Have you ever had pain under or near your shoulder blade, the bone that hugs the rib cage and makes up the back of your shoulder? Well, I did last week and it was so severe it dropped me to my knees and put me up in the emergency room for six hours. This pain can be sharp or burning, like an ice pick near the spine, or an ache that comes in waves under the right shoulder blade. Different kinds of pain, the frequency of the pain, and if the pain flares up with movement leads to different root causes and different diagnosis.
In my case, the pain started in the afternoon with a dull ache in the right upper quadrant of my abdomen, right underneath my ribs. It was met with a pain referral point under the bottom tip of my right shoulder blade. It was familiar and intense. I couldn’t find a comfortable position, not laying on the floor, not sitting, not trying to stand or hunch over. I’ve had this pain since I was 21 years old and now 38 years young, this attack was the most intense. Geez, as I write this out, having this pain on and off for the last 17 years feels absurd.
There are many possible causes of pain under the shoulder blade, which is important in figuring out the best method for treatment. I’ve broken down the top five possible causes here.
1. Gallstones or Gall Bladder Inflammation
My gall bladder pain started when I was 21. I was out to dinner with my mother who was visiting me at the University of Michigan. That night I lay in bed, writhing in pain as waves of nausea kept me up all night. An ultrasound later confirmed gallstones and “sludge” in my gall bladder.
On and off, this pain came right before my menstrual cycle each month, and getting acupuncture was the only thing I found that made it go away. My acupuncturist told me that the gall blade is associated with worry. As a New Yorker, stop worrying darling. Ha.
Many times I’ve considered getting it removed. But I’ve seen dozens of patients years after the surgery and the residual scar tissue leads to a lifetime of self-care massaging the scars and doing very specific core work. And there is no guarantee the pain goes away. My mother is a prime example. Her gallbladder was removed and she still gets the associated pain when she eats fatty foods. The doctors tell her it’s “phantom” pain and recommended a low fodmap diet.
I have kept my gall bladder pain in check by taking digestive enzymes with Betaine HCL before meals and ox bile after meals. But this last episode dropped me to my knees, took my breath away, and I couldn’t get off the floor or find a comfortable position. The Ibuprofen, Tylenol and Percocet I tried didn’t help the pain. And so I had to make a trip to Methodist ER to make sure a gallstone wasn’t stuck.
The official symptoms:
- Sudden and intensifying pain in the upper right quadrant of your abdomen
- Sudden and intensifying pain in the center of your abdomen, just below your breastbone
- Back pain between your shoulder blades, usually more to the right
- Pain in your right shoulder
- Nausea or vomiting
The risk factors for gallstones include:
- Being female, age 40 or older, overweight or obese, and sedentary.
- Having multiple pregnancies and being pregnant. (me in a nutshell this past year)
- Eating a high-fat, high-cholesterol, low-fiber diet.
- Having a family history of gallstones.
- Having diabetes or liver disease.
- Having certain blood disorders, such as sickle cell anemia or leukemia
- Losing weight very quickly
- Taking medications that contain estrogen, such as oral contraceptives or hormone therapy drugs
See a doctor if the abdominal pain is so intense that you can’t find a comfortable position, you become jaundice (the yellowing of your skin and the whites of your eyes), or you have a high fever with chills which usually means infection.
The other causes of pain under your shoulder blade are not as acute and potentially life-threatening but I thought it would be prudent to get the serious stuff out of the way first.
2. Poor Posture
We all experience the rounded back, slouched over posture and jutting chin from prolonged sitting. There’s no escaping it in this day and age where we are behind our computers all day and then on our phones, walking down the street and sitting on the toilet. This amount of screen time and poor posture can cause your spine to undergo structural changes that eventually cause pain underneath the shoulder blade.
Hunching your back, tilting your head forward, or sitting to one buttcheek can weaken certain muscles and place pressure on spinal discs, muscles, and ligaments. This routine imbalance can contribute to upper back pain and pain underneath the shoulder blades. In the medical world, we call this imbalance Upper Cross Syndrome, where there is weakness in the muscles that hold and stabilize the shoulders down and back.
