Pain under the shoulder blade is a frequently reported complaint, affecting many individuals at some point in their lives. This discomfort, often described as a dull ache, sharp sensation, or muscle tightness, can range from a minor annoyance to a significant hindrance on daily activities. It is a common issue that can arise from various sources within the upper back and surrounding structures.
Common Muscular and Postural Causes
Many instances of pain under the shoulder blade originate from the muscles and the way the body is held. Poor posture, such as prolonged slouching or rounded shoulders, places undue stress on the muscles of the upper back, leading to strain and discomfort. This strain can weaken muscles over time. Specific muscles involved include the rhomboids, trapezius, and erector spinae.
The rhomboid muscles, located between the shoulder blades and the spine, can develop strain or spasms from overuse, especially during overhead activities or from carrying heavy loads. Pain from rhomboid issues is often felt as an ache or sharp sensation between the shoulder blades, sometimes worsening with movement or deep breaths. The trapezius muscle, covering the upper back, shoulders, and neck, is susceptible to pain from poor posture, repetitive motions, or stress.
Muscle knots, also known as myofascial trigger points, commonly result from muscle strain and overuse. These tender spots feel like tight nodules within a muscle and can develop from repetitive stress or prolonged awkward positions. Knots can cause localized pain or refer pain to other areas, including the shoulder blade region. Acute muscle strains from sudden movements or overexertion can also lead to immediate pain and stiffness under the shoulder blade.
Nerve Compression and Spinal Issues
Spinal and nerve issues can also cause pain under the shoulder blade. Problems with the cervical spine (neck) or thoracic spine (mid-back) can lead to localized or referred pain. For instance, cervical radiculopathy, often called a “pinched nerve” in the neck, occurs when a nerve root is compressed or irritated. This can cause pain radiating into the shoulder blade, arm, and hand, sometimes with numbness or tingling.
Disc issues, such as bulging or herniated discs in the cervical or thoracic spine, can irritate nearby nerves, leading to pain under the shoulder blade. Though less common in the thoracic spine than the lower back, a herniated disc there can cause sharp, localized pain between the shoulder blades, potentially radiating to the chest, shoulders, or arms, and may include numbness, tingling, or weakness. Facet joint dysfunction, involving small joints connecting vertebrae, can also cause pain in the shoulder blade region, even if the primary issue is in the neck or thoracic spine. This pain is often dull and aching, though it can be sharp, and may worsen with movements that compress the affected joint.
Referred Pain from Other Conditions
Pain under the shoulder blade can be “referred” from issues in other body parts, not directly related to the musculoskeletal system. This occurs due to shared nerve pathways, where the brain interprets pain signals from an internal organ as originating from a different, often distant, area. Recognizing these possibilities is important, especially if other symptoms are present.
Certain heart conditions can cause referred pain to the shoulder blade, particularly on the left side. A heart attack or angina (chest pain from reduced blood flow to the heart) can manifest as pain radiating to the left shoulder, arm, or back. This pain is often accompanied by other symptoms like chest tightness, shortness of breath, dizziness, or sweating.
Lung issues, such as pleurisy or pneumonia, can also cause referred pain to the shoulder blade. Tumors or other lung conditions might also present with shoulder pain. Additionally, problems with abdominal organs like the gallbladder can lead to referred pain under the right shoulder blade or in the upper right back. Gallbladder pain, often associated with gallstones, may feel like a dull ache or sharp pain that can spread to the right shoulder blade, especially after consuming fatty foods.
When to Seek Medical Attention
While many instances of pain under the shoulder blade resolve with self-care, certain signs warrant medical evaluation. Seek medical attention if the pain is severe, sudden, or progressively worsening. Pain that does not improve after a few days or weeks of at-home care, such as rest, ice or heat, and gentle stretching, should be assessed by a healthcare provider.
“Red flag” symptoms indicate a potentially serious underlying condition. These include pain with chest tightness, shortness of breath, dizziness, or sweating, which could signal a heart issue. Other concerning symptoms are fever, chills, unexplained weight loss, or numbness and weakness in an arm or leg. If the pain results from a significant injury or trauma, such as a fall or car accident, medical consultation is important.