma to the shoulder, and is more commonly seen in young adults.
Diagnosis is confirmed through direct assessment and x-ray or CT scans, after ruling out other conditions.
What to do: Treatment consists of analgesic and anti-inflammatory medication to relieve pain and reduce inflammation. Physiotherapy can help to strengthen the scapular muscles and prevent further injuries.
10. Gorham’s disease
Gorham’s disease is a rare condition that causes bone loss. It is associated with sudden and difficulty moving the arm. Diagnosis is usually confirmed by an orthopedic surgeon through CT scans and MRI.
What to do: Treatment is monitored by an orthopedic surgeon and depends on where the disease is most occurring. Medications, like biphosphonates, can help with repositioning of the bone, and surgery may be indicated to stabilize fragile bones.
11. Heart problems
Some heart problems, such as rupture of the aorta artery or heart attack, can cause intense and sudden pain in the shoulder blade region.
Heart problems can also cause other symptoms, like strong and intense pain in the chest, pain that radiates to the shoulder or arm, shortness of breath, dizziness, malaise, nausea, cold sweat or paleness.
What to do: you should seek medical attention immediately, as these are serious conditions that can be life-threatening if not treated quickly.
12. Liver and gallbladder problems
Gallbladder stones and liver problems, like abscesses, hepatitis and even cancer, can lead to scapular pain, particularly on the right side. This symptom can be accompanied by other symptoms, like jaundice, back pain, nausea, fever and diarrhea.
Tests, like ultrasounds, CT scans, MRI and bloodwork, can help to confirm liver or gallbladder issues that can cause scapular pain. Complete our online liver disease symptoms checker to assess your risk for a liver problem.
What to do: If you notice these symptoms, you should seek medical assessment to initiate treatment. Treatment will depend on the underlying diagnosis.
When to see a doctor
Scapular pain can be a sign of another condition that is not skeletal, muscular or nerve-related. It may be a heart or lung condition, like an acute heart attack or aortic aneurysm, which is why you should see a doctor immediately if you have symptoms like:
- Sharp chest pain
- Shortness of breath
- Paralysis on one side of the body
- Excessive sweating
- Coughing up blood
- Pallor
- Increased heart rate
In addition, another symptom you should monitor for is fever, which can indicate the presence of an infection and prompt further testing.