Pain under the right shoulder blade is a common complaint, ranging from a mild ache to severe discomfort. This sensation, often described as a dull throb or burning feeling, can impact daily activities. The shoulder blade area (scapula) involves a complex network of bones, muscles, and nerves. Understanding potential causes is key to finding relief.
Common Musculoskeletal Reasons
Pain under the right shoulder blade often stems from musculoskeletal issues. Muscle strain or spasm, especially in the rhomboid muscles (connecting shoulder blades to the spine), is a common cause. These muscles, along with the trapezius and erector spinae, can strain from overuse, sudden movements, or injuries during activities like lifting. Stretched or torn muscle fibers cause pain that worsens with movement or posture.
Poor posture also contributes to musculoskeletal pain. Prolonged slouching from desk work, phone use, or side sleeping weakens back muscles and pressures shoulder blade structures. This leads to muscle imbalances, causing chronic strain. For example, forward head posture and rounded shoulders tighten chest muscles, restricting rib cage expansion and straining upper back muscles.
Repetitive stress injuries also cause pain under the shoulder blade. These occur from repeated motions or sustained awkward positions, common in activities like prolonged computer use. Such actions lead to muscle fatigue, inflammation, and tightness. Over time, this strain can result in conditions like snapping scapula syndrome, where the bursa between the shoulder blade and spine becomes inflamed.
Myofascial trigger points, hypersensitive “knots” within muscle fibers, can also cause localized or referred pain under the shoulder blade. These commonly develop in muscles like the rhomboids, trapezius, and infraspinatus due to poor posture, repetitive strain, or overuse. Rhomboid trigger points cause a dull ache between shoulder blades, while trapezius points can refer pain to the neck, shoulders, or head. This pain can feel deep and persistent, sometimes radiating.
Internal Organs as a Source of Referred Pain
Pain under the right shoulder blade can indicate issues originating from internal organs, a phenomenon known as referred pain. This occurs because nerves supplying internal organs share pathways with nerves from the skin and muscles, causing the brain to misinterpret the pain’s true source. When an internal organ experiences inflammation or dysfunction, pain might be perceived in an unrelated area like the right shoulder blade.
Gallbladder issues are a common cause of referred pain to the right shoulder blade. Conditions like gallstones or cholecystitis (gallbladder inflammation) cause sharp or cramp-like pain in the upper right abdomen, often radiating to the back or right shoulder blade. This referral is due to phrenic nerve irritation, which connects the gallbladder and shoulder. Nausea, vomiting, or increased pain after fatty meals may accompany shoulder blade pain.
Liver problems can also cause referred pain in the right shoulder blade, back, or neck. Though the liver lacks pain receptors, inflammation or swelling can press on surrounding tissues and nerves, causing discomfort. Conditions like fatty liver disease, hepatitis, or cirrhosis can cause a dull ache or sharp pain in the upper right abdomen that may extend to the right shoulder. Seek medical attention if pain is accompanied by unexplained weight loss, fatigue, or jaundice.
Diaphragm irritation (the muscle separating chest and abdomen) can also refer pain to the shoulder tip or blade. This occurs because the phrenic nerve, innervating the diaphragm, originates from the same spinal cord levels (C3-C5) as shoulder nerves. Diaphragm pain might arise from issues in nearby organs, or conditions like pneumonia or pleurisy, where inflammation affects the lung lining.
Lung or pleural issues can also cause referred pain to the upper back or shoulder blade. Pleurisy (lung lining inflammation) typically causes sharp chest pain worsening with deep breaths, coughing, or sneezing, and can spread to the shoulder or back. Pneumonia, a lung infection, can cause sharp chest or back pain due to pleural inflammation. Rarely, a lung tumor might cause back or shoulder pain, especially if it presses on nerves or has spread to the spine.
Nerve and Skeletal Issues
Pain under the right shoulder blade can also stem from nerve or skeletal issues. A pinched nerve (cervical radiculopathy) occurs when a neck nerve root becomes compressed or irritated. This causes pain radiating into the shoulder, arm, and hand, often with numbness, tingling, or muscle weakness. Symptom location depends on the affected nerve root, but pain can extend from the neck to the shoulder blade.
Rib dysfunction, sometimes called a “slipped” or “misaligned” rib, can also cause sharp pain under the shoulder blade. This occurs when a rib shifts slightly from its normal position, typically where it connects to the spine. Pain can be sharp or dull, worsening with deep breaths, coughing, sneezing, or twisting. Though the rib doesn’t usually dislocate, surrounding muscles, ligaments, or cartilage can become irritated, and pain can radiate to the shoulder or abdomen.
Spinal issues, such as scoliosis or degenerative changes in the thoracic spine, can contribute to chronic pain. Scoliosis (lateral spinal curvature) can lead to uneven shoulders and muscle imbalances, causing tightness, soreness, and a pulling sensation in the shoulder or shoulder blade, especially opposite the spinal curve. Degenerative changes like arthritis or herniated discs in the thoracic spine can irritate or compress nerves, causing localized pain or pain radiating across the chest, abdomen, or to the shoulder blade. These conditions involve gradual breakdown of spinal structures, leading to inflammation and discomfort.
When to Seek Medical Attention
While most pain under the right shoulder blade is not serious, certain “red flag” symptoms warrant immediate medical evaluation. Paying attention to the pain’s nature and accompanying symptoms ensures proper diagnosis and timely intervention, especially for more serious underlying conditions.
Seek immediate medical attention if you experience any of the following “red flag” symptoms:
Severe, sudden, or rapidly worsening pain, especially after injury or trauma.
Pain accompanied by fever, chills, or unexplained weight loss.
Pain with shortness of breath, chest pain, or dizziness.
Numbness, tingling, or weakness in the arm or hand.
Pain that does not improve with rest or self-care, or persists for more than a few weeks.
Pain with digestive symptoms like severe abdominal pain or jaundice.
Recognizing these red flags helps guide you to necessary medical care.
Self-Care and Prevention
For non-severe, musculoskeletal pain under the right shoulder blade, several self-care strategies can offer relief and aid prevention. Maintaining good posture is fundamental, especially for extended sitting or desk work. Adjusting your workstation for ergonomic support helps align your spine and reduce back and shoulder strain. This includes keeping feet flat, relaxing shoulders, and positioning your screen at eye level.
Regular stretching and strengthening exercises are beneficial. Simple movements targeting the upper back, shoulders, and neck improve flexibility and muscle balance. Examples include shoulder blade squeezes, gentle neck stretches, and exercises promoting thoracic spine mobility. Incorporating these into your daily routine counteracts sedentary habits and repetitive motions.
Applying heat or cold therapy provides temporary pain relief for muscle soreness and inflammation. Heat (e.g., warm compress, heating pad) relaxes tight muscles and increases blood flow. Cold (e.g., ice pack) reduces inflammation and numbs pain. Alternating heat and cold may offer more comprehensive relief.
Taking regular breaks to move and stretch, especially from prolonged sitting, prevents stiffness and muscle fatigue. Even short walks or simple stretches throughout the day make a difference. Staying active and incorporating general physical activity maintains overall muscle strength and flexibility, reducing the likelihood of pain under the shoulder blade.