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Scapula Pain

Scapula Pain

Before we talk about scapula pain it is important to first understand the anatomy. Your scapula is a large, flat triangular bone present on the back of the shoulders (upper back). A complex system of muscles surrounds and supports the scapula. These muscles work in synergy to move and rotate the shoulder joint. An injury, trauma, or an underlying health disorder can weaken or disrupt cohesion between these muscles – resulting in scapular pain even at rest or during motion.

Any abnormal change in the motion or position makes the shoulder and arm movement difficult, especially during overhead activities. The shoulders become vulnerable to injury if the normal ball-and-socket alignment of the shoulder joint is not sustained [1].

The injury-related scapular pain involving soft tissues usually resolves within a few days. But in some cases, pain in any of the shoulder blades is a sign of a more severe condition.

A lady holding her scapula pain

Anatomy Of The Scapula:

The humerus (upper arm) and the scapula form a “ball and socket joint” in your shoulders. The humerus forms the ball joint, and the socket joint is formed by the front of the scapula (acromion).

A diverse range of muscles and ligament attachments connect the arm and scapula to your body. The acromion process of the scapula is attached to the lateral clavicle (collarbone) with the help of the acromioclavicular joint [2].

With the movement of the arm around the body, the scapula should also have a movement in order to maintain the normal alignment of the shoulder joint.

What Are The Causes Of Scapula Pain?

Scapula pain is characterized by dull, aching, and sharp pain that spreads across the upper back and shoulder. Sometimes, shoulder pain also occurs near the spine. If scapula pain persists, it can drastically limit your arm a well as back movements and interfere with daily life activities.

The following are some possible causes of scapula pain:

  • Injuries within the shoulder joint or injuries in the bones that support the scapula.
  • Carrying bags with straps over the shoulder.
  • Repetitive arm motions, such as racquet sports, throwing, and swimming.
  • Altered shoulder biomechanics (poor posture).
  • Trauma from an accidental hit or fall.
  • Muscle strain during sleep.
  • Injuries to other areas of the body, such as cervical spine dysfunction, can also lead to shoulder pain [3].

Common Causes Of Referred Pain In The Scapula:

The following health conditions also cause scapular pain:

  • Nerve compression
  • Shingles
  • Fibromyalgia
  • Scoliosis
  • Cervical herniated disc
  • Thoracic disc herniation
  • Spinal stenosis
  • Rotator cuff tears
  • Shoulder impingement
  • Certain cancers, such as lymphomas, liver cancers, and cancers that spread to the bones.
  • Osteoarthritis
  • AC joint dislocations
  • Shoulder instability
  • Scapulothoracic bursitis (aka snapping scapula syndrome)
  • Heart attack, especially among women
  • Pulmonary embolism (involves a sudden, sharp pain in the scapula)
  • Winged scapula: a deviation in the normal resting position of the scapula

Some of the causes, as mentioned above, lead to scapular pain in just one shoulder blade. For instance, gallbladder disease causes pain in the right shoulder blade, while heart attack provokes characteristic pain in the left shoulder blade.

What Are The Symptoms Associated With Scapula Pain?

Common symptoms associated with scapula pain include:

  • The tightness and deep, achy pain on the upper back and shoulder blade.
  • A drooped titled posture on the affected side.
  • Scapular dyskinesia: Pain on the medial (inner) edge and at the top of the scapula
  • Restricted shoulder movement and range of motion, such as inability to raise the arm above shoulder height.
  • Fatigue when performing overhead activities
  • Tenderness around the scapula

How Is Scapula Pain Diagnosed?

Physical examination is critical to rule out the cause of scapular pain. Routine diagnosis of scapular pain starts with a physical exam and interview, during which the doctor rules out the various causes of the pain.

If scapula pain occurs along with other specific symptoms, it may indicate a life-threatening condition that requires immediate medical attention. A patient should immediately see a doctor if they experience shoulder blade pain accompanied by the following symptoms:

  • Irregular and rapid heartbeat
  • Loss of consciousness
  • Loss of vision
  • Sudden difficulty speaking
  • Coughing up blood
  • Excessive sweating
  • Chest pain
  • Shortness of breath
  • Swelling and pain in the legs
  • Lightheadedness
  • Paralysis on one side of the body

A middle-ages man with scapula pain

Treatment Options For Scapula Pain:

The following are some treatment options for scapula pain:

1. Medications: 

The pain and underlying discomfort between shoulder blades can be relieved with certain non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Motrin IB, Advil). Steroid pills and injections can also be given for managing pain and inflammation.

