Pain under the shoulder blades, also known as interscapular pain, can be an uncomfortable and worrying sensation. It often manifests as a dull ache, burning sensation, or even sharp, stabbing pain between the shoulder blades, potentially radiating to other areas like the neck or arms.
Understanding the causes is crucial because the pain could stem from several factors, ranging from musculoskeletal issues to serious underlying conditions.
This blog will dive into the most common causes of pain under the shoulder blades, how to identify the source of discomfort, and potential treatments.
10 Common Causes of Shoulder Blade Pain
1. Muscle Strain
One of the most frequent causes of pain under the shoulder blades is muscle strain. Everyday activities, including poor posture, lifting heavy objects, or even prolonged periods of sitting at a desk, can contribute to this condition.
a. Poor Posture
Slouching or hunching over while sitting or standing can put excess strain on the muscles between the shoulder blades. For example, leaning forward to look at a computer screen can cause the muscles in the back and neck to tighten and become fatigued, leading to pain.
b. Overuse or Injury
Athletes or individuals who engage in repetitive upper body motions (e.g., swimmers, weightlifters) are prone to muscle strain in the scapular region. Lifting heavy objects incorrectly or using improper technique can also overextend the muscles, causing micro-tears and inflammation.
Symptoms:
Dull or sharp pain between the shoulder blades
Stiffness or difficulty moving the shoulders
Pain that worsens with movement or stretching
Treatment:
Rest and avoid activities that exacerbate the pain.
Ice the affected area to reduce inflammation.
Gentle stretching and physical therapy may help restore muscle balance and strength.
2. Poor Ergonomics
In today’s digital world, more people are spending long hours at desks, often with poor ergonomic setups. Sitting in a non-supportive chair, using a desk or computer monitor at the wrong height, or typing at an awkward angle can cause stress on the back and neck muscles, leading to discomfort under the shoulder blades.
Symptoms:
Pain that develops over time, particularly towards the end of the day
Discomfort that improves with changes in position or movement
Associated neck or lower back pain due to compensatory movements
Treatment:
Adjust your workstation to promote a neutral spine position.
Use a chair with lumbar support and ensure your feet are flat on the floor.
Take frequent breaks to stand and stretch to reduce muscle stiffness.
3. Rotator Cuff Injury
The rotator cuff consists of four muscles that help stabilize and move the shoulder. Injury to these muscles or their tendons can cause significant discomfort, particularly under or around the shoulder blades.
a. Tendonitis
Overuse or repetitive motions (e.g., painting, lifting, or overhead sports) can cause inflammation of the rotator cuff tendons, leading to tendonitis. This condition often causes pain to radiate from the shoulder to the upper back and shoulder blades.
b. Tears
Partial or complete tears in the rotator cuff may occur due to acute injury or degeneration. This condition can lead to persistent, nagging pain under the shoulder blades.
Symptoms:
Sharp or aching pain that worsens with arm movement
Weakness in the shoulder, making lifting or rotating difficult
Pain that radiates to the back or neck
Treatment:
Rest, ice, and anti-inflammatory medications for mild cases.
Physical therapy to improve strength and flexibility.
Surgery in severe cases, especially if there’s a complete tear.
4. Shoulder Blade Fracture
Though less common, fractures of the scapula (shoulder blade) can cause significant pain under the shoulder blades. These fractures often occur due to traumatic injury, such as falls or car accidents, and are often accompanied by other injuries.
Symptoms:
Severe, sharp pain immediately after trauma
Swelling, bruising, or visible deformity in the shoulder region
Difficulty moving the arm
Treatment:
Immobilization using a sling or brace.
Physical therapy to restore movement and strength after the bone heals.
Surgery may be required if the fracture is severe or displaced.
5. Spinal Conditions
Pain under the shoulder blades can also originate from the spine. Several spinal conditions can compress nerves or cause referred pain to the scapular region.
a. Herniated Disc
A herniated or slipped disc in the cervical (neck) or thoracic (upper back) spine can compress nearby nerves, causing radiating pain to the shoulder blades. The discs in the spine act as cushions between the vertebrae, but when one becomes damaged, it can press on nerves, sending pain signals to areas such as the shoulder blades.
b. Degenerative Disc Disease
As we age, the discs in our spine naturally begin to wear down, losing their cushioning properties. This degeneration can cause stiffness and pain, which may manifest as discomfort under the shoulder blades, particularly during prolonged sitting or standing.
