Shoulder Blade Pain (Scapula)

1. Bad Posture (Upper Back)

Muscles in the upper back are weak and cause shoulder blade pain. If you have work for long hours stagnantly then it can cause in either one of the shoulders or in between them. Pain witnessed when the head is bent forward.

Exercises which can help in strengthening upper back muscles –

•    Plank – This exercise is extremely beneficial for strengthening the back muscles. Lie down and lift your body, balance on your toes and forearms. Place your elbows under the shoulders and hands into fists. Hold this position till you can feel the pain.
•    Pull your shoulder back and down and hold for 2-3 seconds in standing or sitting position.
•    Hug Yourself – Wrap your arms around your body and hug yourself and squeeze yourself for about 8 seconds. Do this six times.

2.    Emotional Stress

Emotional stress can also cause pain in the shoulders or back. Anxiety, depression increases tension in the upper back muscles. There is a burning sensation or pain experienced between the shoulder blades. The pain felt when stretching back muscles or breathing deeply.

3.    Myofascial Pain Syndrome

It is a condition in which there are palpable knots in the muscle sheaths. These ties act as the trigger points for pain. Deep aches experienced on the back side of the arm, hand, ring and little finger and shoulder.

Serratus Anterior Muscle Pain Syndrome (SAMPS) –

These muscles are present on the chest, near the armpits and assist in raising the upper arms.

Symptoms

•    Pain experienced below both the shoulders, the bottom of the armpit and also the inner side of arms.
•    The pain can also experience when deep breathing.

4.    Muscle Strain or Tear

Pressure commonly refers to overstretched muscle and muscle damage is rupture of a portion or entire muscle. Muscle might strain while doing activities like carrying a heavy backpack, pull-ups, push-ups and different weightlifting exercises. The common symptoms include extreme pain and also in some cases swelling too.

Treatment

The essential treatment includes resting and applying ice packs. As the pain gradually begins to reside, you can begin with a few exercises.

•    Push your hand backward after locking your fingers behind your back.
•    First place the unaffected arm over the shoulder, hold the wrist with the injured side and pull it both sideways and downwards.

5.    Muscle Contusion

That caused when there is a direct hit. The common symptoms include –

•    Swelling, bruising and mild or moderate pain.

Treatment

Rest your shoulder, and the most effective treatment is to apply an ice wrapped cloth on the affected area for about 15 minutes immediately after getting injured. Do not try massage because it will intensify the pain. If required, consult a doctor who will drain with a needle the large hematoma. The bruise will take around two weeks to heal.

6.    Snapping Scapula Syndrome

It refers to the snapping sound which heard while shrugging or lifting your arm sideways. It caused when the shoulder blade rubs against the rib cage. Pain experienced when the arm raised above the shoulder level.

Causes

The different causes for Snapping Scapula Syndrome include sports which have overhead arm movements, for example, swimming. The various results of this are weak upper back muscles, bone scars, scapula fracture or scapular dyskinesia.

Treatment

•    Physical Therapy
•    Surgical fixation, if necessary.

7.    SICK Scapula Syndrome –

Scapula Syndrome is known to enhance the injury risk in athletes performing overhead exercises. It defined by the position of the Inferior medial border prominence, Scapular malposition, Coracoid malposition and pain, and lastly, dyskinesis of the scapular movement)

•    Pain experienced in the shoulder blade and upper side of the arm.
•    Tenderness is felt along the middle shoulder blade borderline.

This syndrome affects throwing athletes like baseball, tennis, swimmers, etc.

Treatment

•    Physiotherapy

8.    Migraine

There are some reports which suggest that a migraine headache elevates pain in the shoulder blade which then progresses to the head (on one side).

9.    Dermatomyositis and Polymyositis

Dermatomyositis is one of the rare autoimmune inflammatory diseases which occur as kids or when we reach adulthood.

•    Weakness in the Bilateral muscle
•    Pain in the hips and shoulders
•    Painful nodules in the skin

Polymyositis is an almost same condition with a rash.

10.    Polymyalgia Rheumatica

It is a muscle disease of unknown cause in people who are above the age of 50. Aches in the hip and shoulder muscles, the pain intensify in the morning. It improves gradually as days pass.

A related called giant cell arteritis causes pain in the temples, fever, and blurry vision.

1.    Whiplash – Neck Strain

It is a strain or tears in the tendons, neck muscles and even ligaments. It can also cause when there is damage to adjoining nerves and spinal discs. That happens most when you meet with a car accident or bike fall.

