The neck and shoulder area contains a complex network of nerves, muscles, bones, tendons, ligaments, and vessels. Injury to any of these structures can cause pain in the shoulder blade and neck.
Occasionally, severe pain in the shoulder blade and neck may indicate a heart condition like pericarditis or aortic dissection. These conditions are life-threatening and require immediate medical care.
Causes
In most cases, shoulder blade pain is due to an injury or condition affecting the soft tissue of muscles, tendons and ligaments. This includes the rotator cuff group of four tendons that hold your upper arm bone into your shoulder blade. These injuries often occur from repetitive overhead activities and can be severe. Other injuries can involve the direct bones of your scapula (shoulder blade) or ribs, especially when you fall onto the front of your shoulder or the top part of your chest. These injuries can cause a fracture, bruise or break.
The tendons and bursa (fluid-filled sacs that prevent friction at joints) of the rotator cuff are prone to inflammation. This is called tendinitis or bursitis. Other musculoskeletal conditions that may cause shoulder blade pain include osteoporosis, scapular inertia or osteoarthritis of the scapula, spinal stenosis and fibromyalgia. Pain in the shoulder blade area can also be caused by referred pain from heart, lung and abdominal problems.
Symptoms
The shoulder blade, also known as the scapula, is the large triangular bone in your back. It is supported by a series of muscles that allow you to move your arms. Pain in the area around or under the shoulder blade may indicate damage to one of these muscles or other problems.
Sometimes a muscle becomes strained or pulled due to an injury or overuse. In other cases, the pain may be a sign of a heart condition or lung disease. The pain may feel like a knot in the muscle, or it might hurt when you try to use your arm or move your neck in certain ways.
In some people, pain in the space between their shoulder blades may be a sign of a blood clot in the lungs (pulmonary embolism). If this occurs, it is a medical emergency and you should seek immediate treatment. Other symptoms of a pulmonary embolism include shortness of breath and chest pain.
Diagnosis
Your doctor will begin with a physical exam, and may also ask about your symptoms and family history. They will then do some diagnostic tests, including a complete blood count and a basic metabolic panel. They may also order an X-ray of the shoulder blade area and/or other imaging studies, like a CT scan.
Other tests that they may order are a chest X-ray, an EKG or cardiac electrogram and liver function tests. Blood tests can help your doctor identify infections and other issues that might be causing your pain.
If a musculoskeletal problem is diagnosed, your treatment options include RICE (rest, ice, compression and elevation). You can do this at home by restricting activities that cause pain, using ice a few times a day, wearing a supportive wrap or elevating the affected area when you are resting. You can also use a technique called myofascial release, where you apply moderate pressure to tight muscle knots.
Treatment
If you have shoulder impingement (a condition where the joint gets pinched) your doctor might recommend a steroid injection into the subacromial bursa, which is a pocket of fluid that cushions the joint. This is proven to be effective in reducing pain and improving shoulder movement. This is typically followed by physiotherapy to help regain your range of motion. You may also be given painkillers, such as NSAIDs.
In the neck, degeneration of the vertebrae, such as cervical osteoarthritis or a slipped disc, can cause pain that radiates from the spine down to the shoulders and arms. Inflammation of the spinal nerves, due to a spinal column problem called foraminal stenosis, can also produce similar pain.
Referred shoulder pain can be caused by problems in other parts of your body, such as gallstones, peptic ulcer disease or acid reflux, pancreatitis and liver diseases. These are known as inflammatory or gastrointestinal conditions that can affect the muscles and ligaments of your shoulder blade.local chiropractors