Symptoms:
Pain that radiates from the neck or back to the shoulder blades
Numbness or tingling in the arms
Pain that worsens with specific movements or positions
Treatment:
Anti-inflammatory medications to reduce swelling.
Physical therapy to strengthen the muscles supporting the spine.
Surgery in severe cases where nerve compression is causing significant pain or weakness.
6. Gallbladder Disease
Surprisingly, internal organ issues can cause referred pain under the shoulder blades. Gallbladder disease, including gallstones or inflammation of the gallbladder (cholecystitis), can trigger pain in the upper abdomen that radiates to the right shoulder blade.
Symptoms:
Sharp, cramping pain in the upper right abdomen
Nausea or vomiting, especially after eating fatty foods
Pain that radiates to the right shoulder or back
Treatment:
Dietary changes, such as reducing fatty foods, can help alleviate symptoms.
Medications to dissolve gallstones or manage inflammation.
Surgery (cholecystectomy) in cases of severe gallbladder disease.
7. Heart-Related Issues
In some cases, pain under the shoulder blades can be a sign of a heart-related issue, particularly in women. Heart attacks or angina (chest pain due to restricted blood flow to the heart) can cause referred pain to the left shoulder blade, along with other symptoms like chest pain and shortness of breath.
Symptoms:
Sudden, sharp pain under the left shoulder blade
Chest pain or pressure
Shortness of breath, sweating, or dizziness
Pain that radiates to the arm or jaw
Treatment:
Seek immediate medical attention if a heart attack is suspected.
Medications such as blood thinners or beta-blockers to manage symptoms.
Lifestyle changes or surgery, such as angioplasty, to improve heart health.
8. Lung Conditions
Lung-related conditions can also cause referred pain under the shoulder blades, particularly on the right side. Conditions such as pneumonia, pulmonary embolism, or pleurisy (inflammation of the lining of the lungs) can cause discomfort that radiates to the back.
Symptoms:
Sharp or stabbing pain that worsens with deep breaths or coughing
Shortness of breath or wheezing
Fever or chills (in the case of infections)
Treatment:
Antibiotics or antiviral medications for infections like pneumonia.
Anticoagulants for pulmonary embolism (blood clots in the lungs).
Rest and anti-inflammatory medications for pleurisy.
9. Nerve Compression or Irritation
Nerve issues, such as compression or irritation, can cause pain to radiate to the area under the shoulder blades. This is particularly common with the brachial plexus, a network of nerves that extend from the neck down into the shoulders and arms.
a. Thoracic Outlet Syndrome
This condition occurs when the nerves or blood vessels between the collarbone and first rib become compressed, causing pain and discomfort in the shoulder and under the shoulder blades.
b. Shingles
Shingles, caused by the reactivation of the varicella-zoster virus (the same virus that causes chickenpox), can cause a painful rash that typically appears on one side of the body. If it affects the nerves near the shoulder blades, it can result in intense pain in that area, even before the rash appears.
Symptoms:
Numbness, tingling, or weakness in the arms
Burning, stabbing pain in the shoulder blade region
Pain that radiates down the arm or up to the neck
Treatment:
Anti-inflammatory medications or physical therapy for nerve compression.
Antiviral medications and pain relief for shingles.
Surgery may be needed in severe cases of nerve compression.
10. Stress and Tension
Stress and emotional tension can manifest physically, often leading to muscle tightness and discomfort under the shoulder blades. Prolonged periods of stress can cause individuals to unconsciously tighten their muscles, particularly in the shoulders and upper back.
Symptoms:
Aching or tightness in the muscles between the shoulder blades
Pain that comes and goes, often worse after stressful events
General fatigue or muscle stiffness
Treatment:
Stress management techniques such as yoga, meditation, or deep breathing exercises.
Regular physical activity to relieve muscle tension.
Massage therapy or chiropractic care to help alleviate muscle tightness.
Preventing Pain Under the Shoulder Blades
Prevention is always better than cure, and in many cases, pain under the shoulder blades can be avoided by making adjustments to daily habits and improving overall health and well-being.
