6 Things That Could Be Causing Your Shoulder Blade Pain

Shoulder blade pain is discomfort in or around your shoulder blades. It usually develops from muscle strain due to injury or overuse. However, it can sometimes be a sign of more serious conditions, like a heart attack.

The shoulder blade (scapula) is one of two triangular bones in the upper back. A complex network of muscles, tendons, nerves, and ligaments stabilize the shoulder blade and support its movements. If the shoulder blade or surrounding muscles are injured, the injury can affect the position of the shoulder blade.

Living with shoulder blade pain can make everyday movements like reaching, lifting, sitting, or lying down uncomfortable. It’s important to address shoulder blade pain promptly to get an accurate diagnosis and relieve discomfort. Seeking medical attention is the best way to ensure effective recovery.

Shoulder blade pain differs from pain in the shoulder joint. It specifically affects the scapula—the triangular bone on both sides of the upper back—and the surrounding muscles and connective tissues that support and move the bone. 

The nature of shoulder blade pain can offer clues about its underlying cause. Pain sensations may feel dull, sharp, burning, throbbing, or aching. It may come and go, worsen with certain activities, or be more persistent and constant. You might also experience the following symptoms:

Arm weakness or difficulty lifting or reaching overheadReduced range of motion in the shoulder A crunching or popping sound when moving the shoulder An uneven posture, with one shoulder appearing higher than the otherThe shoulder blade protruding outward, also known as “winging”

Referred pain is a common type of shoulder blade pain. Referred pain is feeling pain in a body area other than where the source of pain originated. For example, a condition affecting internal organs, such as the gallbladder, liver, or lungs, can present as pain in the shoulder blade area.

Shoulder blade pain has many possible causes, ranging from sudden injuries to chronic (long-term) conditions. Understanding these causes is the first step in seeking an accurate diagnosis and finding effective treatment. 

1. Muscle Conditions 

Seventeen muscles attach to the scapula, stabilizing the shoulder blade, supporting shoulder movements, and connecting the scapula to the spine, ribs, and arms. These common muscle-related conditions can lead to shoulder blade pain:

Muscle strain (pulled muscle): This occurs when the muscles supporting the scapula are overstretched or torn due to repetitive movements (overuse), poor posture, or sudden trauma. Symptoms include pain, bruising, swelling, and a limited range of motion in the affected shoulder. 
Myofascial pain syndrome: This condition involves the development of trigger points—tight knots of muscle that can cause localized pain in the muscle knot and refer pain to other areas, including the shoulder blade. Myofascial pain syndrome can develop due to an injury, muscle overuse, or stress. 
Rotator cuff tear: The rotator cuff is a group of four muscles that stabilize the shoulder joint and support a wide range of shoulder movements. Rotator cuff tears commonly affect the shoulder joint but can cause scapula pain. A partial or complete tear can develop from a sudden injury or wear-and-tear from aging or repetitive overhead movements. Symptoms include pain that worsens at night, pain or weakness when lifting or lowering the affected arm, and crepitus (crackling sensation when moving the shoulder).

2. Bone and Joint Conditions

Conditions affecting the bones that make up the shoulder joint, the connective tissues of the shoulder joint, and the nerves that go through the soft tissue of the shoulder blade may cause shoulder blade pain.

These conditions include:

Frozen shoulder: Also known as adhesive capsulitis, the tissue on the shoulder joint or capsule turns thick and stiff, causing pain and making it hard to move your shoulder. You may have pain over the shoulder, sometimes in the upper arm, and occasionally in the shoulder blade area. 
Osteoarthritis: This wear-and-tear form of arthritis can cause shoulder blade pain when the cartilage in the acromioclavicular joint—where the collarbone meets the scapula—wears away. As the cartilage wears away, bone rubs on bone, causing pain, discomfort, and stiffness at the top of the shoulder.
Cervical degenerative disc disease: Spinal discs that provide cushioning between the neck vertebrae (bones) wear away, lose height, or collapse, leading to nerve compression. Compression of a neck nerve can cause referred pain to the shoulder blades, limited neck mobility, and headaches.
Osteoporosis: This progressive loss of bone mineral density leads to thin, weakened bones and an increased risk of fractures (broken bones). Osteoporosis might not cause pain until a fracture occurs, though some people may develop shoulder blade pain without a fracture. 
Scapula fractures: This rare condition accounts for less than 1% of all broken bones. It usually occurs due to high-impact accidents or falls, causing severe pain in the upper back and shoulder area. The scapula isn’t commonly fractured because surrounding muscles and tissues protect it well. Scapula fractures often occur alongside other major injuries to the shoulder joint or chest, such as rib or collarbone fractures.

