Shoulder blade pain doesn’t always have an obvious cause. It can be a symptom of something serious like a heart attack or lung cancer. But it could also just mean you slept on it wrong or have poor posture at the computer.

Many other causes of shoulder blade pain exist, including degenerative disc disease, arthritis, gallbladder disease, and shingles.

This article goes through the symptoms and causes of shoulder blade pain. It also discusses diagnostic tests and treatment for shoulder blade pain.

Shoulder Blade Pain Symptoms

The shoulder blades are medically known as the scapulae. They’re triangular-shaped bones in your upper back. They stick out and become more visible when you move an arm toward your back.

The shoulder blades have many functions. One is to support pivotal movements of the shoulder.

Shoulder blade pain has different causes than shoulder pain or pain between the shoulder blades.

If you have shoulder blade pain that lasts more than a few days, see your healthcare provider. Get checked even if you suspect an activity (sports, housework) caused your pain.

Causes of Shoulder Pain

Pain in the shoulder blades can be from trauma or inflammation in the area, or it may be referred pain from other parts of the chest or abdomen. It may be a symptom of something as simple as mild muscle strain, or it can be a sign of something serious like a lung condition or cancer.

When to Go to the ER

Signs you need emergency medical help include:

Click Play to Learn How to Treat and Prevent Shoulder Blade Pain

This video has been medically reviewed by Oluseun Olufade, MD.

Causes of shoulder blade pain can be:

  • MusculoskeletalBone and joint-relatedHeart-relatedLung-relatedChest-wall-relatedAbdominal or pelvicCancerous

Some conditions are more likely to refer pain to either the right or left shoulder blade.

Musculoskeletal

The most common cause of shoulder blade pain is muscle strain. That’s often from short-term overuse of your arms and upper body.

The scapula pain may be accompanied by pain in other muscle groups. That can include the shoulder and back. But it may be felt only in your shoulder blade.

Muscle strain is more likely if you’ve:

  • Started a new exercise programDone lifting that you are not accustomed toSlept in a new or different bed

Longer-lasting pain may be related to chronic conditions. These include fibromyalgia or myofascial pain syndrome.

Rotator cuff tears can also cause shoulder blade pain. A condition known as snapping scapula syndrome can, too.

In snapping scapula syndrome, there’s cracking and popping (crepitus) along the inner side of the shoulder blade. Many people with this syndrome also have pain and instability in the shoulder.

Bone and Joint

Bone and joint problems that can cause scapula pain include:

  • Osteoporosis: May affect shoulder blades, shoulders, or neck. All can lead to shoulder blade pain.
  • Arthritis: The scapula may be directly involved, or it could be referred pain from arthritis in the chest, spine, shoulder, or ribs.
  • Compressed nerves: Pressure on nerves in the neck by collapsed or displaced discs or spinal stenosis can cause referred pain to the shoulder blades.

Disc disease may cause pain in your neck or numbness and tingling in your arm and hand.

Sometimes, shoulder blade pain from disc disease can help healthcare providers figure out which nerve is compressed so they can do surgery.

Shoulder blade fractures are uncommon. The scapulae are considered some of the hardest bones to break. Causes usually include falls or high-speed auto accidents.

Heart

Shoulder blade pain alone can be a symptom of heart problems. These include:

  • Heart attacks: A portion of the heart dies from lack of blood flow and oxygen.
  • Aortic dissection: A tear in the artery wall.
  • Pericarditis: Inflammation of the lining of the heart.

Heart attacks and aortic dissection are always medical emergencies. Pericarditis can lead to a cardiac emergency.

Anytime you have undiagnosed shoulder blade or chest pain, you should get immediate medical attention in case it’s a serious cardiac event.

Lung

Many people with lung cancer and mesothelioma (a type of lung cancer) have shoulder or shoulder blade pain. 

Heart attacks, especially in women, need to be considered with any form of pain in the torso.

A type of lung tumor called a Pancoast tumor grows on top of the lungs. It usually causes pain in the shoulders, shoulder blades, and arms.

Other lung problems that can cause scapula pain include:

  • Pulmonary embolism: Blood clots in the limbs that break off and travel to the lungs
  • Pneumothorax: A collapsed lung

These life-threatening conditions give you more reason to get shoulder blade pain checked out right away.

Chest Wall

The chest wall comprises muscles, bones, fat, skin, and other tissues around the vital organs in your chest. A shingles infection in the chest wall may cause shoulder blade pain.

Shingles is a painful condition caused by the chickenpox virus (varicella zoster). It involves a burning or tingling pain.

The first shingles symptoms include body aches. A few days later, a painful rash erupts. This two-stage development makes a quick diagnosis difficult.

Abdominal and Pelvic

Abdominal or even pelvic problems can cause shoulder blade pain. And it’s more common than you may suspect.

The muscles that separate your chest cavity from the abdominal cavity are called the diaphragm. When nerves along the base of the diaphragm are irritated, they can send referred pain to your shoulder or shoulder blade.

These nerves can be irritated during abdominal surgery. This happens when the abdominal cavity is filled with gas so the surgeon can see better.

Several abdominal and pelvic conditions can cause right-side shoulder blade pain. They are:

  • Gallstones
  • Peptic ulcer disease
  • Acid reflux
  • Liver disease

Pancreatitis (inflammation of the pancreas) is more likely to cause left-side shoulder blade pain.

Cancer

Cancerous tumors involving the chest may cause shoulder blade pain. They include:

  • Lymphomas
  • Esophageal cancer
  • Stomach cancer
  • Liver cancer
  • Pancreatic cancer

Bone metastases (cancer spreading to the bones) to the shoulder blades may occur with cancers from various body regions. For instance, such metastases have been reported from cancers of the breast, liver, kidney, lung, prostate, and gastrointestinal tract.

