What Could Cause Shoulder Blade Pain?

Causes and Diagnosis of Scapular Pain

image of the shoulder blade
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Shoulder blade pain can be confusing because the causes aren’t always obvious. This symptom can be a sign of something serious like a heart attack or lung cancer, or something as simple as sleeping wrong. What should you know if you are experiencing pain in the region of your shoulder blades (your scapulae)?

Overview

Before talking about symptoms, it helps to describe exactly what location we are talking about when describing the shoulder blades.

The shoulder blades—medically known as the scapulae—are the triangular-shaped bones of your upper back that stick out and become more visible when you extend your elbows towards your back. The shoulder blades have many functions, one of which is to support pivotal movements of the shoulder.

Pain in the region of the shoulder blade can be due to multiple causes. It may be due to inflammation in the scapula itself or referred pain from other areas of the body. Which shoulder blade is affected is an important question, as some conditions are more likely to affect the left shoulder blade, and others more likely to affect the right.

This article talks about what occurs in the shoulder blades rather than the shoulder. If you are experiencing pain in your shoulder, consider reading more on shoulder pain symptoms and shoulder pain causes.

Possible Causes 

Pain in the shoulder blades can be related to inflammation or trauma to the shoulder area itself, or may instead be due to referred pain from other regions in the chest and abdomen.

Because of this, pain experienced in this area can be something as simple as a mild muscle strain, or as serious as a heart or lung condition or cancer.

Some conditions are more likely to affect the shoulder blades on one side. For example, gallbladder disease may cause referred pain in the right shoulder whereas heart conditions are more likely to cause referred pain to the left shoulder blade.

Let's take a look at the possible causes of shoulder blade pain broken down into different organ systems and regions of the body.

Musculoskeletal Causes 

The most common cause of shoulder blade pain is a muscle strain. Short-term overuse of your arms and upper torso may be experienced in your scapula. This pain may be accompanied by pain in other muscle groups, such as your shoulder or back, but can be felt only in your shoulder blade as well. Even something as simple as sleeping in the wrong position (especially prolonged sleeping on one side) could be a cause of this pain.

In general, muscle strains often feel "like a pulled muscle" and are more likely to be the case if you’ve started a new exercise program, done lifting that you are not accustomed to, or slept in a new or different bed.

Other muscular conditions which may cause shoulder blade pain include rotator cuff tears and a condition known as snapping scapula syndrome. Snapping scapula syndrome is notable for having symptoms of cracking and popping (crepitus) along the inner side of the shoulder blade. Many people with this syndrome also have instability of their shoulder accompanied by shoulder pain.

Bone and Joint ​Related Causes

Bone problems such as fractures are uncommon in the shoulder blade as the scapulae are considered a few of the most difficult bones in the body to fracture. It's unlikely that you would have a scapular fracture without remembering the cause. Causes usually include falls or high-speed motor vehicle accidents.

The bony portion of you scapula may be affected without a history of trauma if you have a history of cancer. Bone metastases to the shoulder blades may occur with cancers such as breast cancerlung canceresophageal cancer, and colon cancer.

Osteoporosis may affect your shoulder blades, shoulders, or neck, resulting in shoulder blade pain.

Arthritis may result in pain in the shoulder blades in more than one way. The scapula may be directly involved, or you may be experiencing referred pain from arthritis in other regions of you chest including your spine, shoulder, or ribs.

Finally, compression of nerves in the neck by collapsed or displaced discs may result in referred pain to the shoulder blades.  With disc disease, you may have pain in your neck or numbness and tingling down your arm into your hands. The location of pain in the shoulder blades related to cervical disc disease is actually being evaluated for its ability to help physicians identify the location of nerve compression requiring surgery.

Heart-Related (Cardiac) Causes 

While pain in the shoulder blades occurs less commonly than pain in the chest, pain which occurs in the shoulder blades alone has been well documented in people having heart attacks. Heart attacks, especially in women, need to be considered with any form of pain in the torso. Conditions such as pericarditis (inflammation of the lining of the heart,) or aortic dissection may be experienced as pain in the left shoulder blade alone.

If you are uncertain about the cause of your pain and have any risk factors for heart disease, seek immediate medical attention.

Lung-Related (Pulmonary) Causes 

A fairly large percent of people with lung cancer experience pain in their shoulders or shoulder blades.  Pancoast tumors are a form of lung cancer that grows on the tops of the lungs, and typically causes pain in the shoulders, shoulder blades, and arms, rather than the more typical symptoms of lung cancer.

Lung conditions such as pulmonary emboli (blood clots in the legs that break off and travel to the lungs) or a pneumothorax (a collapsed lung) are also possible causes.

