Got Pain in the Shoulder Blade?

Got Pain in the Shoulder Blade? Barefoot Rehabilitation Clinic

13 Feb Got Pain in the Shoulder Blade?

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Got pain in the shoulder blade?

If you do, you already know that this location can be stubborn and annoying. It’s one of those places you get massages for and foam roll, relieving it temporarily, only to have it come back with a vengeance later on.  Or at other times, it’s not even there at all, despite the fact that you’re deadlifting or downward-dogging your little toosh off.

The question is “What’s the diagnosis?”

The answer is not a “Deficiency of Massages.”

Are you sure there is pain in shoulder blade?

First, let’s determine the precise location of your pain.

Is it actually on the shoulder blade, underneath it, or around it?

Many patients in our office blindly label their pain as “shoulder blade pain” when the pain is actually off of it, underneath, or even pain shooting from another location. Our rugby patient, Leenie, thought her pain was mainly in the shoulder when it was really in her neck.

See the picture below.

Pain-in-Shoulder-Blade

The shoulder blades’ borders are outlined in light green.

  • If your pain is located where “A” is, you’re correct that you have shoulder blade pain.
  • If your pain is located where “B” is, you actually have spine pain.

The biggest mistake people make in identifying pain in the shoulder blade is thinking the pain is on the shoulder blade when it’s really located where “B” is.

What makes the pain worse when you have a problem at “A”?

According to the location of your pain, if you have pain in shoulder blade, you can be fairly confident that this is a rotator cuff problem.

The rotator cuff is four muscles connecting the shoulder blade and the arm bone (the humerus). Those muscles are:

  1. infraspinatus (this muscle is most commonly involved due to the amount of surface area it covers on the shoulder blade.)
  2. teres minor (this muscle is involved in shoulder blade pain when the pain is close to the arm pit on the back side.)
  3. subscapularis (this muscle is involved when your pain is in the arm pit.)
  4. supraspinatus (this muscle is the most common painful rotator cuff tissue, although it is rarely the cause of the problem in the first place.)

Other possible problems include thoracic disc problems, rib and intercostal muscle problems, and organ-based issues. But these are all very rare.

You know with greater certainty that you have a rotator cuff problem if:

  • your pain worsens when you bring your arm out to the side and try to touch your bicep to your ear (like it does in this 30 second video. If you move as hesitantly as this and your range of motion has a mid-range arc your body is trying to avoid, you’ll need an arthogram).
  • your pain worsens when you do anything that is strictly shoulder dominant (like doing shoulder exercises that don’t involve the neck).

What makes the pain worse when you have a problem at “B”?

If your pain is spine pain, figuring out where the problem is located is a bit more complex.

  • If your pain is present constantly, 100% of the day, you probably have an acute injury and inflammation in the spine. Your medical doctor may want to prescribe anti-inflammatories or steroids to help you.
  • If your pain is worse with sitting, you probably have a neck (cervical spine) injury. Don’t get your big toe adjusted if you have a neck issue.
  • If your pain is worse when you bring your chin to your chest, you probably have a neck (cervical spine) injury.
  • If your pain is not worse with neck movements, you probably have a back (thoracic spine) injury. Your doctor will need a good reason to keep treating your neck if this is the case.
  • If your pain is worse with deep breaths or back (thoracic spine) rotation, you probably have an intercostal or rib injury. Therefore, you should get the ribs and rib muscles worked on.

You might be thinking:

But wait! My pain is worse with multiple movements and postures!

Well, that’s because most pains and injuries do not happen in isolation. There’s rarely only one problem in the very complex human body to be fixed.

And if you’re like most people, you’re in your 30’s to 40’s before your pain is ever bad enough to see a professional. You’ve been letting your body compensate for some time, which means that you’ve allowed various injuries to happen to various body parts as you’ve been living your life.

Practically speaking, once your pain is fixed with one of these movements, then you and/or your health professional can fix the next test.

What’s the most common cause of pain at “B”?

There is one problem that is extremely common but is almost never known by patients in our office at Barefoot Rehab.

You know you have it if:

  • You have exacerbations on a consistent basis, whether that’s bi-weekly, monthly, or quarterly.
  • You’ve been having exacerbations for months to years.
  • Exacerbations last between 2 – 10 days.
  • Your pain is made worse by neck movement.
  • Your pain is located at “B.”

