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Scapula Pain

Scapula Pain

Your scapula is a large, flat triangular bone present on the back of the shoulders (upper back), and it’s supported by a complex system of muscles. These muscles work in synergy to move and rotate the shoulder joint. If an injury, trauma, or underlying health disorder weakens or disrupts the cohesion between these muscles, the result can be scapular pain both at rest or during motion.

Any abnormal change in motion or position can make 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].

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.

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.

You might find this blog useful too: Pain between the shoulder blades

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 these causes can lead to scapular pain in just one shoulder blade. For instance, gallbladder disease causes pain in the right shoulder blade, while a heart attack causes 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
  • Light-headedness
  • 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:

Prolotherapy:

In recent years, Prolotherapy has built its reputation within the medical community for its clinically proven ability to treat the root cause of scapula pain.

Published research has proven its pain-relieving, anti-inflammatory and regenerative benefits.

Prolotherapy involves injecting a natural regenerative solution with small needles, which has been shown to stimulate the production of collagen cells, the small cells the body uses to repair structures in and around the scapula.

As prolotherapy is helping to treat the root cause of scapula pain, it is deemed to be a permanent fix, preventing the symptoms from returning.

Medications: 

Pain and discomfort between the shoulder blades can be relieved with certain non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, but these shouldn’t be a long-term solution.

Surgery:

If the scapula pain is caused by an injury that doesn’t respond to conservative treatments, then 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.

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.

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

Eat plenty of fruits and vegetables and avoid processed foods to reduce inflammation in the affected area. Foods high in omega-3s, such as salmon and tuna are great options.

Exercise 

Exercise strengthens muscles of the back that may alleviate the scapula pain. Situps, pullups, and pushups are 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. but it can also manifest as upper back pain. If it’s caused by an injury or overuse of muscles, it’s likely to 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 good posture, a healthy diet, and avoiding long periods of sitting still, can speed up your recovery process.

Frequently Asked Questions:

What causes scapula to hurt?

Weakness, stiffness, imbalance, or detachment of any muscles that control the scapula may cause the scapula to hurt. Or your scapula may hurt due to pain or stain in other nearby muscle groups.

Some other causes of scapula pain may be:

  • Musculoskeletal disorder
  • Injury to the nerves that supply the scapular muscles
  • Scapular muscle strain
  • Damage to the bone that supports the scapula

What does scapula pain feel like?

You may feel moderate to severe aching or soreness around the scapula, particularly on the upper and inner border. You feel weakness in the affected arm when trying overhead movements, or you may feel fatigued when using your arm forcefully.

How do you stretch your scapula?

You can stretch your scapula by following these steps:

  1. Relax your body and shoulders
  2. Raise your one arm to the height of the shoulder and range it across your trunk
  3. Now, pull that arm a little toward you with your other arm to get a gentle stretch.
  4. Hold the stretch for 6 to 8 seconds and repeat 4 to 6 times.

Can a torn rotator cuff cause pain in the shoulder blade?

Yes, a torn rotator cuff cause pain in the shoulder blade or scapula, also known as snapping scapula syndrome. Besides the rotator cuff tear, injuries to other parts of your body around your shoulders can cause pain in your scapula.

How do you relieve scapular pain?

You can relieve your scapular pain by following the following remedies:

  • Relax your whole body, especially the shoulders, and rest from your routine activities
  • Massage your scapula or upper back
  • Use hot or cold therapy (applying heat or ice on the affected area)
  • Take some over-the-counter medications

How should I sleep with shoulder blade pain?

You should sleep on your back with a pillow snuggled between your shoulder blades if you’ve shoulder blade pain. Sleeping straight on the back release a lot of pressure off your shoulders and helps you with pain.

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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