This lack of stability can cause pain under the shoulder blades. Not only this, but the jutting of the chin creates weakness in the muscles in the front of the neck that stabilize the cervical spine. In turn, the muscles that tighten are the upper traps, the pecs from the rounding of the shoulders, and muscles at the base of the skull.
3. Overused Muscles
Tight spasming muscles can happen from painting a ceiling, moving furniture, or pumping those arms extra hard while sprinting. These are all examples of activities that can put your upper back and shoulders through more work than they’re used to. Overuse can lead to muscle strains, which can cause pain in the upper to mid-back, such as between your shoulder blade and spine. Another example of pain under the shoulder blade is scapulothoracic bursitis, also called snapping scapula syndrome. This is a result of an unstable shoulder blade that inflamed the bursa between the shoulder blade (scapula) and the thoracic spine.
4. Cervical Disc Herniation
A disc herniation in the cervical spine (neck) occurs when a disc’s inner layer (nucleus pulposus) pushes through or tears the outer layer (annulus fibrosus) of the disc. Disc herniations at certain levels can cause pain and may inflame a nearby nerve root that radiates pain down into the shoulder blade, specifically cervical nerve root C5 and C6. While less common, it’s also possible for a disc herniation in the thoracic spine (upper back) to cause pain near the shoulder blade.
5. Subluxated Rib
A rib can pop out of place or become misaligned after repetitive strain or reaching for an item overhead. Our patients at Urban Wellness Clinic that come in with this kind of pain, say they feel sharp stabbing pain similar to a knife stuck in their back when they take a deep breath in. We find this often happens in our patients who are stressed and in a cycle of sympathetic chest breathing. This accentuated breathing from their upper back, neck, and chest, instead of a calm belly breath leads to more rib movement and the ribs getting stuck in a flexed position.
When there’s a subluxated rib, we will often find spasming of the muscles around the rib head including the rhomboid muscle that attaches from the medial border of the shoulder blade to the spine. From clinical experience, if the muscle is massaged but the rib head isn’t moved out of the flexed position, the pain under the shoulder blade will get worse. If the rib head is adjusted, the spasming muscles will typically relax within 12 to 24 hours.
Bonus
Some serious heart conditions can present as pain in the shoulder blade region. For example, aortic dissection is a serious, life-threatening condition that occurs when the heart’s largest artery tears and can cause severe pain that can move under or near the shoulder blade. Secondly, a heart attack can also present as pain felt in the upper back or shoulder, especially in women.
When in doubt, get assessed if you have pain under your shoulder blade. While some conditions can be treated from a biomechanical approach, some causes can be life-threatening.
How to Treat Pain Under Your Shoulder Blade
If you have pain under the shoulder blade, get assessed. At Urban Wellness Clinic, we take a thorough history and do an extensive physical exam to rule out the serious conditions mentioned above. If the pain is from overuse or a muscle strain we use the following tools in our toolbox, Active Release Technique to relax the tight muscles and Neurokinetic Therapy to identify the weak inhibited muscles that are not doing their job.
We then use Dynamic Neuromuscular Stabilization (DNS) and strength from a Strong First background to strengthen the weak muscles. We lean towards Mckenzie Therapy for cervical disc herniations that are acute, and then DNS for more chronic disc herniations to reset the weak muscles.
For any questions on the Urban Wellness Clinic approach, give us a call 212-355-0445 or shoot us an email, hello@urbanwellnessclinic.com
In Good Health,
Dr Emily Kiberd
Dr. Emily Kiberd, DC
Dr Emily Kiberd is a mama, chiropractor, movement expert, strength enthusiast, and the founder of Urban Wellness Clinic. She believes every busy New York woman struggling with chronic pain can feel better in their body through simple and effective strategies developed over the last twelve years in practice.Dr Kiberd treats prenatal and postpartum women, women living with the chronic pain of Hashimoto’s, and the corporate warrior women who are expected to do it all. Over twelve years, Dr Kiberd has refined how she looks and treats the body using healing modalities including Active Release Technique, Neurokinetic Therapy, and Anatomy in Motion. At the end of the day, she believes the stronger and more resilient we are mentally and physically, the more present we can be with the people that matter the most.