3. Abdominal Conditions 

Abdominal organs share nerve pathways with the shoulder, so pain originating in the gastrointestinal system and abdominal organs can present in the shoulder blade area. These conditions may cause referred pain to the shoulder blade: 

Gallstones: These hardened deposits of digestive fluid form in the gallbladder. They can block the duct (tube) leading out of the gallbladder, causing it to stretch and possibly become inflamed. This inflammation can irritate the phrenic nerve that runs from the neck down to the diaphragm, resulting in intensely sharp pain in the right shoulder blade. About 60% of people with gallstones experience right shoulder blade pain.Pancreatitis: Pancreas inflammation can cause referred pain to the left shoulder blade, as well as abdominal pain, nausea, and vomiting.Gastroesophageal reflux disease (GERD): Also known as acid reflux, GERD can cause pain in the left shoulder blade that may feel like a gripping, squeezing sensation.Liver disease: Hepatitis (liver inflammation) and cirrhosis (liver scarring) are examples of liver diseases that can cause referred pain to the right shoulder blade, which some people describe as a sharp, stabbing pain.

4. Lung Conditions 

When lung conditions cause shoulder blade pain, the pain usually develops in the shoulder blade on the same side as the affected lung. Lung conditions that can cause referred pain in the shoulder blades include: 

Pulmonary embolism: This is a blood clot in the lung that can cause sudden, sharp pain in the shoulder blades and back, difficulty breathing, rapid heart rate, lightheadedness, and chest pain.Pleurisy: Inflammation of the lungs’ lining (pleura) that can develop due to a lung infection, such as pneumonia, or an underlying lung condition. Coughing, chest pain when taking deep breaths, and shortness of breath are common symptoms. Some people with pleurisy also experience pain in the shoulder and shoulder blades. Pneumothorax (collapsed lung): This can develop after a lung injury or due to lung conditions, such as asthma or chronic pulmonary obstructive disease (COPD). It can cause sharp pain in the chest or shoulder area and shortness of breath.

5. Heart Conditions 

Some heart conditions can cause pain in the shoulder blade area, including: 

Heart attack: When blood flow to the heart is blocked, it damages the heart muscle. In addition to chest pain, a heart attack can cause pain in one or both shoulders, arms, and back, as well as shortness of breath, cold sweats, and dizziness. Pericarditis: Inflammation of the pericardium, the sac-like membrane surrounding the heart, that can cause sharp, stabbing chest pain that radiates to the shoulder blades. The pain may worsen when taking deep breaths and go away when leaning forward, sitting up, or standing.Aortic dissection: This is a life-threatening tear in the inner layer of the aorta, the major artery that carries blood out of the heart. Symptoms include sudden sharp, tearing, or ripping chest pain that radiates to the shoulder blades, back, abdomen, and hips. 

6. Cancer

Certain types of cancer can cause referred pain to the shoulder blade. Lung cancer, for example, can cause shoulder blade pain. As a tumor in the lung grows, it can press on nearby nerves, causing pain that radiates to the shoulder blade, usually the right shoulder blade area.

Other types of cancers that can cause shoulder blade pain include those that affect the:

PancreasLiver EsophagusStomach

Metastatic cancers that originate in another body area and spread to the bone can affect the scapula (shoulder blade) and cause pain.

