It's 7:00 a.m. Your alarm rings. Your day begins. Off to school or work you go. When you finally get enough energy to get your morning routine rolling, you are ready to the leave the house. Oops. You forgot your backpack or briefcase. Maybe you mentally forgot it on purpose because every time you go to pick it up, you experience back pain between your shoulder blades.
Maybe your shoulder pain isn't there all the time. Maybe it is. Often these pains come and go and are due to nothing more than tired muscles or mild strains that will quickly heal.
If you know that to be the case, your soreness or pain should not be a cause for concern.
There are causes of pain however that stem from disorders that may require prompt attention. These are often referred pains, pains that result from a disorder or an injury to a body part that would seem to have nothing to do with the back. Oh, the complexity of the human spine and back.
In order to grasp why you experience pain between your shoulder blades, you first have to know a bit about how the shoulder is held together, according to Dr. Kevin R. Stone, a pioneer of advanced orthopedic surgical and rehabilitation techniques at The Stone Clinic in San Francisco, California.
“In large part by the rotator cuff and acromion [is how the shoulder is held in place]. The rotator cuff is made up of tendons from the muscles that lift and guide shoulder motion. The acromion is the bone on top of the shoulder; it acts as a roof to the shoulder joint,” said Stone.
“When the space between the tendons and the bony roof narrows, which can be caused by bone spurs or inflammation, impingement occurs. The pain of impingement comes from the four tendons of the rotator cuff muscles impacting against the underside of the acromion.”
Stone says to think of it as putting a tack between your belt and your waist. Every time you stick your stomach out, the pain occurs.
Let's break it down.
If you do experience pain in the shoulder blade area it can be helpful to understand what some of the core common causes are.
Some Rare, but Serious Causes Include:
- Esophageal cancer
- Lung cancer
- Liver cancer
- Torticollis — twisting of the neck
- Other diseases and/or syndromes
Trauma can be an obvious source of discomfort. A broken collarbone, a rotator cuff injury, or a shoulder separation can be the source, as can an injury to the spinal column. A muscle strain or a sprained ligament would be another source of pain. As for the scapulae themselves, they are rarely injured.
Knowing why you are experiencing shoulder blade pain can help guide your health care team, as well as yourself, to discover whether you should seek medical attention, get a massage or take a pain reliever.
Dr. Stone stresses that the key is to locate the cause is to avoid damaging the structures when trying to repair them and to avoid further injury while you wait it out.
“Figuring out the cause of the impingement drives the treatment,” Stone revealed.
“If the lining of the tendons becomes inflamed from repetitive overhead activities, such as pitching or tennis, shrinking the lining solves it.”
Below you will find several common causes of pain between the shoulder blades.
Nine Common Causes of Shoulder Blade Pain
Poor posture is one of the more common causes of discomfort between the scapulae — a.k.a. shoulder blade or wing bone. Hunching forward, whether you are standing or sitting, places an abnormal amount of pressure on your neck muscles due in part to the weight of your head if it is not being held in its proper upright position. Proper posture combined with exercise, including exercises designed to strengthen the neck muscles, is usually an effective cure.
- Herniated discs occur when the disc, a pad-like structure between the vertebrae, breaks down or ruptures. Either disease or an injury can cause one of these discs to become damaged — making it really hard for you to lift that briefcase or walk home from school. Not every disc needs intervention. When needed, treatment includes medication, physical therapy, or possibly surgery.
- Gallbladder disease is a well-known cause of discomfort in the upper abdomen. The pain is usually felt on your right side, and it will at times radiate to your upper back where it can sometimes be felt in the region between your scapulae. Treatment varies depending on the type and severity of the disease and can involve surgical removal of the gallbladder.
- A heart attack, or an impending heart attack, may be a cause of pain between your shoulder blades. This is more common in women than it is in men. During a heart attack, discomfort will initially be felt in the chest and then radiate to the shoulder, down one arm, or to the upper portion of the back where it may center between the scapulae. Pain in the upper back is not the most reliable of indicators that a serious heart condition may exist, as a heart attack may have many symptoms. Nevertheless, any pain that seems unusual or difficult to explain should be given careful attention and a trip to the doctor's office for further testing.
