An Overview of Shoulder Blade Pain

Shoulder blade pain can have many different causes. Although you may assume you sustained an injury or simply slept in the wrong way, the pain might actually be related to your heart, lungs, spine, abdomen, or pelvis. In cases like these, the pain may be referred, meaning that a problem in one part of the body excites nerves that trigger pain in another part of the body, such as your shoulder blade.

In most cases, shoulder blade pain is nothing to worry about. However, in rare instances, shoulder blade pain may be a sign of a severe condition, like a heart attack or cancer.

This article describes the symptoms and causes of shoulder blade pain. It also walks you through how shoulder blade pain is diagnosed and treated.

Shoulder Blade Pain Symptoms

The shoulder blade (scapula) is one of two triangular bones in your upper back on each side of the spine. They enable a wide range of motions of the shoulders, including moving the shoulders forward and backward, rotating the shoulders, or lifting and lowering the shoulders.

Shoulder blade pain differs from shoulder pain or pain between the shoulder blades in that it is limited to the scapula or the muscles and connective tissues that move and support them.

The symptoms of shoulder blade pain can provide clues as to the underlying cause. These might include:

• Scapula pain that may be dull, sharp, throbbing, aching, burning, chronic (persistent), or migrating (moving)
• Weakness in the affected arm, especially when reaching overhead
• Difficulty lifting your arm above your shoulder
• A reduced range of motion in the affected shoulder
• A snapping sound when moving the shoulder
• A tilted posture on the affected side
• A visible protrusion of the shoulder blade (called "winging")

If you have shoulder blade pain that lasts more than a few days, see your healthcare provider.

Causes of Shoulder Pain

The cause of shoulder blade pain may be obvious, such as from a sports injury, or it may be hard to identify. Generally speaking, any time that the pain is severe, persistent, and occurs for no apparent reason, it is in your best interest to see your healthcare provider.

Here are seven possible explanations for your shoulder blade pain, broken down by body part or medical condition:

Muscle Conditions

The most common cause of shoulder blade pain involves the muscles controlling the scapula or the connective tissues supporting the scapula. The pain may be isolated to the shoulder blade or accompanied by pain in other muscle groups, such as the shoulder and back.

Muscle-related problems affecting the scapula include:

• Muscle strain: This is where a muscle is overstretched from an injury or the overuse of the shoulder blade muscles.
• Stress: When you are under extreme stress, your shoulder and back muscles can tighten and spasm, causing pain in your shoulder blades, shoulders, neck, or back.
• Rotator cuff tears: This is a tear in the tendons connecting muscles to bones around the shoulder joint.
• Snapping scapula syndrome: This is a condition that affects the joint that connects the scapula to the ribcage, causing pain and popping sounds (crepitus) when the shoulder blade is moved.
• Myofascial pain syndrome: This is a chronic pain disorder that affects the connective tissues covering muscles (fascia) in different parts of the body.
• Fibromyalgia: This is a poorly understood condition that causes pain and tenderness throughout specific parts of the body (called tender points), including the shoulder blades.
  

Bone and Joint Conditions

Several bone and joint problems are known to cause scapula pain, including:

• Osteoporosis: This is an aging-related condition that causes porous, brittle bones, often affecting the upper back and spine.
• Osteoarthritis: This is the most common form of arthritis, also known as "wear-and-tear arthritis." The scapula may be directly involved, or the pain could be referred from the chest, spine, shoulder, or ribs.
• Spinal stenosis: This is the narrowing of spaces in the spine that can compress spinal nerves and refer pain to different parts of the body, including the shoulder blades.
• Degenerative disc disease: This is when one or more discs between the spinal bones (vertebra) begin to deteriorate and become compressed or displaced. This can cause referred pain in your neck and shoulder.
• Shoulder blade fractures: While uncommon, the scapula can sometimes be fractured due to a fall or high-speed auto accident.
  

Heart Conditions

Shoulder blade pain can also be a symptom of a serious heart problem in which referred pain is felt in the shoulder, shoulder blade, or space between shoulder blades.

These include heart problems like:

• Heart attack: Also known as myocardial infarction, this is when a portion of the heart dies from a lack of blood and oxygen.
• Aortic dissection: This is a tear in the largest blood vessel servicing the heart (called the aorta).
• Pericarditis: This is the inflammation of the lining of the heart (pericardium).
  

Lung and Chest Conditions

Shoulder blade pain may be caused by problems affecting the lungs, thorax (chest cavity), or thoracic wall (chest wall).