1. Posture Correction
Maintaining good posture is one of the most effective ways to prevent shoulder blade pain. This involves keeping your back straight, shoulders relaxed, and head aligned with your spine, whether you’re sitting, standing, or moving. Using ergonomic furniture and adjusting your workstation to promote neutral alignment can reduce strain on your muscles.
2. Regular Stretching and Exercise
Frequent stretching and strengthening exercises for the upper back, shoulders, and neck can help keep muscles flexible and strong. Practices like yoga or Pilates, which focus on core strength and flexibility, can improve posture and reduce tension in the shoulder blade region.
3. Mindful Movements
Pay attention to how you perform activities that involve lifting, reaching, or repetitive motions. Use proper techniques when lifting heavy objects and avoid overextending your shoulders. If your job or daily routine involves repetitive upper body movements, take breaks and alternate between tasks to avoid overuse injuries.
4. Manage Stress
Emotional and mental stress can have a direct impact on your physical health, particularly in the form of muscle tension. Implementing stress management strategies such as meditation, deep breathing, or time management techniques can help reduce the likelihood of stress-related muscle pain.
5. Healthy Weight and Diet
Maintaining a healthy weight reduces strain on your spine and shoulders, which can, in turn, reduce pain under the shoulder blades. A balanced diet rich in anti-inflammatory foods like fruits, vegetables, whole grains, and lean proteins can also support overall muscle and joint health.
When to See a Doctor
While many causes of pain under the shoulder blades are relatively minor and can be managed with rest, stretching, and lifestyle changes, there are instances where the pain could be a sign of a more serious underlying condition that requires medical attention.
1. Persistent Pain
If your pain lasts longer than a week or progressively worsens despite rest and self-care, it’s important to consult a healthcare provider. Persistent pain could be a sign of a more significant issue like a herniated disc or rotator cuff injury that needs specialized treatment.
2. Sudden, Severe Pain
Sudden, intense pain that appears without a clear cause, particularly if accompanied by chest pain, shortness of breath, or dizziness, may be a sign of a heart attack or other serious conditions such as a pulmonary embolism. In these cases, seek emergency medical help immediately.
3. Accompanying Symptoms
If your pain is accompanied by other concerning symptoms, such as numbness, tingling, weakness, fever, or unexplained weight loss, it’s crucial to see a doctor. These symptoms could indicate nerve damage, an infection, or even cancer.
4. Pain Related to Injury
If your pain began after a fall, car accident, or other traumatic events, it’s advisable to have a medical evaluation to rule out fractures, muscle tears, or internal injuries.
Final Thoughts
Pain under the shoulder blades can range from a minor annoyance to a debilitating condition, depending on the cause. While many cases are related to lifestyle factors such as posture, repetitive motion, or stress, it’s important to recognize when the pain may indicate a more serious issue. By addressing the root cause and adopting preventative strategies, many individuals can find relief from shoulder blade pain and improve their overall quality of life.
If you’re experiencing shoulder blade pain that doesn’t go away with rest or self-care, don’t hesitate to seek medical advice. A healthcare provider can help you determine the cause and guide you toward the appropriate treatment, ensuring you can get back to your daily activities pain-free.
By understanding the various causes of shoulder blade pain, including muscle strain, poor posture, spinal conditions, and even heart or lung problems, you can take the necessary steps to prevent, treat, and manage this common issue effectively.
For anyone experiencing Shoulder pain, seeking the expertise of a qualified orthopedic and physiotherapist is a step in the right direction toward recovery and long-term shoulder health.
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About The Author: Dr. Surendra Patil (M.B.B.S DNB / D.Ortho)
Dr. Surendra Patil, MBBS, Diploma in Orthopaedics, DNB - Orthopedics Surgery, is a dynamic surgeon with skilled hands well versed in various surgical procedures in orthopedics and exceptionally well-read in his chosen expertise. He is proficient in Arthroscopic Surgeries, Adult Joint Reconstruction Surgery, Accidents & Emergencies, Joint Replacement, Healthcare Management, and Healthcare in general. He is an experienced Medical Professional with a demonstrated history of working in the hospital & healthcare industry. Follow: LinkedIn