- Inflammation under the diaphragm can sometimes be a referred pain. A pain that is felt in a different body part from where the problem actually exists (like we said, the human body is a complex mechanism). There may not, at first glance, appear to be a logical connection between your diaphragm. As we breathe, muscles in the upper back come into play. If one of these back muscles suffers a strain, breathing can sometimes become painful. Conversely, if an inflammation below the diaphragm affects the action of the diaphragm, it can indirectly affect the actions of the back muscles as well. There are many drugs available to decrease joint pain, swelling and/or inflammation to hopefully prevent or minimize the progression of the inflammatory disease. These medications include anti-inflammatory pain reliever drugs (NSAIDs — such as aspirin, ibuprofen, or Celebrex), or corticosteroids (such as prednisone).
- Spinal stenosis is an abnormal narrowing of the spinal canal. This narrowing can occur anywhere along the length of the backbone. The symptoms are similar to sciatica and include tickling, numbness and even pain that shoots down the legs. If the narrowing becomes too great, spinal stenosis can become a dangerous condition as it can compress the spinal cord, which often leads to serious complications. When the condition occurs in the cervical part of the spine, pain may be felt beneath the neck and below the scapulae. The symptoms of milder cases of this disorder can often be treated with a combination of medication and exercise. A more severe case may require surgical intervention to correct the problem and relieve the pain.
- Cervical spondylosis is a condition in which neck vertebrae, or the disks between them, have begun to degenerate. Spondylosis is more common in the lumbar part of the spine, but this disease can affect any spinal part including the cervical spine. When the vertebrae degenerate up to a point, the nerves feeding out from that part of the spinal column can become pinched and pain can be experienced in the neck or the upper back and between the shoulder blades. In many cases, no specific treatment is needed. If symptoms occur, treatments include medications, corticosteroid injections, physical therapy and sometimes surgery.
- Osteoarthritis of the cervical spine can easily be confused with spinal spondylosis, as the symptoms are similar. In fact, the two disorders sometimes occur concurrently. When osteoarthritis is the cause of pain in the center of the upper back, the pain tends to be worse first thing in the morning and late at night, while often tapering off during the more active hours of the day. Pain will often be localized in the area of the spine at first, but can then radiate to the shoulder area and beyond. Medications, physical therapy, and sometimes surgery can help reduce pain and maintain joint movement.
- Facet joint syndrome is another source of discomfort. Facet joints are stabilizing joints that are found between adjacent vertebrae with the exception of the top vertebra. These joints serve to enable a certain amount of twisting, while at the same time limiting excessive motion that could result in a displacement of one or more of the discs between the vertebrae. Treatments include rest, physical therapy, cold or hot therapy and medications. In addition, your physician may administer a facet joint block, which involves injecting a medication directly into a facet joint. Because the medication numbs pain caused by facet joint problems, temporary pain relief means that the physician has properly identified the problematic joint.
There is Hope
You will want to have your doctor conduct a careful physical exam obtaining a full medical history of yourself and your family in order to make a full, accurate diagnosis. Each muscle can be tested individually, and the point of impingement is usually felt.
“Impingement is so often caused by specific activities, or imbalances of the shoulder, that a careful physical therapy and strengthening program repairs the damage in most cases,” proposed Dr. Stone.
Surgery to remove spurs or chronically swollen bursa — thin, lubricated cushions located at points of friction between a bone and the surrounding soft tissue, such as skin, muscles, ligaments, and tendons — is almost always curative, but it’s usually reserved for patients who fail other non-surgical methods.
BackerNation understands that living with pain between your shoulder blades is literally the opposite of fun. Now fun is a hooky day when you get to hit snooze (or throw your alarm clock across your room) and ditch school/work. We can't play hooky every day. To make your morning routine and commute that much easier, speak with your doctor so you can pinpoint the exact cause of your symptoms. Maybe one day you can actually lift that briefcase or backpack with ease.