This problem is called internal disc derangement (IDD). IDD is a low-level disc arthritis and when untreated, worsens with severity and duration over the long haul.internal-disc-derangement

It’s not an outright disc herniation or bulge of the neck, which is why so many healthcare practitioners ignore it as a problem. It equally confuses patients because the pain is in the mid-back, but the problem is coming from the  neck.

Internal-disc-derangement-referral

If this information describes you, the best way to stop the pain from coming back and minimize the progression of the wear-and-tear of your neck is to get all of the adhesion removed from your neck. As always, when people reach out to us from across the country about fixing their injuries, the first place we look for a practitioner is on Integrative Diagnosis’s Find a Provider application.

Final Words

Pain isn’t fun. It’s even worse than the pain isn’t going away.

You can always try foam rolling, stretching, lacrosse ball-ing, massaging, chiropractic adjustments, ice, and heat. I hope these things work for you. But please don’t let yourself become a victim to the Kitchen Sink Paradox.

If any treatment isn’t working or if your pain has lasted more than a few weeks, it’s time to stop messing around with your body. So many people could get out of pain relatively quickly if they would just get a diagnosis and get properly fixed by a professional as soon as their pain monster peaks its ugly head.

If you live in NJ or NYC, come see us at Barefoot Rehab. We’re good at what we do. : )

speechbubblesIf you have pain in shoulder blade, what do you think is causing it after reading this post? Is it the neck, mid-back, intercostals or ribs, or the rotator cuff? Feel free to share in the comments below.

 

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Dr. Chris Stepien, DC, Full-Body ID Certified, ART Certified, CSCS, and CrossFit Level 1 Certified, fixes your annoying and frustrating pains, even when it's been over 6 months and you've seen 3-5 other doctors or therapists without lasting relief Barefoot Rehab in Denville, NJ. And when you're sad, depressed, or not enjoying life, Dr. Chris wants to hug you. He invites you to reach out, no matter what your concern is. Barefoot Rehab is here to serve you.
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29 Comments
  • Amanda
    Posted at 03:49h, 17 May Reply

    I have horrible pain in my shoulder blade and its getting so miuch worse, you are right massage can’t even touch it. I now have neck pain and I just keep working out thinking its magically going to go away! So dumb…I am in San Diego, CA any recommendaitons??

    I have a lot of sholder pain, down into my elbow no too but the constant pain inside my shoulder blade is always there. Now if I lift my head up I feel it strain and it is hard to look down as well. I drive boats all day and shift a gazillion times a day, I workout regularly, and have a hard time taking time off 🙂

    I would love any recommendations cause I am starting to be in a ton of pain!

    • Dr. Chris
      Posted at 11:52h, 17 May Reply

      Hi Amanda, you have a lower cervical disc problem. Guaranteed. Same as described above. There are no Integrative Diagnosis practitioners in the area. Your best bet is to go to activerelease.com and find the provider with the most certifications and testimonials there. If you don’t experience permanent relief in 5 treatments or less, you’ll need to fly to an ID doctor. FYI – I drive from NJ to Boston at least once a month for treatment. Good treatment beats no treatment, any day.

  • Livia
    Posted at 23:55h, 27 September Reply

    I would love any advice!!
    My pain started very mildly under my right shoulder blade about a year ago not due to anything I can remember. I’ve the year, the pain has increased and feels as though it is up in my right side neck, under armpit and down arm. It’s not constant and it’s not always really painful. If moves in those areas and is sometimes gone completely. It’s driving me nuts. Massage helps for the day and then it’s worse the next few days. Painting made it brutal for 3 weeks. I’m trying Pilates now but think I’m just masking one pain for another.
    Any clue as to what I have done or what I can do to make it better?? Thank you!!

    • Dr. Chris
      Posted at 11:35h, 29 September Reply

      Hi there Livia.

      Under the right shoulder blade is an elusive location that probably requires an exam.

      What you can do right now, is test some things.

      Turn your head all the way to the right, left, down, and all the way back. Does any of this provoke the symptoms under the shoulder blade? If YES, you’ve just confirmed a NECK problem.