Chest Wall (Skin and Soft Tissue) Related Causes 

Shingles, an infection caused by the same virus that causes chickenpox, may cause shoulder blade pain. The pain is usually a burning or tingling pain. While shingles usually involves a rash which occurs in the region of the nerve affected, the pain often precedes the rash by a few days, making the diagnosis difficult at first.

Abdominal and Pelvic Causes

You may be surprised to hear that abdominal or even pelvic problems can cause shoulder blade pain, but this is actually fairly common. Irritation of nerves that pass along the base of the diaphragm (the muscles that separate the chest cavity from the abdominal cavity) can cause pain which feels like it has originated in your shoulder or shoulder blade. You may have heard people talk about having shoulder or shoulder blade pain after surgery.

Some conditions which may cause shoulder blade pain include gallstones, peptic ulcer disease, and liver disease. With these conditions, the referred pain is often to the right shoulder blade. The pancreas is part of the digestive system, but pancreatitis is more likely to cause pain in the left shoulder blade.

Diagnosis

Your doctor will begin by taking a careful history and doing a physical exam. Many causes of shoulder blade pain can be diagnosed based on your history. He or she will perform a careful physical exam, yet studies suggest that it’s often difficult to diagnose the cause of shoulder blade pain based on physical exam alone. Other tests and studies may include:

  • Radiological studies. Radiologic studies may include a chest x-ray, a CT scan of your chest or other regions of your body, an MRI of your chest or other regions, and/or a PET scan if you have a history of cancer.
  • Heart tests. If your doctor is at all concerned that your pain may be originating in your heart, tests such as an EKG or stress test may be recommended. It is worth repeating that heart pain, especially in women, may only be noted in your shoulder blades.
  • Abdominal exams. Tests such as an upper endoscopy may be done to evaluate your stomach and small intestine. In an endoscopy, you are given a medication to make you tired and a tube is threaded through your mouth and into your esophagus and stomach, allowing a physician to carefully visualize these areas.
  • Bloodwork. Blood tests may also be done. Liver function tests may be run to check for inflammation of your liver (which can often be referred to your left shoulder or shoulder blade.) Tests may also be done to look for inflammatory forms of arthritis and other connective tissue diseases. 

Questions Your Doctor Ma​y Ask

While some questions may be unique to your health history and situation, in most cases be prepared to answer:

  • Which shoulder blade is painful? Your right shoulder blade, your left shoulder blade, or both?
  • How long have you been having the pain?
  • Did the pain come on gradually or suddenly?
  • Have you changed your exercise routine lately?
  • Do you participate in activities that often cause pain in the shoulder or shoulder blade? For example, tennis, golf, swimming, basketball, badminton, racquetball?
  • Is the pain on the same side of your body you sleep on?
  • How would you describe your pain? For example, is it sharp or dull, superficial (on the surface) or deep, burning or achy, stabbing or steady?
  • What makes the pain worse? For example, do certain movements, a deep breath, or eating make the pain worse?
  • What makes the pain better?
  • What other symptoms have you been having? For example, shortness of breath, pain in other regions of your body, coughingchest pain, or abdominal pain.
  • Do you, or have you ever smoked?

Treatment

The treatment of shoulder blade pain will depend on the underlying cause of the pain. If it is related to overuse, treatment may be as simple as rest. For pain related to the spread of cancer, options include radiation, chemotherapy, and sometimes surgical procedures to alleviate the pain.

When to Call Your Doctor

If you have shoulder blade pain that persists beyond a few days it is important to make an appointment to see your doctor—even if you have participated in activities that you suspect has caused your pain.  If your pain is severe or is accompanied by symptoms of chest pain or shortness of breath call 911 or your doctor immediately.

Sources:

Choi, H., Lee, P., and K. Kim. Scapuloplasty alleviates scapular pain resulting from lung cancer metastasis. Pain Physician. 2010. 13(5):485-91.

Kibler, W., Sciascia, A., and T. Wilkes. Scapular dyskinesis and its relation to shoulder injury. Journal of the American Academy of Orthopedic Surgeons. 2012. 20(6):364-72.

Suh, B., You, K., and M. Park. Can Axial Pain be Helpful to Determine Surgical Level in the Multilevel Cervical Radiculopathy. Journal of Orthopaedic Surgery. 2017. 25(1):2309499016684091.

Warth, R., Spiegl, U., and P. Millett. Scapulothoracic bursitis and snapping scapula syndrome: a critical review of current evidence. American Journal of Sports Medicine. 2015. 43(1):236-45.

Wright, A. et al. Diagnostic accuracy of scapular physical examination tests for shoulder disorders: a systemic review. British Journal of Sports Medicine. 2012 Oct 18. (Epub ahead of print)

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