Right Shoulder Blade Pain: When to Seek Medical Help - Family Medicine

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Hello! It sounds like you have been experiencing persistent pain in your right shoulder blade for over two months, and despite seeing an orthopedic doctor and undergoing rehabilitation, your condition has not improved. You mentioned that certain movements trigger a sharp pain, and you also experience discomfort in your right arm. Additionally, you are concerned about the possibility of your shoulder pain being related to cardiac issues, especially since you have a history of left shoulder and chest discomfort during exercise.

First and foremost, it's important to understand that shoulder blade pain can arise from various causes, including musculoskeletal issues, nerve compression, or even referred pain from internal organs, such as the heart. Given your history of chest discomfort and the fact that you have undergone cardiac evaluations, it is reassuring that your heart has been deemed normal. However, it is always wise to remain vigilant about any new or worsening symptoms.

In your case, the pain you are experiencing could be attributed to several factors:
1. Musculoskeletal Issues: Conditions such as muscle strains, ligament sprains, or tendonitis can cause pain in the shoulder blade area. The "pop" sound you hear during certain movements could indicate a muscle or tendon issue, possibly related to the rotator cuff or surrounding structures.

2. Nerve Compression: If there is compression of the nerves in the cervical spine (neck region), it can lead to pain radiating to the shoulder blade and arm. This could be due to conditions like cervical spondylosis or herniated discs.

3. Referred Pain: While less common, shoulder blade pain can sometimes be referred from other areas, including the heart or lungs. Given your previous symptoms of chest discomfort, it is essential to rule out any cardiac issues, even if initial tests were normal.

Since you have already consulted with an orthopedic specialist and have undergone physical therapy without significant improvement, it may be beneficial to seek further evaluation. Here are some steps you can take:
1. Consult a Neurologist: Given the symptoms of arm pain and the potential for nerve involvement, a neurologist can perform a thorough examination and may recommend imaging studies, such as an MRI of the cervical spine, to assess for any nerve compression.

2. Consider a Pain Specialist: If your pain persists, a pain management specialist can offer various treatment options, including injections or advanced therapies that may provide relief.

3. Physical Therapy Re-evaluation: Sometimes, a different approach to physical therapy can yield better results. A therapist specializing in shoulder rehabilitation may provide targeted exercises and modalities to address your specific issues.

4. Cardiac Evaluation: If you experience any new symptoms, such as chest pain, shortness of breath, or changes in your exercise tolerance, it is crucial to seek immediate medical attention to rule out any cardiac concerns.

In summary, while your shoulder blade pain may not be directly related to cardiac issues, it is essential to continue investigating the underlying cause. A multidisciplinary approach involving orthopedic, neurological, and pain management specialists may provide the best chance for diagnosis and effective treatment. Remember to communicate openly with your healthcare providers about your symptoms and concerns, as this will help guide your care effectively. Take care, and I hope you find relief soon!