Pain under the shoulder blade is a common complaint, often causing discomfort. This type of pain can arise from a wide range of sources, making it challenging to pinpoint the exact cause. Understanding the potential origins of this pain is the first step toward finding appropriate relief and addressing any underlying issues.
Common Muscle and Joint-Related Causes
Musculoskeletal issues are frequently responsible for discomfort under the shoulder blade. Muscle strains or spasms are common causes, often affecting muscles like the rhomboids, which pull the shoulder blades together, or the trapezius, a large muscle extending from the neck to the mid-back. The levator scapulae, connecting the neck to the top of the shoulder blade, also contribute to pain. These muscles can become tight or develop trigger points due to overuse or injury.
Poor posture significantly contributes to muscle imbalance and tension in the upper back. Prolonged slouched positions during desk work or while using electronic devices can strain the muscles between the shoulder blades. Repetitive movements, like those involved in certain sports or occupational tasks, can also lead to fatigue and inflammation in these muscles. This repetitive stress can result in chronic muscle soreness or spasms.
Joint dysfunctions in the upper back, specifically within the thoracic spine or the ribs that attach to it, can also cause pain under the shoulder blade. Facet joints between the vertebrae can become stiff or irritated, limiting movement and causing localized pain. Costovertebral joints, where the ribs meet the spine, can experience dysfunction, leading to sharp, localized pain that can radiate under the shoulder blade, particularly with deep breaths or twisting movements.
Spinal and Nerve-Related Origins
Pain under the shoulder blade can also originate from problems within the spine, particularly involving nerve compression. Issues in the cervical spine can refer pain down into the upper back and under the shoulder blade. For instance, a herniated disc in the lower cervical vertebrae can press on a nerve root, causing radiating pain, numbness, or tingling that extends into the arm.
Degenerative changes in the cervical or thoracic spine, such as osteoarthritis or disc degeneration, can narrow the spinal canal or nerve pathways. This narrowing, known as spinal stenosis, can lead to chronic nerve compression. Compressed nerves can send pain signals to areas far from the impingement point, including under the shoulder blade.
Cervical radiculopathy describes symptoms that occur when a nerve root in the cervical spine is irritated or compressed. This often results in radiating pain, weakness, or sensory changes in the neck, shoulder, arm, and hand, frequently felt under the shoulder blade. Thoracic outlet syndrome, another potential cause, involves the compression of nerves or blood vessels as they pass through a narrow space between the collarbone and the first rib, leading to pain, numbness, or tingling in the shoulder and upper back.
Referred Pain from Internal Organs
Pain under the shoulder blade can also signal an issue with an internal organ. This phenomenon, known as referred pain, occurs because nerves supplying internal organs share pathways with nerves in the back. For example, heart-related issues, such as angina or a heart attack, can cause pain that radiates to the left shoulder blade, arm, or jaw. This pain may feel like pressure or tightness.
Problems with organs in the upper abdomen can also refer pain to this area. Gallbladder issues (e.g., gallstones, inflammation) often cause sharp pain in the upper right abdomen that can radiate to the right shoulder blade or between the shoulder blades. Liver problems can sometimes present with pain in the right upper quadrant and under the right shoulder blade.
Stomach conditions, including peptic ulcers, can cause a burning sensation or dull ache that may be felt in the mid-back or under the left shoulder blade. Pancreatitis, inflammation of the pancreas, causes severe, deep pain in the upper abdomen that frequently radiates to the back, often felt under the left shoulder blade. Lung conditions, such as pleurisy (inflammation of the lining of the lungs) or pneumonia, can also cause localized chest pain that may refer to the shoulder or upper back, especially with deep breaths or coughing.
When to Seek Medical Attention
While many causes of pain under the shoulder blade are benign, some symptoms warrant immediate medical evaluation. Seek prompt medical attention if the pain is severe, sudden, or accompanied by chest pain, shortness of breath, sweating, or dizziness, as these could indicate a cardiac event. Persistent pain that doesn’t improve with rest or self-care, or pain that worsens over time, also requires professional assessment.
Other warning signs include numbness, tingling, or weakness in an arm or hand, suggesting nerve compression. Unexplained weight loss, fever, or chills accompanying the pain should also prompt a healthcare provider visit. Any pain that significantly interferes with daily activities or sleep patterns should be evaluated for its underlying cause and appropriate management.