FAQs
Why do I have constant pain under my shoulder blade? ›
Pain under the shoulder blade may arise from pulmonary diseases. Conditions like pneumothorax or pulmonary embolism may also cause pain. Lung cancers and Pancoast tumors may also contribute to pain under the shoulder blade.
What causes inflammation under shoulder blade? ›Shoulder bursitis is often the result of overuse or repetitive shoulder movements. Overhead activities increase friction between bones and tissues. This ongoing friction can inflame and irritate bursae. When fluid builds up in the bursa sacs, you have bursitis.
What organ can cause shoulder blade pain? ›Lung and Chest Conditions
Shoulder blade pain may be caused by problems affecting the lungs, thorax (chest cavity), or thoracic wall (chest wall). Examples include: Pulmonary embolism: This is a blood clot in a limb (usually the leg) that breaks off and migrates to the lungs. Pneumothorax: This is a collapsed lung.
Recovery from shoulder strain or sprain
For a mild to moderate shoulder sprain or strain, you may be able to return to your normal activities within one to two weeks. Moderate sprains or strains may take as long as six to eight weeks before you can resume day-to-day shoulder activities.
Latissimus dorsi (lats), the largest muscle in the upper part of your body. It starts below your shoulder blades and extends to your spine in the lower part of your back.
Is there a nerve that runs under the shoulder blade? ›The axillary nerve starts in your neck and extends to your shoulder. It causes movement and sensation in your shoulder and the back of your upper arm. Injuries to this nerve can affect your ability to rotate your arm or lift it.
Is pain under shoulder blade serious? ›Any back or shoulder pain that lingers a few weeks or interferes with daily activities should be evaluated by a doctor. If your pain is severe or accompanied by other red flag symptoms—such as headache, tingling, weakness, or nausea—seek immediate medical attention.
How long does pain under shoulder blade last? ›It can take four to six weeks to recover fully from mild shoulder pain. There are some things you should and shouldn't do to help ease shoulder pain.
What are 3 symptoms of bursitis? ›- Shoulder. Pain when raising arms above head. Discomfort worsens at night. ...
- Elbow. Increased pain if the elbow is bent. Infection is common in this bursa.
- Hip. Pain while walking. Tenderness in groin area. ...
- Knee. Swelling on the front of the kneecap. Pain when knee is bent.
Scapulothoracic bursitis, or snapping scapula syndrome, is caused by weakening of the muscles underneath the scapula, leading to the scapula sitting in close proximity to the ribcage. The shoulder condition causes a grinding, grating, and snapping sensation of the scapula on the back area of the ribcage.
How do I get rid of inflammation in my shoulder blade? ›
Treatments may include a combination of rest, wrapping, and use of ice packs for recent or severe injuries. Aspirin, naproxen and ibuprofen are used to reduce swelling. Physical therapy, which includes range of motion exercises, is also part of the treatment plan.
What cancers cause shoulder blade pain? ›Shoulder pain is the most common symptom of a type of cancer called Pancoast tumor. These tumors are rare. They only make up 3%-5% of lung cancer cases. These tumors start in the upper part of one of your lungs but rarely have symptoms related to your breathing.
What is the most common cause of shoulder blade pain? ›Muscular causes
It is common for an individual to experience a muscular issue that causes shoulder blade pain. Muscles and tendons in the rotator cuff, across the scapula, up into the neck, and down into the arm are common pain sites. A person may damage these tissues due to: an impact injury.
A pinched nerve in the shoulder will typically cause pain, numbness, or discomfort in the shoulder region. A person may also have other symptoms, which include: changes in feeling on the same side as the shoulder that hurts. muscle weakness in the arm, hand, or shoulder.
What does a pulled muscle under your shoulder blade feel like? ›A strain causes pain in the upper back between your shoulder blade and your spine. A spasm feels like a knot or tightness in the muscle. You may have pain when you move your shoulders or when you breathe.