Diagnosis

When you go to your healthcare provider with shoulder blade pain, they have a lot to consider. They’ll start by asking questions and giving you a physical exam.

This is unlikely to be all that’s needed for a concrete diagnosis.

Questions Your Healthcare Provider May Ask

You’ll likely be asked many of these questions about your shoulder blade pain:

  • Which shoulder blade hurts? Right, left, or both?How long has it hurt?Did it come on gradually or suddenly?Have you recently changed your exercise routine?Do you take part in activities that often cause scapula pain? (e.g., tennis, golf, swimming, basketball, badminton, racquetball)Do you sleep on the same side the pain is on?How would you describe your pain?What makes the pain worse?What makes the pain better?Do you smoke, or did you in the past?What other symptoms have you had?

Lab Tests

Your provider may also order blood tests to determine the cause of your shoulder blade pain. Common tests check for:

Important symptoms to mention include:

  • Liver inflammationInflammatory forms of arthritisOther connective tissue diseases

Other tests may be ordered based on your symptoms or other findings.

Imaging Studies

Imaging studies done for shoulder blade pain may include:

  • Chest X-rayComputerized tomography (CT) scan of your chest or other areasMagnetic resonance imaging (MRI) of your chest or other areasPositron emission tomography (PET) scan if you have a history of cancer

These scans allow your healthcare provider to see what’s going on inside your body. Some show bones while others show organs and other soft tissues.

Heart Tests

If your provider is at all concerned about your heart, they may order an:

  • Electrocardiogram (EKG) to check your heart rhythmStress test to see how your heart responds to exercise

It is worth repeating: Heart attack pain, especially in women, may only be in your shoulder blades.

Abdominal Exams

To look at your stomach and small intestine, your provider may order an upper endoscopy. For this test, a tube with a small camera is threaded through your mouth and into your esophagus and stomach.

You may also be given an ultrasound to evaluate your gallbladder. A CT scan to look at your liver and pancreas is also possible.

Treatment

The treatment of shoulder blade pain depends on the underlying cause. If it’s related to a muscle strain, RICE may be helpful. It stands for:

  • RestIceCompression from an elastic bandage or splintElevation (keeping the shoulder blade above the heart)

Heat or physical therapy may be helpful for persistent musculoskeletal shoulder blade pain.

Anti-inflammatory medications such as Advil (ibuprofen) or Aleve (naproxen) may reduce discomfort. Stretching and/or massage benefit some people.

For other causes of pain, treatment should address the underlying cause. That may include radiation, bone-modifying drugs, or chemotherapy.

Summary

Shoulder blade pain can have many causes. It can be from bones, joints, or muscles; heart, lung, or chest-wall problems; abdominal or pelvic conditions; or certain cancers.

Diagnosing shoulder blade pain can be complicated. It may involve a lot of questions, blood tests, imaging, heart tests, and abdominal exams and scopes.

Treatment depends on the cause. It may involve anything from home care for a muscle strain to chemotherapy and radiation for cancer.

Because scapula pain can be a symptom of serious and even life-threatening conditions, you should always have it checked by a healthcare provider.

Frequently Asked Questions

  • When should I worry about shoulder blade pain?
  • Shoulder pain that is severe or accompanied by chest pain and shortness of breath should be evaluated right away. It could be a sign of a heart attack, aortic dissection, or pericarditis.
  • Does stress cause shoulder blade pain?
  • It can. Stress causes muscle tension that can cause pain in your shoulder blades, shoulders, neck, or back. Pain from muscle tension is often resolved by moist heat or massage.
  • How can I relieve shoulder blade pain?
  • It depends on the underlying cause. Ice or heat might help muscle-related pain. These shouldn’t be used for longer than 20 minutes at a time, with a layer of cloth between the pack and your skin.
  • Why do I feel pain between my shoulder blades?
  • The most common cause of pain between the shoulder blades is muscle strain caused by poor posture, frequent lifting, or sports that involve twisting. Other causes include:TraumaArthritisHerniated discHeart attackGallbladder diseaseNerve entrapmentCertain types of cancer
  • What organ is behind the shoulder blade?
  • The organ directly behind your shoulder blade is the lungs. The kidneys are just below each shoulder blade under the ribs.
  • What is referred pain?
  • Referred pain is felt someplace other than where the damage is. A number of health conditions can cause referred pain to the shoulder blades.For example, gallbladder disease can refer pain to your right shoulder blade.

Shoulder pain that is severe or accompanied by chest pain and shortness of breath should be evaluated right away. It could be a sign of a heart attack, aortic dissection, or pericarditis.

It can. Stress causes muscle tension that can cause pain in your shoulder blades, shoulders, neck, or back. Pain from muscle tension is often resolved by moist heat or massage.

It depends on the underlying cause. Ice or heat might help muscle-related pain. These shouldn’t be used for longer than 20 minutes at a time, with a layer of cloth between the pack and your skin.

The most common cause of pain between the shoulder blades is muscle strain caused by poor posture, frequent lifting, or sports that involve twisting. Other causes include:

The organ directly behind your shoulder blade is the lungs. The kidneys are just below each shoulder blade under the ribs. 

Referred pain is felt someplace other than where the damage is. A number of health conditions can cause referred pain to the shoulder blades.

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By Lynne Eldridge, MD

 Lynne Eldrige, MD, is a lung cancer physician, patient advocate, and award-winning author of “Avoiding Cancer One Day at a Time.”