Upper back
Shoulder blade pain can start in the shoulder or the neck
Pain around the shoulder blade can start in the shoulder, the neck, or a nearby nerve, and it often eases with gentle movement over a few weeks [1][2]. Some signs point to something more serious and need prompt attention [1].
Key points
- Staying active and gently moving the shoulder usually helps more than stopping use of it [1].
- Pain that does not start to improve after 2 weeks may have a cause that needs treatment [1].
- A pinched nerve in the neck can cause pain at the shoulder blade, sometimes weeks before arm pain begins [3].
- Sudden or very bad pain, pain after a fall, or loss of feeling in the arm needs prompt medical attention [1].
- Rarely, pain between the shoulder blades has come from the heart or from bleeding around the spinal cord [4][5].
Shoulder blade pain can start in the shoulder or a nearby nerve
The shoulder, the neck, and the nerves that run between them can all produce pain at or near the shoulder blade. Some conditions cause similar pain, and even clinicians can mistake one for another [6]. Pain that lasts beyond 2 weeks might have a cause that needs treatment, and you should not try to diagnose it yourself [1].
| Possible source | Typical clue |
|---|---|
| Tendon, bursa, or impingement problems in the shoulder | Pain that is often worse while you use the arm or shoulder [1] |
| Frozen shoulder or arthritis | Pain and stiffness that do not go away over months or years [1] |
| Shoulder instability | A tingling, numb, or weak arm, or a clicking or locking feeling [1] |
| Pinched nerve in the neck | Neck pain with pain that can reach the shoulder blade and arm [3] |
| Irritated dorsal scapular nerve | Pain along the inner edge of the shoulder blade [6] |
When to get care
Sudden severe shoulder pain or an injury needs prompt medical attention
Some shoulder signs can mean a broken or dislocated bone, or a torn ligament or tendon [1]. These signs need prompt medical attention:
- Sudden or very bad shoulder pain [1].
- You cannot move your arm [1].
- Your arm or shoulder has changed shape or is badly swollen [1].
- Pins and needles that do not go away, or no feeling in your arm or shoulder [1].
- Your arm or shoulder feels hot or cold to the touch [1].
- The pain started after an injury or accident, such as a fall [1].
- Severe pain in both shoulders [1].
- You feel feverish or unwell [1].
These signs call for you to call your doctor [1][2]:
- Shoulder pain is getting worse, or it has not improved after 2 weeks [1].
- It is very difficult to move your arm or shoulder [1].
- Neck pain or stiffness has not gone away after a few weeks, or pain relievers have not worked [2].
If you think you may have a medical emergency in the United States, call 911 or go to the nearest emergency room.
A pinched nerve in the neck can send pain to the shoulder blade
Cervical radiculopathy means a nerve root in the neck is compressed or irritated. A 1944 paper described it as neck pain and stiffness with pain into the shoulder and down the arm [3]. A pinched nerve is also one of the most common causes of neck pain [2].
Pain at the shoulder blade is part of this picture more often than older definitions suggest. A review of 81 studies that described pain patterns found neck pain in 88 percent, arm pain in 85 percent, and shoulder blade pain in 72 percent [3]. Pain at the shoulder blade may come weeks before arm pain [3].
Experts still disagree on how to define the condition. Some have long linked shoulder blade pain more closely to irritated joints in the neck, called facet joints [3]. Diagnosis is largely based on your symptoms and an exam, with MRI and nerve testing used to confirm it [3].
The dorsal scapular nerve can cause pain along the inner edge of the shoulder blade
This nerve usually starts at the C5 nerve root in the neck and often passes through the middle scalene muscle, which is the most common place for it to become trapped [6]. It is an uncommon cause of shoulder blade pain, and it is often overlooked [6]. It controls the rhomboid muscles, which pull the shoulder blade back and help keep it stable [6].
Signs that may point to this nerve include [6]:
- Pain along the inner edge of the shoulder blade [6].
- Weakness of the rhomboid muscles [6].
- A subtle lifting of the shoulder blade away from the ribs, called winging [6].
- Trouble raising the arm forward or out to the side [6].
Repeated overhead work, such as painting or electrical work, can compress the nerve. So can overhead sports, a shoulder dislocation, a large middle scalene muscle, or an injection near the nerve [6]. Treatment usually starts with changing activity, rehabilitation, and physical therapy, and surgery has been described in cases that did not respond to other treatment [6]. Evidence for treatment is limited [6].
Pain between the shoulder blades has rarely pointed to the heart or the spinal canal
Pain around the shoulder blade is a common musculoskeletal complaint, and nerve trouble is an often overlooked cause [6]. Rarely it is not. In one reported case, a man receiving chemotherapy for rectal cancer had severe pain between his shoulder blades and was diagnosed with myopericarditis, a heart condition [5]. The authors advised considering this possibility in people on that type of chemotherapy who have cardiovascular symptoms [5].
Bleeding around the spinal cord is another rare cause. Less than 1 percent of subarachnoid hemorrhages start in the spine [4]. A French physician described sudden, intense stabbing pain between the shoulder blades as a feature of some cases [4]. Later authors questioned whether such pain is always present [4].
Gentle movement and good posture are the main home care for shoulder pain
You usually need to follow home care for 2 weeks before shoulder pain starts to ease, and full recovery can take 6 months or longer [1]. Try these steps:
- Keep your shoulder moving gently instead of resting it completely, because stopping use can slow recovery [1].
- Use pain relief so you can keep moving. Options include painkillers such as ibuprofen, and heat or cold packs [1].
- A pack of frozen peas wrapped in a towel is one cold option the source describes [1].
- Stand and sit with your shoulders down and gently back, and avoid slouching [1].
- Rest your arm on a cushion in your lap, and put a cushion behind your lower back when you sit [1].
- Try shoulder exercises for 6 to 8 weeks to help stop the pain from returning [1].
Common mistake
Do not make up strenuous exercises or use heavy gym equipment, and avoid movements that seem to make the pain worse [1].
If your neck hurts too, avoid wearing a neck collar unless a doctor tells you to, because keeping the neck moving is better [2]. A pharmacist can suggest a painkiller, such as tablets, a cream, or a gel, and other ideas for pain relief [1].
Sources
- Shoulder pain nhs.uk
- Neck pain nhs.uk
- Scapular pain in cervical radiculopathy: A scoping review North American Spine Society journal
- Le Coup de Poignard Rachidien: A Historical Perspective Cureus
- Capecitabine-induced myopericarditis - A case report and review of literature Journal of oncology pharmacy practice : official publication of the International Society of Oncology Pharmacy Practitioners
- Dorsal scapular nerve entrapment: a systematic review JSES reviews, reports, and techniques
Not medical advice. This page is general education written from the sources above. It cannot diagnose a condition or replace a licensed clinician who knows your history. If you may be having an emergency, call your local emergency number or go to the nearest emergency department.