Pain experienced under the scapula, particularly when breathing, can be a concerning symptom. While this discomfort is often associated with less serious conditions, understanding its various potential origins is key. This article provides general information on its causes and management.
Understanding the Origin of the Pain
Pain under the scapula, especially when accompanied by breathing, can stem from issues with muscles, bones, or conditions affecting the respiratory or nervous systems. The discomfort often arises from musculoskeletal problems, such as muscle strains in the upper back due to poor posture, heavy lifting, or repetitive motions. Muscles surrounding the shoulder blade, like the rhomboids or trapezius, can become strained or develop trigger points, leading to localized pain that intensifies with movement or deep breaths.
Rib-related issues, including costochondritis or rib subluxation, are also common causes. Costochondritis involves inflammation of rib cartilage, causing sharp chest pain that can radiate to the back and worsen with deep breathing or coughing. A rib subluxation, a slight rib shift, can result in sharp pain under the shoulder blade, exacerbated by breathing or upper body movements.
Respiratory conditions can also cause referred pain under the scapula because the pleura, the lining around the lungs, shares nerve pathways with areas in the back. Pleurisy, an inflammation of this pleural lining, causes sharp chest pain that worsens with deep breaths, coughing, or sneezing, and can spread to the shoulder or back. Infections like pneumonia or bronchitis can lead to pleurisy or directly irritate nerves, causing pain between the shoulder blades or in the upper back, which may intensify with breathing or coughing. Fluid buildup around the lungs from these conditions can also compress the pleura, leading to pain.
Nerve-related issues are another cause, where irritation or compression of nerves in the neck or upper back can manifest as pain radiating to the scapular region. A herniated disc in the cervical (neck) or thoracic (upper back) spine can press on nerves, leading to sharp, stinging, or burning pain that may include numbness or tingling. Poor posture can contribute to muscle imbalances and nerve impingement, causing discomfort under the shoulder blade.
Less commonly, referred pain from issues in other parts of the body can present under the scapula. For instance, gallbladder problems, such as gallstones or inflammation (cholecystitis), can cause pain in the upper right abdomen that radiates to the right shoulder blade or back. Certain cardiac conditions, including a heart attack or pericarditis, can cause referred pain to the shoulder, arm, jaw, or back, especially the left shoulder blade, due to shared nerve pathways.
When Medical Evaluation is Necessary
While pain under the scapula when breathing can be benign, certain accompanying symptoms warrant prompt medical evaluation to identify serious conditions. Seek immediate medical attention if the pain is severe, sudden, or accompanied by shortness of breath, chest pain, dizziness, lightheadedness, or excessive sweating. These symptoms could indicate a heart attack, a pulmonary embolism (blood clot in the lungs), or an aortic dissection, all of which are medical emergencies.
It is also important to consult a healthcare professional if the pain follows a trauma or injury, such as a fall or accident. Pain accompanied by fever, chills, or a persistent cough could suggest an infection like pneumonia. Numbness, tingling, or weakness in the arm or hand alongside scapular pain may indicate nerve compression that requires assessment. Additionally, if the pain does not improve with rest or over-the-counter pain relievers, or if it worsens over time, a medical consultation is advisable.
Approaches to Diagnosis and Treatment
When seeking medical help for pain under the scapula during breathing, a healthcare provider starts with a thorough physical examination and a review of medical history. The doctor will ask about the pain’s characteristics, including its location, intensity, and what makes it better or worse, and inquire about any other symptoms. Depending on the suspected cause, diagnostic tests may be ordered. These can include X-rays to visualize bones, CT scans for detailed cross-sectional images, or MRI scans to examine soft tissues like muscles, nerves, and discs. Blood tests might be performed to check for inflammation or infection.
Treatment approaches vary significantly based on the diagnosed cause. For musculoskeletal issues, treatment includes rest from aggravating activities, applying ice or heat to the affected area, and physical therapy. Physical therapy can involve exercises to improve posture, strengthen muscles, and increase flexibility. Over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or naproxen are used to reduce pain and inflammation. In some cases, muscle relaxants may be prescribed for short-term relief of muscle spasms.
For respiratory causes, treatment focuses on the underlying infection or inflammation. Bacterial infections require antibiotics, while anti-inflammatory medications can help manage conditions like pleurisy. Nerve-related pain might benefit from physical therapy, nerve blocks, or specific exercises aimed at correcting posture and reducing nerve compression. Lifestyle adjustments such as maintaining good posture, ensuring an ergonomic workspace setup, and stress management techniques are recommended as supportive measures or to prevent recurrence. A proper diagnosis from a healthcare professional remains essential for effective and personalized treatment.