Shoulder Blade Pain: Symptoms, Causes, And Treatment In Singapore

Our shoulders are an important structure of the body where they provide support for a good posture and allow us to carry on various activities with our hands and arms. Because of their constant use, the shoulders are prone to various aches and pains. One such associated pain is shoulder blade pain. It is a common complaint among individuals of various age groups and the pain can range from mild to extreme. To learn about effective shoulder blade pain treatments in Singapore, it is essential to first understand how our shoulders work, what are the causes of shoulder blade pain, and how does it manifest in the form of symptoms. Let'g dig in.

Anatomy of the Shoulder Blade

The shoulder joint is made up of three bones: the scapula (shoulder blade), the clavicle (collarbone), and the humerus (upper arm bone). The shoulder blade is a flat and roughly triangle-shaped structure that connects the upper arm bone and the collarbone.

Located in the upper back, it is surrounded and supported by a complex system of 17 muscles, 12 tendons, six ligaments, and two nerves working together to move the arm in many directions.

What Function Does the Shoulder Blade Serve?

The scapula has several important functions: 

• Enabling shoulder movement in six directions: protraction, retraction, elevation, depression, upward rotation, and downward rotation.
• By connecting the humerus to the clavicle, the shoulder blade joins your arm to your torso.
• Being flat and due to its location, the scapula serves as a shield protecting the chest. It is a strong bone that can absorb a blow without breaking easily.
• Providing a large area for the attachment of several muscles necessary for shoulder and arm movements.

Common Causes of Shoulder Blade Pain

There are many possible causes of shoulder blade pain. It can be as simple as sitting in a cold draft for many hours or sleeping in an awkward position. Pain under the shoulder blade can also result from something more serious, such as a heart condition. Sometimes shoulder dislocation can also cause pain in the shoulder blade. Here we list some common reasons for shoulder blade pain.  

1. Muscular Strain or Injury

Pain in the shoulder blade due to muscular issues can originate in several ways.

Overuse. Pain below the right shoulder blade can result from muscle strain due repeating the same movements over and over, for example, repeating the serving motion in tennis, or spending hours reaching up to paint large surfaces. These actions involve excessive use of the structures that form part of the shoulder blade, leading to pain.

Poor posture. Slouching on a couch or in front of your desk causes more than a poor posture. This habit, especially when slouching forward for long hours, strains the muscles in the upper back, causing pain in the shoulder blade. Sleeping in an awkward position or in the same position all the time can also lead to pain in the shoulder. 

Rotator cuff tears. A tear in the tendons that connect the muscles of the shoulder joint can also cause shoulder blade pain. Read more about rotator cuff injury here.

Muscular pain caused by stress. Tense and knotted muscles are the most common reason for consulting physiotherapists for pain relief.  Muscles can become tense, stiff and painful due to prolonged stress and anxiety. 

2. Joint and Bone Issues

Since the shoulder blade is a joint where bones, muscles, tendons and ligaments come together, problems that affect bones, can result in shoulder blade pain.

Fracture of the shoulder blade. Shoulder blade fracture can happen but it is uncommon. Since the scapulae are exceptionally strong, they only break because of a direct blow or a trauma such as falling from a great height.  

Cervical herniated disc. A cervical disc in the lower part of the neck pushes or herniates, pressing on nearby nerves, causing pain in the shoulder blade area.

Arthritic facet joints. Facet joints run the length of the spine. They can develop arthritis with resulting inflammation and pain.

Osteoporosis. Osteoporosis is a bone disease that weakens bones. It can also affect the vertebrae of the spinal column, where it can cause a compression fracture. When vertebrae of the upper back are affected, it can cause shoulder pain as well.

Osteoarthritis. In shoulder osteoarthritis, the cartilage in the shoulder joint gradually disintegrates, leaving the bones in the joint without any cushioning. The resulting friction in the joint causes pain and loss of mobility. 

3. Referred Pain from Other Health Conditions

Heart Conditions

Certain heart conditions can lead to pain in the entire shoulder and shoulder blade. It can be a symptom of a heart attack, an aortic tear, or the lining of the heart that is inflamed.

Gallbladder Disease

When the gallbladder is inflamed and enlarged due to disease, it irritates the phrenic nerve. This nerve runs from the abdomen, through the chest, and into the neck. The irritation of the phrenic nerve can be felt as referred pain in the right shoulder blade.

Lung conditions 

Examples of lung conditions that can cause referred pain in the shoulder blades are lung cancer, a collapsed lung, and a pulmonary embolism. A pulmonary embolism is a blood clot that causes a blockage of blood flow to the lung. The blood clot usually originates from a blood vessel in the leg.

Various Cancers

In addition to lung cancer, pancreatic, oesophageal, stomach, and liver cancer can lead to pain in the shoulder blade.