Many cases of shoulder blade pain develop due to minor muscle strain or overuse, and home care strategies like rest and ice therapy often help relieve the pain. It’s a good idea to see a healthcare provider for pain that persists for more than two weeks despite at-home treatments or if you have shoulder blade pain with any of the following symptoms: 

Swelling or redness in the affected areaA shoulder blade that looks distortedDifficulty moving the affected shoulder or arm Fever 

Shoulder blade pain can be a sign of a medical emergency, such as a heart attack. Seek immediate medical attention for shoulder blade pain accompanied by: 

Crushing pressure or pain in the chest, jaw, or arm Shortness of breath DizzinessRapid heart rateConfusion

Diagnosing the cause of shoulder blade pain involves a medical history review and physical examination. Your healthcare provider will discuss your symptoms with you (e.g., is it sharp or dull?). They’ll also examine your shoulders, neck, and upper back to check for signs of inflammation and injury and test the affected shoulder’s range of motion and muscle strength.

To determine the underlying cause, your healthcare provider may order diagnostic tests, such as:

Imaging scans: X-rays, magnetic resonance imaging (MRI) scans, ultrasounds, and computed tomography (CT) scans help visualize the bones, muscles, and supportive tissues of the shoulder blade and surrounding area to identify abnormalities. Blood tests: A complete blood count and blood tests that check for markers of inflammation can help diagnose certain causes of shoulder blade pain. Electrocardiogram (ECG): This test measures the heart’s electrical activity to diagnose or rule out cardiovascular conditions associated with shoulder blade pain.

Treatment options for shoulder blade pain depend on what’s causing your pain. Treatments include rest, physical therapy (PT), over-the-counter (OTC) pain medications, and, in some cases, surgery.

At-Home Treatments 

When an injury, such as muscle strain, is causing shoulder blade pain, at-home treatments can help relieve pain while you recover. Here’s what you can do at home to relieve shoulder blade pain: 

Rest: Avoiding activities that worsen or trigger the pain can help reduce inflammation and prevent worsening injury. 
OTC pain relievers: OTC medications, including non-steroidal anti-inflammatory drugs (NSAIDs) like Advil (ibuprofen) or Aleve (naproxen), reduce inflammation and temporarily relieve pain. 
Ice and heat therapy: For the first 48 hours following an injury, applying towel-wrapped ice packs for 20 minutes at a time, up to four times a day, can reduce swelling and pain. After that, switching to heat therapy, such as using a heating pad or a hot shower, can help relax tense muscles. 
Good posture: Keeping your shoulders back and head aligned with the spine can reduce stress on the shoulder blade muscles and connective tissues.

Medical Treatments

Medical treatments for shoulder blade pain vary widely depending on the underlying cause. Your healthcare provider will recommend a treatment plan specific to what’s causing shoulder blade pain to reduce pain and restore the function of your shoulder and arm. Your treatment plan may include: 

Physical therapy (PT): A physical therapist can create a treatment plan that includes exercises and stretches designed to strengthen the muscles that support and move the scapula and stretch tight muscles that limit the range of motion in the shoulder blade.Medications: Moderate-to-severe shoulder blade pain may require prescription-strength NSAIDs or corticosteroid injections to reduce inflammation and relieve pain in muscle, tendon, or ligament injuries affecting the shoulder blade area. Underlying conditions affecting internal organs, such as the heart and lungs, require specific medications to address the condition. Surgery: A procedure may be necessary to address certain injuries, such as a rotator cuff tear, scapula fracture, or nerve compression. The type of surgery you need will depend on the diagnosis.

Shoulder blade pain has many possible causes, including minor injuries like muscle strain, chronic conditions like osteoarthritis, and more serious conditions with the heart or lungs, such as heart attack or pulmonary embolism. 

While self-care measures like rest and ice can help relieve some causes of shoulder blade pain, other causes require medical attention and treatment to address the underlying cause.

See a healthcare provider if you have shoulder blade pain that persists for more than two weeks or if you have difficulty moving your shoulder or performing everyday tasks.