      Bring your biceps to your head. Does this provoke the symptoms under the shoulder blade? If YES, you’ve just confirmed a SHOULDER problem.

      Is the pain down your arm numb, tingly, burning, or lightning-like? If YES, you’ve confirmed a NERVE problem.

      Yeah, the problem with massage, chiropractic, PT, or regular meds is that these all work for very simple, low level problems. Once your problem becomes BIGGER, you need to find someone who knows what they’re doing to fix it..

      : )

  • Corinne A Barker
    Posted at 14:21h, 28 September Reply

    I have pain under my shoulder blade that seems to get worse throughout the day. Heat helps and rest but as soon as I activate my back/shoulders/neck I feel it for the rest of the day. I do a lot of computer work and relax at the casino, someone there said it’s probably RMS?
    Ty Coirrine

    • Dr. Chris
      Posted at 11:37h, 29 September Reply

      Hi Corrine,

      Read my response to Livia above. My best guess from the little information you gave me is, again, a disc problem in your neck.

      The best thing you can do is respect the sit-slide-lean rule. People are almost always surprised by how, when they sit properly, their symptoms get better. barefootrehab.com/sitting-correctly-sit-slide-lean-rule/

  • Bryan
    Posted at 05:51h, 03 October Reply

    I have constant tightness in both my traps at the base of the neck and down to between my shoulder blades that never goes away. Some days it causes my neck to cramp up from the base of my neck to the base of the skull. The pain then causes a headache which turns into a migraine if not reduced with pain meds.. I was told that I had a “clean MRI” but it doesn’t improve.

    • Dr. Chris
      Posted at 11:57h, 03 October Reply

      Hi Bryan, most people with symptom patterns like this have a lower cervical disc problem. MRIs are under-weighted if there is no serious problem that makes you a candidate for surgery. My recommendation is to find a good adhesion removal doctor/therapist and have them help you get rid of the constant tightness and occasional pain. It’ll be worth it because this will get worse as you get older if you don’t.

  • Saad Taje
    Posted at 17:57h, 19 December Reply

    I have pain for the last 6 weeks I’m my right shoulder blade that I mainly feel when I cough or sneeze or blow my nose or hock, I had an a chest X-ray 3 weeks ago and it was clear, I am concerned because I worry what will happen if I catch cold and have to cough, appreciate your feedback, and best diagnostic tools Ex: MRI or ct
    regards,
    Saad

    • Dr. Chris
      Posted at 09:01h, 20 December Reply

      Hi Saad, Do you have any right shoulder blade pain when you move your neck or sit with bad posture? What about taking a deep breath or rotating your mid back? If the latter, could be rib cartilage or a intercostal muscle problem. If the former, coming from neck. LMK the answers and I can point you in the right direction.

  • Jeff Fraser
    Posted at 03:09h, 15 March Reply

    Pain is located in what feels like just underneath the lower part of my left shoulder blade on the very bottom edge. For left to right reference using your your ‘where is the pain?’ picture with a then b then a. The pain is just too the left of the dotted line in the a column.

    For over a year had needle like pain randomly acting up once a month or so for a few hours while working. (Grabbing boxes above my head and moving them down) Onset is immediate and just trigged with arm movements, pain being quick prick and gone. Like someone snapping a rubberband on your skin.

    Just 4 days though I got a significantly painful band like pain in that exact spot. Random arm movements can cause increased pain but not replicable. Meaning an arm movement might cause pain for it however if i do it again, it won’t a second time. Pain is constant 24/7 and only doesn’t hurt when laying down in any position. However moving around I can feel that the issue is still there but not painful.

    I drive and the pain gets progressively worse as the day goes on becoming unbearable towards the end of my day. Sitting is by far the most painful. Bending over and grabbing boxes off the floor also causes constant repeatable increase in pain. Making the pain feel hot if that makes sense. Grabbing and lifting boxes from waist or above though just causes random spurts of increased pain that goes away quickly and isn’t repeatable.

    After the second day the lower part of my shoulder blade became numb to touch and hasn’t stopped being numb.