4. Left vs. Right Shoulder Blade Pain

It is useful to distinguish between left and right shoulder blade pain because the location of the pain may point to different underlying health issues that may require medical attention. 

Left shoulder blade pain could signal a heart attack or angina, especially if you also experience chest pain or shortness of breath. Right-side pain is often associated with gallbladder problems, liver issues, or conditions affecting the lungs. 

Especially if the pain comes on suddenly, it might be more than a muscle strain, poor posture, or issues with the spine.

Symptoms of Shoulder Blade Pain

In addition to pain around or under the scapula, other symptoms may include:

• Impaired ability of the shoulder and arm, with overhead movements being particularly difficult or greatly restricted.
• Restricted range of motion, making many routine tasks challenging, especially tasks that require the arm to be higher than the shoulder, such as getting dressed or packing a high shelf.
• In some instances, a snapping sound may be audible when the shoulder is being used.
• There could be visible signs of a protrusion of the shoulder blade. From the back, the shoulders don't look the same, with one sticking out and not lying flat as it should. This is called a winged scapula. It can be debilitating, making movements difficult and painful.

When to See a Doctor

Since shoulder blade pain can be a symptom of serious health issues, such as heart attack, a blood clot, or cancer, it's imperative to seek medical advice and assistance for a proper diagnosis if, in addition to shoulder pain, there is also chest pain, shortness of breath, or dizziness. Such pain should always be checked by a qualified specialist so that the underlying cause can be diagnosed and effective shoulder pain treatment can be started.

Diagnosis

Determining the cause of shoulder blade pain involves a detailed physical exam of the back, neck, and shoulders. Your doctor will interview you to discuss your symptoms and medical history.

This information will create a general picture of your condition but may not deliver an accurate diagnosis. Your doctor will probably order additional tests to determine the exact cause of your discomfort. 

Depending on the nature of the symptoms, these tests may include: 

• A complete blood count that includes a liver function test 
• MRI or CAT scans of the shoulder area, the lungs, and the chest 
• An electrocardiogram (ECG) or cardiac stress test to evaluate the state of your heart
• Endoscopic examination for more detailed information

How to Relieve Shoulder Blade Pain

Home Remedies

In some cases, shoulder blade pain may resolve with simple home treatments, such as:

Immobilising the shoulder. Sometimes, complete rest over one or two days is all that's needed to achieve some relief. Complete rest gives the shoulder time to recover and heal, especially if you have been overdoing exercise, gardening, or painting. If the shoulder doesn't get better with rest, you may need medical intervention.

Heat Therapy. A hot bath or a heating pad can do wonders for sore and tight shoulder muscles.

Ice Therapy. Ice therapy is excellent for reducing pain and inflammation. Don't put ice directly on the affected area. Wrap it in a towel so it can't damage your skin. 

You can alternate between heat and cold treatments. Use the heat or ice for 20 minutes and wait 45 minutes to switch to the other treatment. Cold treatment reduces pain and inflammation, and heat treatment relaxes sore and tense muscles and promotes blood circulation.

Pain Medication. Over-the-counter pain medications can be invaluable in relieving shoulder blade pain. Medicines like aspirin, ibuprofen, naproxen, and acetaminophen reduce pain and inflammation.

Although these medicines are available over the counter, they are not meant to be used long-term. They have gastrointestinal side effects with prolonged use. If the pain doesn't subside with these medications, consult your doctor. Your doctor may prescribe stronger medication such as corticosteroid medications or injections.

Physical Treatments

Exercise. Preventative and stretching exercises for shoulder blade pain can help you recover. Exercises help to rebuild muscles and strength and also help release strained muscles. Consult a physiotherapist about the correct exercises to relieve the pain.

Physical therapy. A qualified physical therapist can introduce targeted exercises and perform manual therapy to improve mobility in the shoulder and relieve discomfort. 

Manual therapy is a hands-on technique that involves the manipulation of soft tissue, joints, and nerves. The aim is to rehabilitate the shoulder.

Massage. Massage by a skilled professional is very effective in helping tense muscles to relax. The aim is relaxation. A massage therapist is not qualified to attempt rehabilitation of limbs. 

Surgery

Shoulder blade pain typically doesn't require surgery. Most people respond to conservative treatments like exercise, massage, and medication. 

Surgery is usually reserved for cases involving:

• Severe, unresolved pain in shoulder blade despite conservative treatments
• Shoulder blade fracture
• Severe arthritis
• Rotator cuff tears
• Severe damage to the structures of the scapula, including tendons or ligaments

Surgeons may choose to perform open surgery or keyhole surgery, using microscopic instruments and cameras.

For more information about various orthopaedic conditions, contact our orthopaedic specialist Dr James Tan today.