Last reviewed by Dr. Raj MD on January 12th, 2022.
The scapula is also known as the shoulder blade. It is the structure that connects the humerus bones of the arm to the collarbone.
The scapula’s movement is enabled by three muscles:
- Trapezius – It is responsible for the movement of the shoulders and head.
- Levator – It is a small, thin muscle that arises from the vertebrae of the neck. It pulls up the scapula and enables you to shrug off the shoulders.
- Rhomboideus – it consists of major and minor muscles situated deep in the base of the shoulder blade. It allows you to raise the shoulder blade and move it backward. (1, 2, 3)
Where is the shoulder blade?
The shoulder blade (scapula) is a flat triangular bone found in the upper back. It is the one responsible for connecting collarbone at the front part of the body. Just like other parts of the body, the scapula also experiences pain and discomfort. There are a variety of reasons for scapular pain. (4)
Image 1: The scapula and the surrounding bony structures.
Picture Source: orthoinfo.aaos.org
Photo 2: The scapula outlining the three muscle groups responsible for the movement of the scapular region.
Image Source: www.theptdc.com
Picture 3: Upper back pain specifically in the scapular area.
Photo Source: www.chiropractic-help.com
Scapular Pain Causes
The scapula is made up of bones, muscles, tendons, joints, and tissues. For some reasons, the scapula gets inflamed and damaged. It is the reason why a patient complains of scapular pain symptoms including mild to severe scapular pain and discomfort. The common reasons for scapular pain are as follows:
- Injury to the bones – The scapular bones are not prone to injury or fracture. However, a great impact such as a direct blow to the scapular or car accident can injure the shoulder blade causing intense scapular pain.
- Muscle strain – Strain to the scapular muscles could lead to muscle spasm. There are reasons for scapular muscle strain and the common ones are improper posture, repetitive movement of the hands, damage to the muscles, and overexertion. Intense left scapular pain and right scapular pain can also be attributed with muscle tumor (myositis).
- Inflamed joints – The joints connected to the scapula can be inflamed and the condition is similar to that of typical arthritis. The scapular pain caused by the joint problem is called frozen shoulder.
- Torn tendons – The tendons attach the muscles to the bones. Overstretching of the muscles can cause torn tendons, which can be extremely painful. The pain can even radiate around the shoulder blades. (4, 5, 6)
- Damage to the tissues – Chronic scapular pain is caused by damage to any of the connecting tissues that form the joints, muscles, and tendons. It causes excruciating pain to the point that the patient’s ability to do activities of daily living are affected.
- Other health conditions – Severe scapular pain can be linked with other health conditions not related to the muscles, tissues, joints, and tendons. It could be an indicator of a respiratory-related problem, cardiac-related disease, fibromyalgia, and gallbladder issues.
- Degenerative changes – As the person grows older, the cervical spine (neck bone) deteriorates causing pain between the shoulder blades.
- Stress – This does not only pertain to physical stress but also psychological stress. As a matter of fact, those who are feeling depress always complain of back pain. (2, 4, 7)
- Scapular dyskinesis – What is scapular dyskinesis? It is called SICK scapula syndrome. It is the deviation of the normal resting or active position of the scapula during the movement of the shoulders. One of the clinical manifestations of scapular dyskinesis is pain and tenderness on the shoulder blade, especially when carrying heavy objects or even just raising the arm overhead. (1, 4, 10)
Diagnosing Scapular Pain
To thoroughly and accurately diagnose the underlying condition for scapular pain, the doctor needs to conduct a series of test, which includes physical examination, blood work, and other special procedures. The purpose of the blood work is to check for the functions of the liver and to detect arthritis and other serious health issues.
The condition of the heart will be checked in the form of an electrocardiogram. The radiologic test can also be ordered such as CT scan, x-ray, and MRI. For patients with family history of cancer, a PET (Positron Emission Tomography) scan is ordered. (2, 3, 5)
Treatment for Scapular Pain
The Scapular muscle pain treatment is vast. The doctor will use different treatment modalities to make sure that the pain will completely go away and the underlying cause will be thoroughly addressed. For mild scapular pain, it can be dealt right in the comfort of home.
For severe scapular pain, it would require hospitalization and aggressive treatment approach. Below are the guidelines for treating scapular pain.
You should refrain from moving your hands because it will cause further strain to the muscles. Keep the affected part of the body rested. To hasten the healing process, you have to apply a hot and cold compress. It will promote blood circulation, alleviate the pain, and relieve swelling.
Maintain a good posture
Poor posture can cause pain on the shoulder blade. Keep your back straight and your shoulders relaxed. Sit and walk properly. When going to bed, make sure that your head and body are aligned. (3, 5)
There are a lot of exercises for scapular pain. There are stretching techniques that can improve the symptoms of scapular pain. How do you stretch your shoulder blade? Lift your arms straight in front of you with the same level as your shoulders. Gently round your shoulders imagining that you are hugging someone.
Hold for about 10 seconds and release. Be very careful when performing stretching exercise. If you do it wrong, then you could induce more harm than good. Make sure you strictly follow the exercise guidelines to avoid further complications. (9)
The treatment for scapular pain primarily depends on the underlying cause. If it is just a simple muscle strain, it will completely go away by resting in a couple of days. If the underlying cause is a serious condition, then the doctor will come up with the best course of treatment.