Symptoms

1.    Pain which gets triggered by moving your head
2.    Stiffness of Neck
3.    A headache and drowsiness

Treatment

1.    Ice packs
2.    Massage
3.    Cervical Collar

The recovery time for this type of strain can be between few months or even weeks.

2.    Fibromyalgia

It is a condition with both muscular and skeletal aches, fatigue and several issues like sleep, mood, and memory.

There are ten tender points which can found on the back of the head, between the shoulder blades, the upper part of the buttocks, the front side of the neck, hips, and elbows.

It affects mostly women and can develop mostly after you have met with an accident, a disease or without a particular reason.

Treatment

•    Analgesics
•    Sudden change in lifestyle
•    Stretching exercises

1.    Fractures

Fracture in the shoulder blade can occur if you fall on your arm or suffer a direct hit on the shoulder. In cases like bike accidents, the sports accidents shoulder blade fracture can happen.

Symptoms

•    An extreme, sharp and rapid pain in the shoulder blade after a click or pop sound heard.
•    The shoulder blade fracture gets aggravated if there is a movement of the arm, lying on the hurt side or any contact. It might slowly spread to the neck or the upper arm.
•    Swelling or deformity.

The diagnosis of a shoulder blade fracture is only possible through an x-ray.

Treatment

•    Rest
•    Wear a sling
•    Physiotherapy
•    In extreme cases, surgery

The ‘scapula’ fracture, as it called, takes around two weeks to heal with proper treatment.

Fracture of ribs caused by events of same magnanimity, i.e. different kinds of accidents. Sharp pain is experienced just near the shoulder blade. The pain increases with various types of movements like moving, bending, coughing, etc. A cracking sound can hear when there is a movement.

Thoracic spine or fracture of the vertebra in the cervical most often experienced by older people who are already suffering from spinal cancer. It can cause due to minor accidents. It can cause severe and sudden pain between the shoulder blades.

2.    Scoliosis

It sometimes causes pain between the shoulder blades and majorly causes uneven shoulders.

3.    Paget’s Disease

Paget’s disease is mostly experienced by people who are above 40. It is a viral infection of the bones.

Symptoms

•    Weakness
•    Blindness and other different kinds of Neurological symptoms
•    Pain in the pelvis including both the shoulder blades

4.    Scapular Cancer

Various types of cancers like bone cancer, shoulder blade cancer can cause the following things –

•    Pain in the shoulder back, especially when lying.
•    Loss of weight, weakness, and nausea.

Treatment

Usually, bone cement injected into the injured bone which helps in relieving the pain.

1.    Pinched Spiral Nerves

It arises from the spinal cord in the neck and cause severe pain and burning sensation in different places on the shoulder blade

•    Above the shoulder blade if the affected nerve roots are C4, C5, and C6.
•    Between the shoulder blades if the affected nerve roots are C7 and C8.
•    On either side of the shoulder blade if the affected nerves root is C8.

Causes

It majorly caused due to a significant injury. Degenerative disc disease, spinal wear and tear and cervical spinal stenosis can also be causes for it.

The pain experienced when the neck is bent backward; the head is turned sideways or even while lying. The pain gradually starts spreading downwards to the backside of the neck or the arm right up to the fingers. If hands placed above the head, then the pain subsides.

Symptoms of thoracic outlet syndrome can experience when an abnormal pair of ribs above the first pair of rods called the cervical ribs gets pressed on the nerves at their exit on from the thorax. The symptoms are –

•    Numbness, pain and pin and needle in the shoulder blade.
•    Fatigue or coldness in any of the arm or the fingers.

The pain aggravated when the arm is raised above the shoulder for any activity, like scratching the head.

Pectoralis minor Syndrome – It is a small muscle which is present in the scapula till the ribs. It causes pain just below the collar bone. The pain spreads below to the arm up to the last two fingers of the hand.

Causes

•    Crutches used incredibly
•    Heavyweight carried on the shoulder
•    Sitting in front of the computer for long hours
•    Injuries
•    Hyperventilation, mostly due to anxiety

2.    Upper Thoracic Syndrome

Upper Thoracic Syndrome is also is known as the T4 syndrome causes irritation of the spinal joints, and the sympathetic nerves present near the TH4 level.

Symptoms

•    Stiffness and extreme pain in the neck or even, i.e. between the shoulder blades
•    Abnormal sensations and tightness experienced in the hand and forearm.

The pain, however, does not increase with the movement of hands and arms.

Causes

•    Carrying heavy weights
•    Repetitive movements like moving forward, backward, sideways, etc.

Pain can subside by lying flat without the pillow.

3.    Shingles

It arises from the upper chest part or neck of the spinal cord. It caused when the Herpes zoster virus is reactivated in on the spinal nerves. The pain remains for a few weeks to a month’s time.

