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.
Some illnesses or clinical findings that can lead to shoulder blade pain are:
1. Muscular injury
The back muscles attached to the shoulder blade, like the rhomboid muscle, help with movement of the shoulder. This muscle is located between the upper vertebrae in the spine and the edge of the shoulder blade. Excessive physical activity or brisk movements with your arms can cause excessive stretching and even tearing of the muscle, which can lead to shoulder pain.
In some cases, a rhomboid muscle injury can also lead to reduced arm strength and pain with shoulder movement. These usually resolve over time as the body starts to recover.
What to do: With mild injuries, you should rest and apply a cold compress to the affected area to relieve pain. After 48 hours of the initial injury, you should switch to hot compresses and apply a topical anti-inflammatory ointment. If your symptoms worsen over time or if they persist for longer than 7 days, you should see a doctor, who may prescribe anti-inflammatory and analgesic medication to reduce swelling and relieve pain.
2. 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.
3. 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.
4. 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.
5. Suprascapular nerve compression
The suprascapular nerve is located in the brachial plexus, which is a group of nerve fibers that help with movement of the shoulder and arm. The suprascapular nerve can undergo damage, leading to intense scapular pain. .
Compression of this nerve can occur with inflammation, overuse or following direct trauma, from a car accident, for example. Nerve compression can also occur with rotator cuff injuries.
Shoulder blade pain that occurs due to suprascapular nerve compression can worsen at night and on cold days. Other symptoms include muscular fatigue and weakness, which should be assessed by an orthopedic surgeon. Diagnosis can be confirmed through x-ray and MRI.
What to do: Mild cases of this condition can be treated with anti-inflammatories and analgesics to decrease inflammation and relieve pain. More advanced cases may require nerve decompression surgery.
6. Shoulder blade fracture
Fractures in the shoulder blade are rare, as this bone is very resistant and mobile. However, when they do occur, due to a fall or direct trauma, they are associated with pain that appears some time after the initial injury.
It is important to seek medical attention if you suspect you have a scapular fracture. The doctor may order an x-ray to confirm a break and to help evaluate the extent of the injury.
What to do: Most shoulder blade fractures are treated with pain relievers, physiotherapy and immobilization with arm braces or splints. Severe cases may require surgical repair.
7. 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.
8. 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.
9. 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.
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