Scapulae or shoulder blades are triangular bones in the upper back between the spine and the arms. Pain between shoulder blades is a common problem and is also addressed by various other names such as scapular pain or interscapular pain or upper back pain.The most common cause of pain in this region is muscular problems, however the list of possible causes is a long one and includes some serious causes as well.
Pain in this region may be like an aching, sharp, burning, throbbing or heaviness sensation and the underlying causes may be challenging to identify. The pain can interfere with daily activities and affect the shoulder and neck movements.
Causes
The common reasons of pain in this region, which I see in my day to day practice include
Muscle injury or strain. Simple things such as poor posture, long sitting periods, improper lifting technique, sedentary lifestyle, unaccustomed sudden increase in physical activity, heavy lifting and sleeping in the wrong posture can predispose one to injury in this region. This is generally described as a pulled muscle sensation.
Pain in this area can be quite annoying and frustrating as it interferes with your daily chores and keeps coming back. Overuse of arms and upper half of body (torso) as during activities such as ironing, washing dishes, gardening etc is often blamed for increased scapular pain. Front focussed workouts can produce muscular imbalance predisposing the back muscles to injuries, strains andsprains.
Severe pain and localised spasm of muscles can be treated by trigger point injections. Physiotherapy is important in the long term strengthening of these muscles.
To read more about trigger point injections click here
Pain originating from Slipped disc in the neck. I see this commonly in my practice.A bulging disc in the lower part of neck can compress the nerves coming out of the spine and lead to shoulder blade pain. The pain resulting from pressure on the nerve may be felt more in the areas supplied by the pinched nerve including the shoulder blade, shoulder and the arm. These pains can be helped by injections close to the bulging discs such as cervical epidural injections.
To read more about Cervical Epidural Injection click here
Pinched nerve in the Neck or upper body. Specific nerves which supply the muscles in this area can get entrapped in the neck and lead to pain. This includes the Dorsal scapular nerve, and the suprascapular nerve. Unfortunately, the awareness regarding these nerves being a source of pain is low and hence this diagnosis is often missed. Ultrasound guided injections of the involved nerve can produce good relief in this condition.
To read more about Dorsal Scapular Nerve Block and its treatment click here
Pain originating from the Neck joints. Neck is made of seven bones called the vertebrae. These are stacked one above the other and join with each other at joints known as facet joints. Wear and tear or arthritis of the joints in the lower part of neck can give rise to pain in the scapular region. This condition can be present despite a normal MRI scan and the best way to diagnose this is diagnostic injections of the joints or the nerves supplying them. If the pain gets relieved after the injection then these joints are the likely source of one’s pain.
To read more about Cervical Facet joint Injection click here
Post Herpetic Neuralgia (PHN or Shingles). PHN is an infection caused by the same virus that causes chickenpox. Although it may affect any body part, back of chest wall including the scapular region is commonly involved. This infection can cause severe burning pain with increased sensitivity in the area, which can persist for long. Diagnosis is generally made with the help of the typical rash which appears in the distribution of the involved nerve.
To read more about Post Herpetic Neuralgia and its treatment click here
Pancreatitis and pancreatic cancer. This generally presents as abdominal pain associated with nausea, vomiting, constipation and increased pain with oral intake. The associated pain may be severe requiring strong painkillers. Shoulder blade pain is commonly seen with pancreatic disorders and is generallymore left sided although it may be located in the middle or may involve both sides.
To find out more about Pancreatic Cancer and its associated painmanagement click here
Thoracic Spine issues such as a compression fracture, arthritis of spinal joints, disc bulges or a spinal curve (scoliosis)– Osteoporosis or trauma can lead to vertebral fractures and pain in the shoulder blade region. In severe osteoporosis the fractures can occur with minimal or no trauma and can take a long time to settle, requiring strong painkillers. Elderly and those on long term steroids are more prone to this problem.
To find out more about Thoracic Spine pain generators and their treatments click here
Infections such as TB of the spine.
Intercostal Nerve problems such as intercostal neuralgia. Intercostal nerves travel in between the ribs, from the spine posteriorly towards the front of the chest wall. These can be damaged as a result of previous injuries such as fractured ribs or operations. Sometimes involvement is also seen secondary to cancers or metastasis in the chest wall region. Pain originating from these nerves can be treated with modalities such as nerve blocks, radiofrequency treatment or cryoablation.
To read more about Intercostal Nerve Blocks click here
Fibromyalgia and Myofascial pain syndrome. In these conditionspain is the shoulder blade region is observed as a part of widespread body pain.Multiple trigger points may be present which can be treated by physical therapy, pain medicationsand local injections.
To read more about Fibromyalgia and its treatment click here
Other causes include
Abdominal and Pelvic causes such as gallstones, stomach ulcers, acid reflux, and liver disease
Cancers such as lymphomas, abdominal cancers such as oesophageal, stomach, liver or pancreatic cancer can cause shoulder blade pain.Spread of cancers such as breast and colon cancer to the bones in the scapular area may also lead to shoulder blade pain.
Heart and blood vessel problems such as inflammation of the lining of the heart (pericarditis) or tearing of the blood vessels (aortic dissection)
Lung problems such as lung cancer, clots in the lungs (pulmonary emboli) or puncture of lungs(pneumothorax)
Treatment
As you can appreciate, pain is this region can result from numerous, varied causes. Identifying the cause is important as it determines thefurther course of action and thetreatment. Detailed history and examination can provide important clues to narrow down the investigations and the list of possible pain generators. Some of the treatments have been discussed in the links provided at the end of individual causes.
For the common muscular sprain or pulled muscle sensation, physical therapy can be helpful. Apart from that simple home remedies include
Giving rest to the area
Ice compression
Simple pain relief medications including medicated rubs and ointments
Massage and stretching may provide short term relief
Certain lifestyle modifications may be required as a part of long term management plan. These include
Adding exercise, stretching to the daily routine
Being more mindful of correct posture
Physical therapy aimed at strengthening of back muscles
Ergonomic changes to your workstation such as height of computer screen, chair type etc.
If the pain is severe or non-resolving or if there are any warning signs of a underlying serious problem, then its best to seek early help early from experienced medical professionals.
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