4.    Brachial Neuritis

Passenger-Turner syndrome (PTS) also known as Brachial Neuritis is a different neurological problem which includes trauma, surgery, infection, etc.

Symptoms

•    Severe pain in the upper arm.

The pain lasts for a few days to multiple weeks. It followed by shoulder blade protrusion. Total recovery might take few months or years.

Symptoms

•    Initially, burning pain
•    Red, itchy blisters are running horizontally from the radial line above the shoulder blades, towards the front of the chest in the form of a stripe.

The pain remains for several weeks or months.

5.    Transverse Myelitis

It caused by a viral infection leading to inflammation of the spinal cord. Viral infections like multiple sclerosis, Lyme disease and systematic lupus erythematosus (SLE) causes this.

Symptoms –

•    Extreme pain by light touches or even cloth bit in the upper back and neck
•    Weakness felt in the arms

6.    Long Thoracic Nerve Injury

This nerve runs down from the armpit to one portion of the chest. A direct hit to the side of the ribs, the constant carrying of heavy weights and continuous arm movements causes this injury.

Symptoms –

•    A shoulder blade sticks out which called as Winging scapula.
•    Mild pain on the side of the chest.
•    Difficulty in lifting the arm on the injured side above and forward.

The recovery time for this injury is very long, about two years.

1.    Gastric Reflux

Symptoms of the Gastro-oesophageal reflux disease (GERD) are:

•    Pain experienced between the shoulder blades. It aggravates after eating when lying down after the meal.
•    Sour taste in mouth
•    Burning sensation in the breastbone

2.    Pneumonia

Infection of the lungs has the following symptoms –

•    High fever, heavy breathing, and coughing mucus
•    Pain on one side of the chest

3.    Pleurisy

It caused by a viral infection like flu, bacterial infection, pneumonia, tuberculosis, and cancer. It causes an inflammation of the lung membrane.

Symptoms

•    Extreme chest pain on both sides of the chest or even the upper back which aggravates during heavy breathing, coughing or even sneezing.

It lasts for a period ranging from 2 days to 2 weeks.

4.    Pneumothorax

It occurs due to the collapse of the lung causing extreme pain on one side of the chest, followed by vague pains, aggravates by breathing and coughing. It is due by the rupture of the lung membrane.

5.    Lung Cancer

Symptoms

•    Continuous pain on one side of the chest
•    Coughing up blood
•    Nausea
•    Loss of weight

Pancoast syndrome caused by a malignant tumor which grows on top of the lung invading the nerves.

Symptoms

•    Continuous pain in the shoulder blade that gets spread down to the arm
•    Drop of eyelid and sweat absence on the affected side of the arm and face

6.    Pulmonary Embolism

It is a clot in the pulmonary artery that supplies the lungs. It occurs in people who have deep vein thrombosis.

Symptoms

•    Sudden extreme pain one any one side of the chest
•    Mild fever and coughing up blood

7.    Heart Attack and Coronary Heart Disease

Coronary heart disease occurs in men after 45 and women after 55.

Symptoms

•    Extreme sudden pain in behind the breast stone and shortness of breath gets aggravated by stress or cold and relieved by pressure or an analgesic nitroglycerin.
•    The pain spreads to the neck, jaw, and both the shoulder blades or between them.

Pain caused by heart attack is similar but a bit stronger and lasts for a longer period (more than 5 minutes). It spreads to the neck, chin, left shoulder, and arms.

8.    Pericarditis

It is the inflammation of the Heart Sac.

Symptoms

•    Mild fever
•    Nausea
•    Shortness of breath
•    Sharp pain in the center or left side of the chest which slowly spreads to the throat, jaw or both the shoulders. The pain aggravates by deep breathing, coughing or even lying down.

The pain is relieved by sitting and leaning forward.

Causes

•    Tuberculosis
•    Trauma
•    Heart attack
•    Kidney failure
•    Cancer
•    Viral infections

9.    Oesophageal Cancer

It causes pain behind the breast stone and between the shoulder blades. The pain intensifies during swallowing.

10.    Enlarged Lymph Nodes in the Chest

In Lymphoma, leukemia, tuberculosis, cystic fibrosis, etc. enlarged lymph nodes seen. It causes an extreme cough, wheezing, and difficulty and swallowing.

11.    Aortic Dissection

It causes severe, sudden pain in between the shoulder blades right in the middle of the chest.

1.    Trapped Gas in Intestine

With constipation, there is trapped gas in a part of the colon which causes slight pain in the upper abdomen, shoulder, and chest. The pain lasts for a few hours.

