Pain under the shoulder blade when breathing can be an unsettling sensation, manifesting as sharp, dull, stabbing, or aching discomfort, sometimes with tightness. While concerning, it often stems from less severe causes.
Common Causes of Pain Under the Shoulder Blade When Breathing
Pain under the shoulder blade worsening with breathing can stem from various sources, including muscle issues, lung conditions, or nerve problems.
Musculoskeletal Issues
Muscle strains are a frequent cause of pain in this region, particularly affecting muscles like the rhomboids and trapezius in the upper back. Overuse injuries from repetitive motions or poor posture can strain these muscles, leading to pain that intensifies with movements such as deep breaths or coughing. Prolonged slouching or hunching over can weaken back muscles and put pressure on structures around the shoulder blades. Rib dysfunction, such as costochondritis (inflammation of cartilage connecting ribs to breastbone) or intercostal muscle strain (muscles between ribs), can also lead to sharp pain under the shoulder blade, making deep breathing difficult. If a rib becomes misaligned, surrounding muscles can become overworked during normal breathing, causing pain to radiate through the upper back and shoulder blade.
Nerve-Related Issues
Nerve compression, often called a pinched nerve, can cause pain that radiates to the area under the shoulder blade. Cervical radiculopathy, a pinched nerve in the neck, can lead to sharp or burning pain in the shoulder, arm, or hand, worsening with neck movements or deep breaths. A herniated disc in the cervical or upper back (thoracic) spine can also compress nearby nerves, resulting in pain under the shoulder blade. This pain is often described as stinging, electric-like, or burning, and may be accompanied by numbness or tingling.
Respiratory Conditions
Conditions affecting the lungs or pleura (the thin membranes surrounding the lungs) can cause sharp or stabbing pain that worsens with deep breaths or coughing. Pleurisy, an inflammation of the pleural lining, is a common example where sharp chest pain may radiate to the shoulder. Other respiratory issues like bronchitis or pneumonia can also intensify pain with breathing due to inflammation or infection. A pneumothorax, where air escapes into the space between the lung and chest wall, causes sharp pain that significantly worsens with deep breaths as the lung partially collapses. Asthma exacerbations can also contribute to discomfort if breathing becomes labored.
Other Potential Causes
Less common causes can also lead to pain under the shoulder blade when breathing. Acid reflux (GERD) can cause referred pain in the chest, throat, and sometimes the shoulder blades due to esophageal irritation. Gallstones, typically causing upper right abdominal pain, can sometimes refer pain to the right shoulder blade, which might be noticed more with certain movements or breathing patterns.
When to Seek Medical Attention
While many instances of pain under the shoulder blade when breathing are not serious, certain symptoms warrant professional medical evaluation. Consult a doctor if the pain persists, worsens, or does not improve with home care. Immediate medical attention is necessary if the pain is severe, sudden, or accompanied by “red flag” symptoms. These include:
Severe or worsening pain, especially with fever or chills.
Shortness of breath, difficulty breathing, or chest pain (potential heart attack or pulmonary embolism).
Numbness or tingling in the arm or hand.
Pain radiating to the arm, jaw, or neck.
Dizziness or lightheadedness.
Pain after a significant injury or trauma.
These symptoms indicate a potentially serious underlying condition.
Home Strategies for Relief
For less severe pain, home strategies can reduce muscle tension, inflammation, and support the area.
Rest and Activity Modification
Rest the affected area, avoiding aggravating activities. Gentle activity modification is often more beneficial than complete inactivity.
Temperature Therapy
Apply ice packs for 10-20 minutes for acute pain, with at least a two-hour break between sessions. For muscle tension, heat therapy can be used for 15-20 minutes. Alternating between ice and heat can also be explored.
Over-the-Counter Pain Relievers
NSAIDs (ibuprofen, naproxen) or acetaminophen can help reduce pain and inflammation.
Gentle Movement and Posture
Simple stretching exercises, such as arm circles or shoulder blade squeezes, can improve flexibility and circulation. Being mindful of posture throughout the day, especially when sitting, can prevent further strain.
Diaphragmatic Breathing
Focus on breathing deeply from the diaphragm (belly breathing) to reduce reliance on accessory breathing muscles. This involves placing one hand on the chest and the other on the abdomen, then inhaling slowly through the nose, allowing the abdomen to expand while keeping the chest relatively still.
Stress Management
Stress management techniques can be beneficial, as stress can contribute to muscle tension. Relaxation practices can help calm the body and mind, potentially reducing pain perception.
These home strategies offer temporary relief, but if symptoms persist or worsen, professional medical advice should be sought.