Can you tear something under your shoulder blade? ›The subscapularis connects from your shoulder blade to your humerus, or upper arm bone. All the muscles of the rotator cuff, including the subscapularis, can tear from overuse, trauma, or age-related conditions. Tears can be small or can go through most of the muscle.
What does a torn ligament in shoulder blade feel like? ›Symptoms of a torn rotator cuff include tenderness and soreness in the shoulder when using the shoulder. If the tendon has ruptured, you may not be able to raise the arm at all. It may be hard to sleep lying on that side. You may feel pain when pressure is put on the shoulder.
What is the bottom of your shoulder blade called? ›The inferior angle of the scapula is the lowest part of the scapula and is covered by the latissimus dorsi muscle. It moves forwards round the chest when the arm is abducted. The inferior angle is formed by the union of the medial and lateral borders of the scapula.
Why does my upper back hurt by my shoulder blade? ›Poor posture, injury, or problems with the spine can all lead to upper back pain. A common cause of pain between the shoulder blades is muscle strain. Treatments for mild upper back pain include stretching exercises and pain relievers. Some cases of pain between the shoulder blades are preventable.
Why does my upper back hurt near my shoulder blade? ›Upper back pain between the shoulder blades has many causes, including muscle strain, herniated discs, arthritis, or, less often, a serious health problem. Treatment for pain between the shoulder blades depends on the cause but frequently includes stretching and medications for pain.
What is neuropathic pain in shoulder blade? ›
Brachial plexus neuropathy (BPN) occurs when nerves in your upper shoulder area become damaged. This can cause severe pain in your shoulders or arms. BPN may also limit movement and cause decreased sensation in these areas.
What does suprascapular nerve pain feel like? ›Injury at the suprascapular notch can present dull, aching, or burning pain in the posterolateral shoulder that may radiate to the neck or ipsilateral upper extremity. Pain may also be exacerbated with overhead shoulder movements.
Can shoulder blade pain be treated? ›OTC medications, which can be purchased at a local grocery store or drug store without a prescription, may ease some types of shoulder blade pain. Some of these medications work to reduce inflammation, such as aspirin, ibuprofen (Advil, Motrin), or naproxen (Aleve, Anaprox DS, Naprosyn).
Why wont my shoulder blade pain go away? ›Shoulder blade pain could be caused by various factors, including poor posture, muscle strain, joint dysfunction, nerve compression, or underlying medical conditions such as fibromyalgia, arthritis or gallbladder disease. In some instances, shoulder blade pain could be due to heart or vascular related conditions.
How should I sleep with pain under my shoulder blade? ›If you face rotator cuff pain—or shoulder pain, in general—try sleeping on your back with a small pillow nested between your shoulder blades. Often, morning shoulder pain is caused by your body's flatness during nighttime hours.
What is the best painkiller for shoulder pain? ›Nonsteroidal anti-inflammatory drugs, or NSAIDs, can relieve shoulder pain by reducing inflammation in the shoulder joint. Ibuprofen and naproxen are two NSAIDs doctors commonly recommend.
What can be mistaken for bursitis? ›Tendons and bursae are located near joints. Inflamed soft tissues will often be felt by patients as joint pain. This will be mistaken for arthritis. Symptoms of bursitis and tendonitis are similar.
Does bursitis show up on xray? ›X-ray images can't positively establish the diagnosis of bursitis, but they can help to exclude other causes of your discomfort. Ultrasound or MRI might be used if your bursitis can't easily be diagnosed by a physical exam alone.
What triggers bursitis pain? ›The most common causes of bursitis are repetitive motions or positions that put pressure on the bursae around a joint. Examples include: Throwing a baseball or lifting something over your head repeatedly. Leaning on your elbows for long periods.
What does bursitis in the shoulder blade feel like? ›In infected bursitis patients usually experience excessive warmth at the site of the inflamed bursa. They often complain of a great deal of tenderness, pain, and fever. The swelling and redness may spread away from the affected site and go up or down the arm.