After several tests like laparoscopy and hysteroscopy, a gas which installed during the process usually gets trapped and causes pain in the shoulder blade. Pain is relieved by lying flat. Pain in the left shoulder blade is common after colonoscopy.

2.    Stomach Disorders

In the middle abdomen, severe pain experienced during Gastritis. Peptic ulcer causes pain in the midst of the belly or the back in between the shoulder blades. Antacids help in relieving the pain.

3.    Gallbladder Disease

Chronic pain experienced in the gallbladder along with the following symptoms –

•    Severe pain experienced below the rib cage. The pain can experience from anywhere between minutes to several hours. The pain aggravates while breathing.
•    Vomiting
•    Fever
•    Nausea

If there are stones in the bile duct, then it can have few other symptoms like –

•    Smelly stools
•    Jaundice
•    Dark urine

Disorder of the biliary tract causes Biliary Dyskinesia. It creates similar sort of pain which experienced during gallbladder inflammation. The pain might remain even after gallbladder removal.

4.    Kidney Disease

It causes pain in below either of the shoulder blades. It is aggravated by tapping on the kidney and not by body movements. Stones in the kidney can cause severe pain which might last for several hours. It can spread to the abdomen or groin.

5.    Pancreatic Cancer and Acute Pancreatitis

Acute Pancreatitis causes:

•    Pain in the upper abdomen. It intensifies after meals.
•    Diarrhoea
•    Nausea
•    Fever

Pancreatic Cancer Causes

•    Weight loss
•    Jaundice
•    Nausea
•    Loss of appetite
•    Lump in upper middle abdomen

6.    Enlarged Spleen

Constant pain experienced in the upper abdomen, which aggravates with deep breathing. Enlarged spleen happens in cases like malaria, leukemia, lymphoma, etc.

7.    Liver Cancer

It causes:

•    Jaundice
•    Weight loss
•    Lump and pain below the rib cage

Post liver biopsy, pain is experienced in the shoulder blade area for a few days.

8.    Other Causes of Pain Due to Irritation of the Diaphragm

Any process which irritates the diaphragm can result in pain in the left or right shoulder blade.

•    Duodenal Ulcer – It causes extreme pain in the upper abdomen or middle back.
•    Ruptured Appendix – It causes pain in the central or right or lower abdomen resulting in fever, vomiting, and nausea.
•    Peritonitis – It causes extreme abdominal pain, tenderness, and fever.
•    Ruptured Ectopic Pregnancy – It causes a sudden and severe pain in the lower abdomen.
•    Ruptured Ovarian Cyst – It causes pain in the lower abdomen.
•    Pelvic Disease – It causes pain in the abdomen.
•   Endometriosis – Abdominal pain which worsens during ovulation and periods.

1.    Tear and Rotator Cuff Tendonitis

Rotator cuff helps in moving the shoulder. It happens due to inflammation in the rotator cuff tendons. Different activities like sports which have over the head movements. Extreme pain experienced in the front of the shoulder, and it slowly starts spreading. Pain increases when the arm lifted above the shoulder.

Using the shoulder a lot can also cause inflammation of tendon sheets which is called as Tenosynovitis or Bursitis, inflammation of the subacromial bursa.

2.    Calcific Tendonitis

It causes mild fever and extreme pain in the shoulder. Among other things, it also causes stiffness and snapping in the shoulder.

3.    Adhesive Capsulitis

The frozen shoulder also is known Adhesive Capsulitis is inflammation of the shoulder capsule. The different causes of it include diabetes, immobilization of the shoulder, etc. It develops amongst people above 40. The pain resides in a week or two.

4.    Arthritis of the Shoulder Joint

The most common types of arthritis are Osteoarthritis and post-traumatic arthritis and Rheumatoid Arthritis. It causes extreme pain in the shoulder and swelling in the entire arm. Pain intensifies with the change in weather.

5.    Subluxation and Shoulder Sprain

A shoulder injury is overstretching of the shoulder joint. It can cause due to falling on an arm, overuse of one of the shoulders and the direct hit to the shoulder. It causes extreme pain in the shoulder swelling, redness, and stiffness.

Subluxation of the shoulder joint is partial dislocation of the head of the upper bone. It can happen due to any injury on the shoulder joint capsule. It can result in clicking or popping when the shoulder moved.

6.    Avascular Necrosis

Avascular Necrosis is bone death owing to the low blood supply. The exact cause behind this is not known, but the likely ones are alcoholism, AIDS, shoulder trauma, etc. The symptom is extreme, throbbing pain around the shoulder.