Shoulder Blade Pain: Causes and Treatment Options

Pain in the upper back around the scapula?

I have been experiencing shoulder, neck, and back pain for over a year, but it has become more pronounced in the past few months.
About a week ago, I suddenly felt pain in my right rib area under the armpit, as well as pain in the right side of my back and shoulder blade.
The pain is more noticeable on the right side, and I also have pain in both sides of my back and soreness in my left lower back, especially severe in the morning upon waking.
Occasionally, I have a few coughs.
A few days ago, I had a chest X-ray, which showed no significant issues with my lungs or heart.
I am a smoker.
Could this pain be related to a lung issue? Is it a musculoskeletal problem? Is a frontal X-ray sufficient for diagnosis? Thank you.

Last June, I underwent a comprehensive health check-up, which included examinations of my lungs, stomach, kidneys, liver, and gallbladder.
I was found to have mild fatty liver, and a colon polyp was removed; otherwise, there were no significant issues.
This month, I also had a breast ultrasound, which showed no problems.
Six months ago, I had an endoscopy, which revealed a mild gastric ulcer and gastroesophageal reflux, for which I am still taking medication.

A month ago, I noticed swelling in the middle of my left back and had an X-ray taken, which indicated spinal curvature.
I have also undergone acupuncture and massage therapy, which has significantly reduced the swelling, but there is still mild swelling present, and I continue to feel soreness in that area and my lower back.
Could this indicate that the deep muscles have not healed yet, or could it be an internal organ issue?
In recent days, I have also seen an acupuncturist and massage therapist, but I still experience pain in my shoulder and shoulder blade.
The practitioner mentioned that the pain might last another week.
Could this pain in that area affect my right back? Thank you.

Especially in the morning, my entire back and lower back feel sore and numb, and I am unsure what is happening.
I have too many questions, and I would appreciate your analysis.
Thank you very much.

MM, 40~49 year old female. Ask Date: 2016/06/22

Dr. Li Weiqiang reply Rehabilitation

Dear MM,
1.
You have been experiencing shoulder, neck, and back pain for over a year, but it has become more pronounced in recent months.
About a week ago, you suddenly felt pain in the right side of your ribcage under the armpit, as well as pain in the right side of your back and scapula.
Both shoulders hurt, with the right side being more noticeable.
You also have pain in both sides of your back and a dull ache in your left lower back, especially severe in the morning upon waking.
Occasionally, you have a few coughs.
A few days ago, you had a chest X-ray, which indicated that there were no significant issues with your lungs or heart.
You are a smoker.
Could this pain be related to a lung issue?
Answer: It is unlikely that the pain is directly related to smoking, but smoking is generally harmful to your health, so it is advisable to quit if possible.
2.
In June of last year, you underwent a comprehensive health check-up, which included examinations of your lungs, stomach, kidneys, liver, and gallbladder.
You were found to have mild fatty liver, and a colon polyp was removed, but there were no other significant issues.
This month, you also had a breast ultrasound, which showed no problems.
Six months ago, you had an endoscopy that revealed a mild gastric ulcer and gastroesophageal reflux, for which you are currently taking medication.
Answer: It appears that there are no major gastrointestinal issues.
3.
A month ago, you noticed swelling in the middle of your left back and had an X-ray that indicated spinal curvature.
Answer: How many degrees of curvature were noted?
4.
You have undergone acupuncture and massage therapy, which has significantly reduced the swelling in that area, but there is still mild swelling present, and you continue to feel soreness in that area and in your lower back.
Answer: This may be due to muscle relaxation and is likely not related to any internal organ issues.
Wishing you peace and health,
Dr.
Li Wei-Chiang
Department of Rehabilitation, Taoyuan General Hospital, Ministry of Health and Welfare

Reply Date: 2016/06/22

More Info

Shoulder blade pain can be a complex issue, often stemming from a variety of causes, including musculoskeletal problems, nerve issues, or even referred pain from internal organs. Given your symptoms and medical history, it’s essential to consider several factors that could be contributing to your discomfort.

Potential Causes of Shoulder Blade Pain
1. Musculoskeletal Issues:
- Muscle Strain: Overuse or strain of the muscles around the shoulder blade can lead to pain. This is common in individuals who perform repetitive tasks or have poor posture.

- Rotator Cuff Injuries: As mentioned in previous discussions, injuries to the rotator cuff can cause significant shoulder pain and weakness. A complete tear, as seen in some cases, can lead to persistent pain and limited range of motion.

- Thoracic Outlet Syndrome: This condition occurs when blood vessels or nerves in the space between your collarbone and your first rib are compressed, leading to pain in the shoulder and neck.

2. Nerve Issues:
- Cervical Radiculopathy: Nerve root compression in the cervical spine can cause pain that radiates to the shoulder blade and down the arm. Symptoms may include numbness, tingling, or weakness in the arm.

- Referred Pain: Pain from internal organs, such as the lungs or heart, can sometimes manifest as shoulder or back pain. Given your history of smoking and recent chest pain, it’s crucial to rule out any cardiac or pulmonary issues.

3. Internal Organ Issues:
- Pulmonary Problems: While your recent chest X-ray showed no issues with your lungs, persistent pain in the shoulder blade area could still warrant further investigation, especially if accompanied by other symptoms like coughing or shortness of breath.

- Gastrointestinal Issues: Conditions like gastroesophageal reflux disease (GERD) or peptic ulcers can sometimes cause referred pain to the shoulder area.

Diagnostic Considerations
Given the complexity of your symptoms, a thorough evaluation is necessary. While X-rays can provide valuable information about bone structure, they may not reveal soft tissue injuries or nerve compression. An MRI or CT scan may be more appropriate for assessing soft tissue, including muscles, tendons, and nerves.

Treatment Options
1. Physical Therapy: Engaging in physical therapy can help strengthen the muscles around the shoulder and improve flexibility. A therapist can provide targeted exercises to alleviate pain and improve function.

2. Pain Management: Over-the-counter pain relievers, such as NSAIDs (e.g., ibuprofen), can help reduce inflammation and pain. In some cases, corticosteroid injections may be beneficial for more severe pain.

3. Alternative Therapies: Acupuncture and chiropractic care can provide relief for some individuals. However, it's essential to consult with a healthcare provider to ensure these treatments are appropriate for your specific condition.

4. Lifestyle Modifications: Improving posture, especially if you spend long hours at a desk, can significantly reduce shoulder and back pain. Ergonomic adjustments to your workspace may also help.

5. Further Evaluation: If symptoms persist or worsen, further evaluation by a specialist, such as an orthopedic surgeon or a neurologist, may be necessary. They can provide a more detailed assessment and recommend advanced imaging if needed.

Conclusion
Your symptoms of shoulder blade pain, along with the history of neck and back issues, suggest a multifactorial problem that may involve musculoskeletal, nerve, or even internal organ-related issues. It’s crucial to continue working with your healthcare providers to explore these possibilities and develop a comprehensive treatment plan tailored to your needs. If you experience any new or worsening symptoms, such as significant shortness of breath, chest pain, or neurological changes, seek immediate medical attention.

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