Sharp and Electric Pain in the Right Shoulder Blade: Causes and Next Steps

Intermittent sharp pain and electric shock-like sensations in the right scapular region?

This condition has persisted for nearly four months since June 30 of this year.
On that day, while working in the morning, I suddenly experienced a very intense sharp pain in my right scapula, which also radiated to my chest.
The pain lasted only a brief moment, and I was stunned for several seconds at that moment.
Afterward, I did not feel any discomfort in my body or the affected area.
That afternoon and evening, I experienced it again, and at night, the pain became so severe that I couldn't sleep.
A few days later, I visited an orthopedic clinic, and the doctor diagnosed it as a muscle strain.
However, after two days without significant improvement—only less painful than on the day of the incident—I was advised to see a cardiologist.
I underwent X-rays and both resting and exercise electrocardiograms, all of which showed no major issues.

The pain began to manifest in two different ways.
The first type is as previously described: sudden sharp, electric-like pain that feels as if my whole body is about to jump up; it is extremely painful! The main pain point is in the right scapula, but sometimes it is closer to the right chest, although it is almost always in that same spot.
The second type is also sudden but starts as a dull ache that intensifies into a tight, pulling pain, lasting about 5 to 10 seconds.
In both cases, after the pain subsides, I usually do not feel any discomfort when moving that area, nor do I experience significant soreness or numbness.
The situation varies from severe to mild; sometimes it recurs several times throughout the day, while other times I only feel a dull ache a few times in a day.
By mid-August, I visited another orthopedic clinic nearby, where the doctor concluded that my incorrect sitting posture was causing a hunchback and tightness in my chest, leading to weakness and pain in my right scapula.
Following their advice, I underwent B12 injections (once a week for a total of four times) and was scheduled for rehabilitation.
Although the pulling pain of the second type has gradually diminished, the sharp pain still exists, though it has become less frequent.
However, more than a week after completing the treatment, the sharp and electric pain has started to become frequent again! It is definitely not soreness but rather a sudden, intense pain, and aside from psychological discomfort at the moment of pain, I generally do not feel any physical discomfort afterward.
Sometimes it seems that certain movements of my arm or scapula trigger it, but most of the time, I can twist around without any issues.
I am really at a loss and would like to ask the doctor whether this is a neurological or muscular issue.
If I need to seek further medical advice, should I consult a neurologist or a rehabilitation specialist? Thank you very much!

Mr. Wu, 20~29 year old female. Ask Date: 2017/09/24

Dr. Jiang Junyi reply Neurology

Hello, your symptoms are more indicative of an intercostal muscle strain, which is typically associated with pain related to movement and posture.
As for the intercostal nerves, they run along the ribs in the chest, passing from the back through the lateral abdomen to the front of the chest.
Intercostal neuralgia refers to intense pain that follows the path of these nerves, presenting as a semicircular pattern of severe pain across the chest and abdomen.
I recommend discussing examination and treatment options with a rehabilitation specialist.
Wishing you good health and peace.
Sincerely, Taoyuan Medical Center, Neurology Department, caring for you.

Reply Date: 2017/09/24

More Info

Understanding sharp and electric pain in the right shoulder blade can be quite complex, especially given the duration and nature of your symptoms. Based on your description, it seems that you have been experiencing intermittent sharp and electric-like pain in your right shoulder blade for nearly four months, which can be quite distressing.

Possible Causes
1. Muscle Strain: The initial diagnosis of a muscle strain is plausible, especially if you have been engaging in activities that may have overexerted your muscles. Muscle strains can lead to sharp pain, particularly if the muscle is suddenly stretched or contracted.

2. Nerve Impingement: The sharp, electric pain you describe could also suggest nerve involvement, such as a pinched nerve in the cervical spine or thoracic outlet syndrome. This occurs when nerves that exit the spine are compressed or irritated, leading to pain that can radiate to the shoulder blade and chest area.

3. Referred Pain: Sometimes, pain in the shoulder blade can be referred from other areas, such as the neck or even the heart. Given that you have already undergone cardiac evaluations with no significant findings, this may be less likely, but it’s still a consideration.

4. Postural Issues: Your mention of poor posture and the development of a hunchback (kyphosis) could contribute to muscle imbalances and nerve compression, leading to the symptoms you are experiencing. Poor ergonomics, especially during prolonged sitting, can exacerbate these issues.

Next Steps
1. Further Evaluation: Since your symptoms have persisted and even worsened, it would be advisable to seek further evaluation. A neurologist could provide insights into whether there is a neurological component to your pain, especially if there are signs of nerve involvement. An MRI of the cervical spine may be warranted to rule out any disc herniation or other structural issues.

2. Physical Therapy: Continuing with physical therapy is essential. A physical therapist can help you with exercises to strengthen the muscles around your shoulder and improve your posture. They can also provide modalities such as ultrasound or electrical stimulation to help alleviate pain.

3. Pain Management: If the pain becomes unmanageable, discussing pain management options with your healthcare provider may be beneficial. This could include medications, injections, or alternative therapies.

4. Lifestyle Modifications: Pay attention to your posture during daily activities. Ergonomic adjustments at your workstation, regular breaks, and stretching can help alleviate some of the strain on your muscles and nerves.

5. Follow-Up: Keep a detailed record of your symptoms, including when they occur, their intensity, and any activities that seem to trigger them. This information can be invaluable for your healthcare provider in determining the best course of action.

Conclusion
In summary, the sharp and electric pain in your right shoulder blade could be due to a combination of muscle strain, nerve impingement, and postural issues. It is crucial to follow up with a healthcare professional who can perform a thorough evaluation and guide you through the appropriate diagnostic tests and treatment options. Seeking a neurologist's opinion may be beneficial, but continuing physical therapy and addressing any ergonomic concerns should also be prioritized. Your health and comfort are paramount, and with the right approach, there is a good chance of recovery.

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