Back pain under the right shoulder blade is common, ranging from a dull ache to a sharp, stabbing sensation. While often benign and related to musculoskeletal issues, this pain can sometimes indicate more serious conditions. Understanding its possible origins helps individuals navigate symptoms and determine appropriate next steps.
Common Causes of Pain Under the Right Shoulder Blade
A frequent reason for pain under the right shoulder blade is muscle strain or tension, often involving the rhomboid muscles. Located in the upper back between the shoulder blades and spine, these muscles stabilize the shoulder blades and maintain posture. Overuse from repetitive activities or lifting heavy objects can lead to strain or spasms. Symptoms may include tenderness, tightness, or a popping sensation when moving the shoulder blade.
Poor posture is another common contributor to discomfort. Prolonged sitting or standing in a slouched position, especially when using computers or mobile devices, weakens upper back muscles and strains the shoulder blade area. This continuous strain results in aching pain or tension that worsens with extended sitting or standing. It can also affect how efficiently shoulder muscles work, leading to discomfort.
Nerve impingement can cause pain under the right shoulder blade. A herniated disc or degenerative disc disease in the cervical (neck) or upper thoracic spine can compress nerves extending to this region. This pain is often shooting, electric-like, or burning, and may be accompanied by numbness, tingling, or weakness in the arm. Arthritis in the neck, spine, or rib joints may also contribute to pain radiating towards the shoulder blades.
When Pain Signals Something More Serious
While often musculoskeletal, pain under the right shoulder blade can be referred pain from internal organs, indicating a serious issue. The right side of the body houses several organs that can radiate pain here. Conditions affecting the liver, such as hepatitis or congestion, cause discomfort in the upper right abdomen or shoulder blade, sometimes with jaundice or abdominal swelling. Liver pain can also spread to the back and neck, described as a dull ache or throbbing sensation.
Gallbladder issues, including gallstones or inflammation, are another source of referred pain to the right shoulder blade. Pain from gallstones may be felt in the center or right upper abdomen, between the shoulder blades, or in the right shoulder. Issues with the diaphragm, the muscle separating the chest and abdomen, can also cause referred pain to the shoulder or chest.
Certain “red flag” symptoms accompanying shoulder blade pain require immediate medical attention. These include shortness of breath, chest pain, lightheadedness, excessive sweating, or a rapid heart rate, which could signal a heart attack (especially in women). Sudden, severe pain between the shoulder blades, particularly with breathing difficulties, may indicate a pulmonary embolism or an aortic tear. Other concerning symptoms include fever, chills, unexplained weight loss, persistent nausea or vomiting, and yellowing of the skin.
Immediate Relief and Self-Care Strategies
For mild to moderate pain, several self-care strategies can provide relief. Resting the affected area by avoiding strenuous activities for a day or two can reduce discomfort and prevent overuse. However, avoid prolonged inactivity, as staying in one position can sometimes exacerbate the pain.
Applying heat or cold packs can be beneficial. Cold therapy, such as an ice pack wrapped in cloth, can be applied for 10 to 20 minutes, with at least a two-hour break. Heat therapy, like a heating pad, can be used for 15 to 20 minutes per treatment, also with a two-hour interval. Alternating between hot and cold may provide greater relief.
Gentle stretching exercises alleviate tension in the muscles surrounding the shoulder blades. Simple stretches like shoulder blade squeezes or doorway stretches improve flexibility and reduce stiffness. Over-the-counter pain relievers, such as NSAIDs like ibuprofen, manage pain and reduce inflammation. Improving posture by maintaining a straight back and avoiding slouching also relieves stress on upper back muscles.
Medical Evaluation and Treatment Approaches
When pain under the right shoulder blade persists, worsens, or is accompanied by concerning symptoms, medical evaluation is advisable. A healthcare provider begins with a thorough physical examination, assessing posture, range of motion, muscle strength, and medical history. This assessment helps identify potential causes and determine if further diagnostic tests are needed.
Imaging tests are often ordered to visualize the spine and surrounding tissues. X-rays help rule out fractures, alignment issues, or osteoarthritis. Magnetic resonance imaging (MRI) provides detailed images of soft tissues like muscles, ligaments, discs, and nerves, useful for detecting nerve compression or disc problems. In some cases, a computed tomography (CT) scan might be used, especially if bone injuries are suspected.
Treatment approaches vary depending on the diagnosis. Physical therapy involves exercises to strengthen weak muscles, improve posture, and increase flexibility. Chiropractic care may be recommended to address spinal alignment issues. Prescription medications, such as muscle relaxants or stronger pain relievers, manage acute pain.
For localized muscle pain and knots, trigger point injections, involving a local anesthetic and sometimes a corticosteroid, provide relief by inactivating trigger points. In rare instances, if conservative treatments are ineffective or a serious structural issue is identified, surgical considerations might be explored.