Pain behind the shoulder blade is a common experience. It can be a dull ache, sharp stabbing, or persistent throbbing. While often minor and self-resolving, this pain is a symptom, not a diagnosis, with varied underlying causes. Understanding its origins helps identify when professional medical attention is beneficial.
Common Musculoskeletal Causes
Musculoskeletal issues typically stem from the muscles, bones, and joints in the upper back and shoulder.
Muscle strain or spasm results from overuse, poor posture, or sudden movements. Muscles like the rhomboids, between the shoulder blades, can strain or contract involuntarily, leading to pain, stiffness, or tightness. Overexertion from activities such as overhead lifting or repetitive motions can strain these muscles, creating painful trigger points or muscle knots.
Poor posture contributes to stress on upper back muscles. Prolonged slouching or sitting with a rounded back can weaken supporting muscles and alter shoulder blade position, causing discomfort. This sustained stress can lead to muscle fatigue and pain between the shoulder blades.
Rib dysfunction occurs when a rib joint becomes misaligned or “locked,” causing sharp pain that worsens with movement or deep breathing. The first rib, at the top of the ribcage, is particularly susceptible due to neck muscle attachments and its role in shoulder movement. This misalignment can impact shoulder function and contribute to referred pain to the shoulder blade.
Rotator cuff issues, while primarily affecting the shoulder joint, can refer pain to the shoulder blade. Conditions like shoulder impingement (pinched tendons) or rotator cuff tendinitis (tendon inflammation) can cause pain spreading to the shoulder blade. This pain often intensifies with arm movement, especially when lifting the arm overhead.
Scapular dyskinesis describes abnormal shoulder blade movement or positioning during arm motion. This alteration can arise from muscle weakness, imbalances, or nerve injuries affecting scapular control muscles. Symptoms include pain or tenderness near the shoulder blade, weakness in the affected arm, and sometimes visible “winging” or protrusion.
Nerve Compression and Irritation
Nerve compression and irritation can cause pain behind the shoulder blade, with symptoms extending beyond localized discomfort. When nerve roots exiting the spinal cord become compressed, it can lead to radiculopathy, radiating pain, numbness, or tingling. This compression can occur in the cervical (neck) or thoracic (upper back) spine due to a herniated disc or bone spur, sometimes described as burning or electric-like.
Thoracic Outlet Syndrome (TOS) is another condition involving nerve compression in the space between the collarbone and first rib. This syndrome can compress nerves and blood vessels, leading to pain in the neck, shoulder, arm, or hand. Symptoms of TOS include numbness, tingling, weakness, or changes in skin color and temperature.
Pain Originating Elsewhere
Pain behind the shoulder blade can be referred from other body areas, indicating non-musculoskeletal conditions. This referred pain often does not change with movement.
Cardiac issues, like angina or a heart attack, can cause pain in the left shoulder blade, arm, or jaw. Women might experience shoulder blade pain, fatigue, sweating, or nausea during a heart attack. Aortic dissection, a tear in the body’s largest artery, can also cause severe pain near the shoulder blade.
Pulmonary conditions can also cause pain behind the shoulder blade. Pleurisy, inflammation of the lung lining, causes sharp chest pain that worsens with deep breathing or coughing, and pain can spread to the shoulder or back. Lung cancer, especially Pancoast tumors at the lung’s top, can directly cause shoulder blade pain.
Gastrointestinal issues are another source of referred pain. Gallbladder disease often causes pain in the upper right abdomen that can radiate to the right shoulder blade or back. Peptic ulcers can also lead to back pain, including the right shoulder blade. Pancreatitis, inflammation of the pancreas, often results in severe abdominal pain that may spread to the back or below the left shoulder blade, sometimes worsening after eating.
Other less common causes include shingles, a viral nerve infection. Spinal tumors or inflammatory conditions like ankylosing spondylitis can also cause pain around the shoulder blades. Ankylosing spondylitis often involves lower back pain and stiffness that can extend to the shoulders.
When to Consult a Professional
While many instances of shoulder blade pain resolve with self-care, certain signs warrant medical attention. Seek immediate care if the pain is sudden and severe, or if it appears after significant trauma such as a fall or accident.
Consult a professional if the pain is accompanied by other symptoms. These include chest pain, shortness of breath, dizziness, excessive sweating, or nausea, signaling a heart attack or pulmonary embolism. Unexplained weight loss, fever, or changes in bowel or bladder function alongside shoulder blade pain also suggest medical assessment.
Seek medical advice if the pain persists for more than a few days or weeks despite rest. New or worsening numbness, weakness, or tingling in the arm or hand also require evaluation, as they may indicate nerve compression or damage.
General Relief and Prevention Strategies
For mild shoulder blade pain, several strategies can offer relief and prevent recurrence. Maintaining proper posture is fundamental, especially for those who sit for extended periods, by correcting slouching to reduce muscle strain.
Optimizing workspace ergonomics helps prevent pain. Position your monitor at eye level and ensure keyboard and mouse allow elbows to rest at 90 degrees, promoting proper spinal alignment.
Regular stretching and gentle movement alleviate muscle tension and improve flexibility. Exercises like shoulder rolls and doorway chest stretches are beneficial. Incorporating physical activity strengthens core and back muscles, supporting spinal health.
Applying heat or cold therapy manages muscle soreness and inflammation; heat relaxes muscles, while cold reduces swelling. Stress management techniques, such as progressive muscle relaxation, can also reduce muscle tension associated with stress.