2. Surgery:

If the scapula pain is caused by an operatable injury and is extremely painful for the patient, the doctor may recommend surgery. During the surgical procedure, tendons in the shoulders or upper back are repaired, and scar tissues are removed. About 90% of patients with scapula pain respond well to non-surgical options, such as medication, rest, and exercise, says the American Academy of Orthopaedic Surgeons.

3. Therapy:

If the scapula pain is caused by an injury or overuse of the shoulder joints and muscles, physical or massage therapy can help.

  • Physical Therapy: Physical therapy involves specific exercises to improve pain symptoms. Physical therapy is also very effective for improving the range of motion for the scapular joint. It is also ideal for Levator Scapulae syndrome, in which physical therapist targets levator scapula muscle.
  • Massage Therapy: Massaging the areas between the shoulder blades relaxes muscle tissue and alleviates pain.

4. Home Remedies:

Some therapies performed at home can significantly reduce scapular pain:

  • Stretching: Stretching techniques not only offer pain relief but also improve blood circulation in shoulder muscles and aid in better mobility [4].

The following shoulder stretch can be helpful in this regard:

  • Crossing one arm over the body.
  • Pulling the elbow of the overstretched arm towards the chest by using the other hand.
  • Holding the stretch for 10-15 minutes.
  • Hot or Cold Therapy: The scapula pain is also relieved by applying hot or cold compresses between the shoulder blades for 15 minutes every 4-5 hours.
  • Diet: Eating plenty of fruits and vegetables and avoiding processed foods can reduce inflammation in the affected area. Foods high in omega-3s, such as salmon, tuna may also help.
  • Exercise Program: Exercise strengthens muscles of the back that may alleviate the scapula pain. Situps, pullups, and pushups are some excellent exercises for rotator cuff and shoulder rehabilitation.

The Bottom Line:

Scapula pain is a sharp, aching pain between the shoulder blades that interferes with daily life activities. Scapula pain, which can also manifest as upper back pain, caused by an injury or overuse of muscles, can be alleviated with minimal medical intervention. NSAIDs, physical therapy, and surgery (for more severe pain) can provide complete symptom relief. Certain preventive tips, such as maintaining good posture, eating a healthy diet, and not sitting still for too long, can speed up your recovery process.

References: 

  1. Kibler BW, Sciascia A, Wilkes T. Scapular Dyskinesis and Its Relation to Shoulder Injury. JAAOS – J Am Acad Orthop Surg 2012;20.
  2. Miniato MA, Mudreac A, Borger J. Anatomy, Thorax, Scapula. StatPearls 2021. https://www.ncbi.nlm.nih.gov/books/NBK538319/
  3. Lollino N, Brunocilla PR, Poglio F, Vannini E, Lollino S, Lancia M. Non-orthopaedic causes of shoulder pain: what the shoulder expert must remember. Musculoskelet Surg 2012;96:63–8. https://doi.org/10.1007/s12306-012-0192-5.
  4. Page P. Current concepts in muscle stretching for exercise and rehabilitation. Int J Sports Phys Ther 2012;7:109–19. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3273886/
  5. Warth, R. J., Spiegl, U. J., & Millett, P. J. (2015). Scapulothoracic bursitis and snapping scapula syndrome: a critical review of current evidence. The American journal of sports medicine43(1), 236–245. https://doi.org/10.1177/0363546514526373
  6. Suh BK, You KH, Park MS. Can axial pain be helpful to determine the surgical level in the multilevel cervical radiculopathy?. J Orthop Surg (Hong Kong). 2017;25(1):2309499016684091. doi:10.1177/2309499016684091.
  7. Stapley S, Sharp D, Hamilton W. Negative chest X-rays in primary care patients with lung cancer. Br J Gen Pract. 2006;56(529):570-3.
  8. Lee SG, et al. (2006). Winged scapula caused by rhomboideus and trapezius muscles rupture associated with repetitive minor trauma: A case report. DOI:  10.3346/jkms.2006.21.3.581

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