Examples include:

• Pulmonary embolism: This is a blood clot in a limb (usually the leg) that breaks off and migrates to the lungs.
• Pneumothorax: This is a collapsed lung.
• Pancoast tumor: This is a benign (non-cancerous) tumor that forms on the top of the lungs. It usually causes pain in the shoulders, shoulder blades, and arms.
• Shingles: This is a viral infection caused by the reactivation of the chickenpox virus that can cause pain if the nerve roots servicing the scapula are affected.
  

Abdominal and Pelvic Conditions

Abdominal or pelvic problems can also cause shoulder blade pain. This is because the muscle that separates the thorax from the abdominal cavity, called the diaphragm, contains a network of nerves that can become inflamed and irritated by conditions like:

• Gallstones: These are hardened deposits of bile that form in the gallbladder.
• Peptic ulcer disease: This is an open sore on the lining of your stomach, small intestine, or esophagus (feeding tube).
• Acid reflux: This is a condition in which stomach acid backflows into the esophagus.
• Liver disease: These include diseases like hepatitis (liver inflammation) and cirrhosis (scarring of the liver)
• Pancreatitis: This is the inflammation of the pancreas.

Gallstones, peptic ulcers, acid reflux, and liver diseases typically cause right-sided referred shoulder pain, while pancreatitis typically causes left-sided referred shoulder pain.

Cancers

Malignant (cancerous) tumors in the chest or upper abdomen can also cause shoulder blade pain. These include cancers like:

• Lymphomas
• Lung cancer
• Mesothelioma
• Esophageal cancer
• Stomach cancer
• Liver cancer
• Pancreatic cancer

Bone metastases (cancer in one part of the body that spreads to the bones) can also affect the shoulder blade. This has been reported with cancers of the breast, liver, and digestive tract.

Diagnosis

The diagnosis of shoulder blade pain starts with a review of your symptoms, medical history, and family history as well as a thorough physical exam of the back, neck, and shoulders.

You’ll likely be asked many questions about your pain, such as:

• Which shoulder blade hurts?
• How long has it hurt?
• Did it come on gradually or suddenly?
• Have you recently changed any physical routines?
• Does the pain occur with certain activities?
• Do you sleep on the same side the pain is on?
• How would you describe your pain?
• What makes the pain worse?
• What makes the pain better?

Lab Tests

Your healthcare provider will also order tests to help narrow the possible causes, such as:

• Complete blood count (CBC): This common blood test can help detect infections.
• Erythrocyte sedimentation rate (ESR): This blood test detects general signs of inflammation
• C-reactive protein (CRP): This blood test also checks for inflammation.
• Liver function tests (LFTs): This is a panel of tests that help detect liver disease.

Based on the findings of these tests, additional tests and procedures may be ordered.

Imaging Studies

Imaging studies may be used to look at the shoulder blades specifically or at organs and structures in the chest and abdominal cavities.

These include tests like:

• Chest X-ray: This imaging technique exposes you to low-dose ionizing radiation.
• Computerized tomography (CT): This imaging technique composites multiple X-rays to create 3-D "slices" of internal structures.
• Magnetic resonance imaging (MRI): This imaging technology uses powerful magnetic and radio waves to create highly detailed images of soft tissues.
• Positron emission tomography (PET); This imaging technology is used primarily for the diagnosis of cancer.

Heart Tests

If your healthcare provider is concerned about your heart, they may order in-office cardiac (heart) procedures like:

• Electrocardiogram (ECG): This non-invasive device measures the electrical activity of your heart during a heartbeat.
• Cardiac stress test: This test measures your heart function while jogging on a treadmill or riding a stationary bike.
  

Treatment

The treatment of shoulder blade pain depends on the underlying cause. If it’s related to a muscle strain, RICE may be helpful.

RICE stands for:

• Rest
• Ice application
• Compression (using an elastic bandage or splint)
• Elevation (keeping the shoulder blade above the heart)

Heat or physical therapy may also be useful for muscle-related shoulder blade pain. Anti-inflammatory drugs like Advil (ibuprofen) or Aleve (naproxen) can help reduce pain and swelling. Stretching or massage might also help.

For other causes of shoulder blade pain, the treatment would vary by the underlying cause. This might include medications, surgery, physical therapy, electrical nerve stimulation, or cancer treatments like radiation or chemotherapy.

Summary

Shoulder blade pain can have many causes involving the bones, joints, muscles, heart, lungs, chest, abdomen, and pelvis. On rare occasions, cancer may be the cause.

Diagnosing shoulder blade pain may involve a physical exam, a review of your medical history, blood tests, imaging studies, and cardiac tests.

The treatment varies by the cause. It might involve anything from home care for a muscle strain to chemotherapy for cancer.