Pain under your shoulder blade?

Shoulder blade pain is confusing. The blade itself is rarely the part that is actually hurt. Scapular fractures do happen, usually after a car crash or another high-energy hit, and stress fractures in the scapula turn up now and then in throwers and overhead athletes. More often the ache comes from the muscles and cushions that let the blade glide. It can also come from an irritated nerve in the neck, a nearby rib or joint, or a bone in the spine.

What sits under your shoulder blade

Your shoulder blade doesn't lock into a socket against your rib cage. It rests there, held in place by muscles, with small fluid-filled cushions (bursae) between it and the ribs to cut friction. When those muscles tire or weaken, the blade can rub instead of glide, and it starts to ache.

Match your symptoms before you guess at a cause

How the pain behaves tells us more than where you point. Use this table as a rough guide, not a diagnosis. If sharp pain with breathing comes with shortness of breath, see the emergency list below. If no row fits, come in for an exam and we'll sort it out together.

Get emergency care right away for these

• Shoulder blade or upper back pain that comes with chest pain or pressure, shortness of breath, sweating, nausea, or pain spreading to your jaw or arm. This can be a heart problem. Call 911.
• Sharp pain when you breathe that comes with shortness of breath, coughing up blood, a racing heart, or a swollen, painful calf. This can be a blood clot or a lung problem. Call 911.
• New weakness in your legs, unsteady walking, numbness in the groin or inner thighs, or changes in bladder or bowel control. Go to the emergency room right away.

See a doctor soon for these

These aren't usually emergencies, but don't wait a few weeks to see if they settle.

• Pain that started right after a crash, a fall, a heavy lift or a direct blow to the upper back
• New weakness in the arm or hand, or numbness that stays instead of coming and going
• Shoulder blade or upper back pain in anyone with a history of cancer, a weakened immune system, or a history of injecting drugs
• Pain that is worse at night, doesn't ease when you change position, or wakes you from sleep
• Fever, chills, night sweats, or weight loss you can't explain
• Pain on the right side with nausea or belly symptoms, often after meals, but no chest pain or shortness of breath. It can come from an organ like the gallbladder and needs a medical check. When in doubt, call 911.
• Pain that doesn't change no matter how you move your arm

Fever or chills with new back pain should be checked the same day, especially if your immune system is weak or you have injected drugs.

The everyday causes: too much load, too little support

The cause we see most is simple: the muscles that hold your shoulder blade steady get overworked from desk work, a heavy bag, or lots of reaching, and they turn sore and tight.

A pinched nerve in the neck feels different: burning pain, often with tingling down the arm into the hand. Irritated joints or ribs in the upper back tend to cause a sharp, catching pain with a deep breath, a cough or a twist.

When it grinds, clicks or snaps

Some people hear their shoulder blade and feel it. It can grind, click or snap against the ribs as you raise your arm, often after lots of overhead work. A hands-on exam usually tells us what's going on.

When the blade sticks out like a wing

Sometimes the inner edge of your shoulder blade lifts away from your ribs. Weak muscles can cause this, and a nerve problem can also make the shoulder blade stick out like a wing. Come in for an exam so we can tell which it is.

The cause that hides: a spine fracture

If you're over 50 or have thin bones, sudden pain in your upper back or around your shoulder blade should be checked within a day or two, not weeks. A minor fall or lift can be enough to crack a bone in the spine so it squashes down (a compression fracture). If we find one, we treat it and help you start a bone-health plan.

Your desk is part of the treatment plan

Sitting at a computer all day long can be the culprit. Moving often, getting up, stretching and paying attention to your posture are helpful. No single posture protects you on its own, so take short breaks. Set up your desk in this order, since each step affects the next.

1. Set the chair first, with your feet flat and your lower back supported.
2. Adjust the armrests next. Armrests set too high keep your shoulders shrugged.
3. Bring the mouse in close, so your shoulder isn't holding your arm out all day.
4. Then set the screen height. A screen that's too high makes you tip your head back.
5. Last, check how high your arms sit while you type. Arms held too high or too low both strain your shoulders.

On a laptop, a separate keyboard and a stand that raises the screen often help your neck.

How we pin down the cause

We start with your story and a hands-on exam, watching how your shoulder blade moves and checking your neck, ribs, spine and strength. We add imaging, such as an X-ray or MRI, only when it will change the plan. Many people never need an MRI or CT scan.

Treatment, simplest first

Almost every plan starts without surgery. Rest, medicine, physical therapy and home exercises help many people, and injections or surgery come up only if the pain stays strong. Worsening arm weakness needs to be seen quickly.

What you can do this week

You don't have to wait for your visit to start. Try these and write down what happens.

• Hold anything heavy close to your body, not out at arm's length.
• Break up overhead work into shorter blocks, with rests in between.
• Notice whether turning your head toward the sore side brings back the pain or tingling in your fingers.
• Notice whether a deep breath or a twist makes the pain sharp.
• Work through the desk steps above, in order.

Let's find out what's actually causing it

If your shoulder blade pain has lasted more than a couple of weeks, keeps coming back, or comes with weakness, numbness or grinding, we'd like to take a look. Our orthopaedic physicians, physiatrists (rehabilitation doctors) and physical therapists work side by side on a plan built around your goals.

Schedule Exam with Princeton Orthopaedic Associates and let's get you moving comfortably again.

The information here is educational and is not a substitute for individual evaluation, diagnosis or treatment by a qualified clinician.

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This blog post is meant to be informative and should not act as a self-diagnosis tool. If you’d like to see one of our doctors, please contact us here.