How do you test for shoulder bursitis? ›
Bursitis is typically identified by localized pain and/or swelling, tenderness, and pain with motion of the tissues in the affected area. X-ray testing can sometimes detect calcifications in the bursa when bursitis has been chronic or recurrent. MRI scanning (magnetic resonance imaging) can also define bursitis.
What is the fastest way to heal bursitis in the shoulder? ›- Rest. In the acute phase, you should rest your shoulder. ...
- Ice. Also in the acute phase, ice can help calm inflammation and offer acute pain relief. ...
- Warmth. ...
- Medications. ...
- Shoulder bursitis stretches. ...
- Physical therapy. ...
- Chiropractic care. ...
- Acupuncture.
In fact, a study published in 2012 comprehensive literature review published in Sports Health, low vitamin D levels correlate with degeneration of the rotator cuff muscles in the shoulders and supplementation of Vitamin D can reverse atrophy of these muscles. Vitamin D has many benefits.
What painkiller for shoulder blade pain? ›Over-the-counter pain relievers such as acetaminophen (Tylenol, others), ibuprofen (Advil, Motrin IB, others) and naproxen sodium (Aleve) may help.
How do you know if you have a tumor in your shoulder blade? ›Instead, many patients experience sharp shoulder pain, arm pain and muscle weakness as a result of a tumor placing pressure on a nearby nerve. Patients may also experience other neurological symptoms like tingling sensations, impaired hand function and sensation loss.
What does a tumor in the shoulder blade feel like? ›Shoulder blade pain Pain is one of the common symptoms of shoulder blade cancer. At first, patients often feel dull pain, intermittent pain, gradually become persistent pain, pain increases when moving, affecting work as well as daily activities.
What are the signs of Pancoast tumor? ›- Severe shoulder pain, which may include pain in your shoulder blade.
- Pain that radiates down your arm and stops at your wrist, just above your pinky finger.
- Arm and hand weakness.
- Neck pain.
- Pain in your upper ribs.
- Upper arm swelling.
- Loss of dexterity in your hand and fingers.
The most common symptoms of scapular dyskinesis include: Pain and/or tenderness around the scapula, especially on the top and medial (inner) border. Weakness in the affected arm — your arm may feel tired or "dead" when you try to use it vigorously. Fatigue with repetitive activities, especially overhead movements.
Can a pinched nerve cause pain in shoulder blade? ›A pinched nerve happens when a nearby structure presses on or irritates the nerve. When this happens in the shoulder blade, you may experience numbness and pain spanning from the shoulder and down the arm.
What organ is under the right shoulder blade? ›What is the gallbladder? Shaped like a tiny pear, your gallbladder resides on your right side, just below your liver. It stores bile, which is a vital fluid your liver manufactures that plays an essential role in digestion.
What helps nerve pain under shoulder blade? ›
- Over-the-counter (OTC) medication. Pain relievers such as ibuprofen (Advil, Motrin), naproxen (Aleve), and acetaminophen (Tylenol) can be helpful for a pinched nerve. ...
- Ice, then heat. ...
- Oral corticosteroids. ...
- Steroid injections. ...
- Physical therapy. ...
- Cervical collar.
- Apply ice and heat packs. ...
- Elevate your arms. ...
- Rest the area. ...
- Get a gentle massage. ...
- Stretch for increased flexibility. ...
- Be aware of your posture. ...
- Improve your workstation. ...
- Use a splint.
What Are Muscle Knots? If you've ever had pain in your back, in your neck, or under your shoulder blade, you've probably had a muscle knot. The name makes it sound like the muscle is twisted or kinked, but that's not the case. Knots are usually a type of spasm that causes a small portion of a muscle to tense up.
How do I know if my shoulder blade pain is serious? ›Any back or shoulder pain that lingers a few weeks or interferes with daily activities should be evaluated by a doctor. If your pain is severe or accompanied by other red flag symptoms—such as headache, tingling, weakness, or nausea—seek immediate medical attention.