    • Dr. Chris
      Posted at 10:53h, 12 April Reply

      If you have numbness, you definitely have a nerve entrapment somewhere. Next question is where? Could be an intercostal nerve with one of it’s branches or could be a cervical or thoracic disc. Best thing for you to do to manage would be to make sure you’re sitting properly according to the Sit-Slide-Lean Rule.

  • Veronica A
    Posted at 04:41h, 30 March Reply

    It hurts kind of at the line at A and B. I bent my chin to my neck and raised my arm upwards (bicep to ear) ant it both hurt. It only started yesterday, but today, I was walking, and when I stepped on my opposite foot, it would hurt. And also, moving my arm to the side would hurt.

    • Dr. Chris
      Posted at 10:54h, 12 April Reply

      Sounds like you have severe degeneration in the neck. I’d get an MRI.

  • monique
    Posted at 01:34h, 20 April Reply

    hi can you help me please? 10years ago i feel a little pain right under my scupula now am 28 i feel it felt worse when i bring my left hand to the side it hurt when i lye on left pressing on my ribs i feel it hurt and when i lye on my back pressing on my left scupula,oneday my doctor give me cold medicen i cough up a lot of cold and it go away then it come right back,when i bend farward and take a deep breath it felt sore and tender it would more felt like the pain
    is comeing from my left lungs but ii dont have short breathing it felt more like A left underneat at the point of the green dotted line the soft inner
    spot when i sneeze and cough it hurt and twisting my whole body i feel pain only on A left side with out twistnng i dont feel no pain

    • Dr. Chris
      Posted at 09:37h, 20 April Reply

      Hi Monique, what kind of help do you need? It can possibly be a lower neck disc shooting pain down, but it sounds like a more local problem. Potentially adhesion in the ribs, a thoracic disc issue, or a rib/cartilage issue. Someone would have to do a history and exam to really know what is going on and what the potential solution/treatment would look like.

  • Melissa
    Posted at 03:58h, 09 May Reply

    Hi Dr. Chris!

    I’m a licensed massage therapist . I get regular massages but I have spine pain closer to the spine in the B area. I been hit from behind in a car wreck many years ago . I went to.a chiropractor. He said my C5 and C6 are narrow.. almost touching.. my L4 and L5 have fused together. I also have a narrowing happening in L5 and S1. I have gotten chiro treatments twice a week and the decompression for the neck and lower back. I did it for a few months with no significant change. My question is how can so get those 2 narrow areas to become wider so I don’t feel the pain. I’ve seen 2 different chiros with no help ! It just cost me alot of $$$ ! I know the vertebrates in those 2 areas are pressing on nerves . What do you think ? Thankyou!

    • Dr. Chris
      Posted at 10:54h, 09 May Reply

      Hi Melissa. Unfortunately, you can’t reverse joint degeneration. This is “Aging”. If this were possible, there’d be no one getting “older” and be way more 80 year olds doing CrossFit and lifting big weights. You’re really asking, “Is there anything better for this pain I have?” YES – I’d stop going to see the chiros. You’ve already wasted a lot of money. Where do you live? Can you find someone to remove your adhesion? You likely have Internal disc derangement shooting the pain down.

  • Greg
    Posted at 02:54h, 31 May Reply

    Hey how’s it going. I have left shoulder blade pain. I feel under and in between spine. Can also feel in upper chest. It seems to worsen after I have been lifting something and then aches. I can also feel in the left side of neck. I’m 40 and have been dealing with this for two years. I started with primary dr then chiropractor. Recently I went to a orthopedic, first visit cortazone shot in the bursa? Second I was told could be costocronditis and given steroids. Neither worked and I think I’m being misdiagnosed. The best was probably the chiropractor. Any any help would be greatly appreciated, I live in pa outside philly.
    Thanks

    • Dr. Chris
      Posted at 07:48h, 01 June Reply

      Hi Greg, sounds like a lower cervical disc problem. Small probability of a thoracic disc problem too. Can you come to see us in Denville, NJ? There are no more local adhesion doctors than us. I wouldn’t waste time with anyone local. We have patients seeing us from all over the country.

