Shoulder Blade Pain

Are you experiencing shoulder blade pain?  Scapula pain is a fairly common issue.  What causes pain in the shoulder blade?  Most importantly, what can you do about it?  Learn more about this common problem and the best treatment options. 

 



Anatomy

The shoulder blade, or scapula, is part of the shoulder complex.  The scapula is the triangular bone that is attached to both the humerus (arm bone) and clavicle (collar bone) and together they form the shoulder complex. 

The scapula also functions as an attachment point for various muscles.  The rotator cuff muscles all attach to the scapula.  In addition, various muscles of the mid and upper back attach to the scapula. 



What Causes Shoulder Blade Pain?

The cause of pain around the shoulder blade is not as easy to determine as one might think.  It would be easy (and wrong) to simply look at the anatomical structures around the scapula and automatically conclude one of those structures is the cause.  If you go in to your doctor and the answer you receive is muscle strain (without checking your spine) you may want to consider getting another opinion.   Most pain around the scapula is not because of a strain of one of the muscles that attach to the shoulder blade. 


Insidious Onset Scapula Pain

What is insidious onset?  It simply means the pain started for no known cause.  There was not trauma.  You didn't fall.  You didn't throw a ball or start a lawn mower and after that began to have scapula pain.  The most common kind of insidious onset pain in the scapula is aggravated simply by sitting, specifically at the computer.  If you have this type of scapula pain then the chance that it is being caused by a muscle is extremely low.  Muscles hurt when you use them, much less so at rest. 

If you have pain around the scapula and it's not a muscle, what is it?  More often than not it is coming from the neck or cervical spine.  The scapula is the most common region for referred cervical pain.  Just as someone having a heart attack can feel left arm pain and no chest pain, pain around the scapula can be caused by the neck, even if   you have no neck pain. 

Below is a picture of common referral pain sites for the cervical spine.  That tension you feel in your upper trapezius that keeps coming back, even after having massage after massage, is probably coming from the fourth and fifth cervical joints (C4 and C5).  That pain along the inside or medial border of the scapula (between the shoulder blades) is most often coming from the sixth and seventh cervical joints (C6 and C7). 



A less common spine related source of pain between the shoulder blades is irritation to one of the facets of the mid back, or one of the joints that connects the ribs to the thoracic spine.   These joints associated with the thoracic spine can be of insidious onset or can be related to a trauma (like swinging a bat).  It is more common for the joints of the thoracic spine to create pain in one specific area.  People will point to one specific spot as opposed to a general feeling around the scapula.

Although the spine is the most common source for scapula pain, another much less common source of insidious onset scapula pain is referred pain from an organ.  The lungs, stomach, and even liver can caused referred pain around the scapula region. 



If your pain began without any trauma, how do you know if it is coming from your spine or an organ?  If you pay attention to when you feel pain you'll be able to tell.  Organ referred pain has no pattern.  It will hurt no matter what position, it will hurt during the day when moving, and at night while trying to sleep.  No matter what position you are in it will still be painful.

Spine (cervical or thoracic spine) related shoulder blade pain more often has some type of a pattern.  Generally if you are up and walking around for a while it feels better, sitting at the computer or driving makes the symptoms worse.  Correcting your posture makes it feel slightly better.  Often when you first wake up in the morning it is stiff and sore but as you get up and start moving around it feels better.   Shoulder blade pain related to the spine is aggravated by being in one position for too long and generally feels better when you are moving. 


Trauma Related Scapula Pain  

Shoulder blade pain related to trauma is much easier to diagnose.   A fall or an automobile accident could cause a scapula fracture.   A fall could also cause a fracture to one of the thoracic vertebrae resulting in mid back pain around the scapula.  Using your arm to pull something, like starting a lawnmower, or a quick throw can result in a strain of one of the muscles around the scapula. 

Repetitive throwing, like a baseball pitcher, can create traction on a nerve around the scapula (the long thoracic nerve) resulting in a winging scapula.  If you've had some type of shoulder injury this can result in abnormal movement of the scapula thus resulting in shoulder blade pain.  If pain around the scapula follows a specific incident, a diagnosis for the source of the scapula pain is much easier to make. 

 

Diagnosis And Treatment

The most important aspect of treatment of shoulder blade pain is obtaining an accurate diagnosis.  Your physician should evaluate shoulder, neck, and mid back range of motion noting not just how much you can move but the quality of the movement.  Strength testing around the shoulder would be necessary to determine any muscle or nerve component.  For insidious onset pain, evaluating your posture would also be important in determining potential causes.  X-rays and other diagnostic tests may be warranted if a trauma occurred but generally not when the pain is of insidious onset.

Typical conservative treatment for spine related shoulder blade pain includes anti-inflammatory medication, ice, and physical therapy.  A referral to a qualified orthopedic physical therapist is an important piece for management of scapula pain.  The typical plan of physical therapy care generally includes a mix of passive (joint mobilization or soft tissue massage) and active (strengthening and stretching exercises) treatments. 

Addressing posture should also be a component of addressing scapula pain, specifically if sitting and/or driving is an aggravator.  If you spend extended amounts of time at a computer, consider having a work station ergonomic assessment to determine if your station is set up correctly.  In the short term, an easy way to help correct posture is to utilize a rolled up towel or lumbar roll anytime you sit.  This will help to ensure more appropriate alignment and minimize tissue stresses. 



If conservative treatment is not successful other diagnostic tests, such as an MRI, may be recommended.  If the spine is determined as the cause of the pain cortisone injections are often effective after conservative treatment has failed. 


What Can You Do Now?

If you suffered some type of trauma, obtaining medical care is the first step.  If you have insidious onset pain and have yet to see a doctor, your first goal is to determine if there is a pattern to your pain.  If you have pain with sitting and driving, start by using a rolled up towel or pillow behind your back to maintain good posture.  Evaluate the position of your computer monitor (too high should be avoided).  If you wear reading glasses be aware that moving your neck to assist with focusing could be aggravating your symptoms or that you may need a new prescription.  Consider beginning a routine of over the counter anti-inflammatory medication.  Begin utilizing ice (not heat) specifically on the lower neck region, ten minutes at a time a few times a day.  If taking these steps does not significantly reduce your shoulder blade pain, see your physician and obtain a referral to a physical therapist. 

 

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