  • Sally-Anne Branagan
    Posted at 09:08h, 04 June Reply

    Hello, I am a 21 year old violinist studying at conservatory and I have been able to play due to issues like this for about 4 months and have had to postpone my exams and final year.
    I started having pain just to the left of my spine in section B in about September. I was able to keep playing and working through the pain while attending physiotherapy. They said that it was just muscle imbalance and tension but I went to physio for 4 months twice a week and no improvement. The pain spread then down my arm and I was treated with tennis elbow also.
    The pain worsened in February and it was unbearable to play so I had to leave college. It was still in that same spot off my spine but was also radiating around my ribs at the side. I went and had an mri done and was diagnosed with tendinitis in my shoulder and bursitis and given a shot in my shoulder which I was surprised at because that was no where near my pain. I then when to see a shoulder specialist and he believed that this was just something that showed up on the mri and not necessarily related so he had my get a full spinal mri. I then saw a spine specialist (in Ireland consultants work really specifically it’s quite ridiculous) and he said that there was minor schmorls nodes in my thoracic spine but nothing obvious and said physio and tension release would help.

    I am months on from this and still have the pain and it is no better. I do Alexander technique and physiotherapy (with a different physio) and there is not improvement. I also had dry needling done for quite a while but had a collapsed lung as a result.
    I am beginning to think something must have been missed on the scans because they all said I should be able to play with out pain soon and I am very far away from that.

    Sorry for the very long winded message but your advice looked great on the other messages. I am willing to try anything because finishing my degree and having a career in music is all I ever wanted and this is just stopping everything in its tracks.

    Thank you
    Sally-Anne

  • Dr. Chris
    Posted at 11:02h, 04 June Reply

    Hi Sally, I’m sorry for your struggles. Your best bet is a myofascial therapist to release these areas. What movements provoke the pain? Chin to your chest? Rounding your upper back? Bringing shoulders overhead? That would confirm the primary cause of the pain. Most often, pain at “B” is caused by a lower neck disc problem.

  • Kevin kavanagh
    Posted at 20:19h, 26 July Reply

    Hi

    I have a left shoulder blade pain underneath blade.
    the diaphragm IT’S A were it is. It’s not sore just a burning feeling all day the last 3 days . I took the week of from crossfit and I have been putting ice on it. Any ideas what it could be.

    Regards
    Kevin

  • Dr. Chris
    Posted at 21:25h, 28 July Reply

    Hi Kevin, “burn” is typically a nerve entrapment or could be a slightly torn muscle. What movements or postures provoke it and make it worse? What makes it better? Chin to your chest? Turning your head? Raising your shoulders? Etc.

  • Kimberly Birchfield
    Posted at 19:30h, 15 September Reply

    Hi..
    I am 53 years old, very active, I have “A” shoulder blade pain in both blades. It happens after a couple hours of work, or after cleaning my house. If I sit for a bit, seems like it let’s up to where I can finish. I have tried stretching but it doesnt seem to help. I guess i am just getting old..‍

    • Dr. Chris
      Posted at 12:34h, 16 September Reply

      Hi Kim, I’m sorry for your pain. What type of work? Yes, you’re getting old, but that doesn’t mean this isn’t fixable. Where do you live?

  • Noreen hayes
    Posted at 19:59h, 19 September Reply

    I have been told I have a rotator cuff injury. My shoulder hurts in certain places but not the classic cuff symptoms. I have a pain in my left shoulder blade that always seems to settle there. If I manipulate my arm and back, I can get the pain to lessen and/or move places. But it always comes back to my left shoulder blade. Sometimes a burning pain. I have a curve in my neck and slight scoliosis that was founded when I was about to be given an epidural with my first child during labor. I’ve been given muscle relaxant and ibuprofen 600. Neither do anything. Tiger balm works the best but only for a few hours. Surprisingly, pressure on that side makes things better sometimes. Any ideas what I’m dealing with? 🙁

  • David
    Posted at 03:27h, 22 October Reply

    Im hoping you can help as i think i have learned more in 5 minutes on here than i have from my last 2 physio sessions!

    I had a gym injury during a bench press. The initial pain seems to be at B on the rightside during deep breaths but with another strain at the back of my head (right up to the rear of the skull)

    The strain on my head has nearly subsided but my shoulder blade/back is worse after weeks off of the gym

    The pain is worse when looking down and to the left

    Any help would be highly appreciated

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