Shoulder Blade Pain
Do you have pain on the inside of the shoulder blade? This can be due to many different factors. I’ll be helping you figure out what could be causing the pain. Pain in the shoulder blade is a tricky area to self-treat because it is a hard spot to reach and difficult to assess on your own. But perhaps with some better understanding through this blog, you can learn what to do next to help relieve your discomfort.
Background Anatomy
It’s best to understand some of the structures that surround the shoulder blade (aka the scapula). Your shoulder blade is a triangular bone that sits on your upper back. Your shoulder blade has the ability to move up, down, towards the middle of your spine, and wrap forward around your upper back. It can also rotate upwards and downwards, which is great too! What helps the shoulder blade move this way are a series of muscles that attach to the shoulder blade from the neck, upper back, and upper arm. Think of these muscles as pulleys that help with the movement of your shoulder. These muscles are responsible for controlling the shoulder blade to provide optimal movement as you lift with your arms, providing stability and strength during activity. The scapula is important, but it is only half of the joint.
The 6 primary movements of the Scapula
Bone structure of the shoulder and arm
Your shoulder is a ball-and-socket joint. The shoulder blade houses the socket portion of the shoulder, whereas your upper arm bone has the ball piece known as the humeral head. Together, this creates a very mobile joint that gives you the most degrees of motion in the body! There are muscles that attach to the ball-and-socket piece known as the rotator cuff. These particular muscles help control and center the ball portion of the socket. You may have heard of the rotator cuff as an important muscle group that often gets injured in athletes.
There are a lot of moving parts in the shoulder, and it can sometimes be overwhelming! But Break Free is here to help make sense of it all. The best way to make sense of injuries is to start with where you’re feeling the pain.
Where does it hurt?
When coming in for an assessment by a physiotherapist, we will often ask where you’re feeling the discomfort. It can be one isolated location or multiple areas. It’s important to figure out where the pain is and what movements bring it on. Having a pain journal or mentally noting pain patterns can help your physiotherapist hone in on the potential source.
This image depicts many of the exterior muscles responsible for shoulder and neck movements.
Pain on the shoulder blade. This pain is often described as a dull ache, painful to touch, and worse with movement depending on what is irritated. A lot of times it could be some of the rotator cuff muscles. The rotator cuff is a series of four muscles that attach to the shoulder blade and to your upper arm. The names of these muscles are the supraspinatus, subscapularis, teres minor, and infraspinatus. Some of these muscles sit in the grooves of the shoulder blade itself, which can sometimes create local pain where they originate from. The nerves of your neck can also create pain in this area, which we will get to later in this blog.
A diagram depicting where the ribs meet the spine.
Pain on the inner portion of the shoulder blade. There are a series of muscles that attach or sit in the inner portion of the shoulder blade. Some of these muscles are the levator scapulae, rhomboids, trapezius, and serratus anterior. There are a series of muscles that attach to the shoulder blade that allow the shoulder joint to move freely on your upper back. Decreased strength in these muscle groups can lead to pinching at the front of your shoulder. This leads to compensatory patterns and pain.
The attachment point of your ribs to the spine is in this area. This section of the spine is known as the thoracic spine. If you have trouble with pain while breathing and there is pain that increases in this area, this could be one sign of rib dysfunction. If you have stiffness in this general area, bending backwards with your upper back or rotating may be difficult. There are muscles known as the erector spinae that sit between the middle of your back and the inside border of your shoulder blade.
Pain in the upper shoulder, inner shoulder blade, and upper arm. Does your shoulder blade tingle, get numb, or feel weak? It could be a pinched nerve in your neck causing the pain to radiate towards your shoulder blade. If you notice that the pain, tingling, or numbness runs further down your arm, it may be nerve-related. Also, be cautious if it runs down the left arm. You may want to consider if it is a heart problem. Heart attacks will also create pain down the left arm, so talking to your doctor or getting more tests done would be advised if this is an ongoing symptom you have. Physiotherapists at Break Free are able to differentiate nerve pain from other symptoms. We are able to complete special tests to determine if your arm pain is related to your neck.
Referral pain from internal organs
Your pain could be related to an internal organ. Your heart, lungs, gallbladder, and stomach can cause pain to radiate to the inside of your shoulder blade. Does your pain change when you eat? Have you already tried physiotherapy, chiropractic, massage therapy, or osteopathy with no real change? If so, you may want to speak to your family physician to get more investigative tests done to determine if an organ is referring pain to your shoulder blade.
Why does shoulder blade pain happen?
When there are muscular strength asymmetries, this can lead to less optimal positions and movement that can lead to pain or discomfort. Many people report several sensations such as a dull ache, sharpness with certain movements, restricted movement, tingling, and/or numbness. These symptoms can either be constant or intermittent. They can become worse with overhead movements, reaching behind or across your body. Putting on your bra or taking your wallet out of your back pocket can create more pain as well.
Does this sound like you?
If so, it’s time to figure out what could be causing your pain. If you’d like professional help, visit our booking page here to book with one of our skilled physiotherapists in London, Ontario today.
How do we figure out if your shoulder blade pain is one or the other?
Physiotherapists can use certain tests with some degree of certainty. One example is some manual muscle tests that can help you figure out if a muscle is weak or painful. There are some nerve tension tests to see if certain nerves in your upper arm are tighter, resulting in the pain you’re experiencing. Physiotherapists at Break Free are trained to complete a spinal screen, which allows you to find out the potential source of your injury. Without proper screening of the nerves in your neck, this can result in confusion, as many conventional exercises may not work, resulting in frustration and ongoing pain.
What are some other factors that could be affecting my shoulder blade pain?
The following are some common factors that seem to affect people in my practice as a physiotherapist with 11 years of experience when writing this blog:
Posture – especially desk setup if you work at a computer
Repetitive movements – a sport or job can repetitively create strain on certain muscles
Muscular tightness – an old injury or just not enough stretching can lead to pain
Motor vehicle accident – this leads to neck injuries that affect the nerves going to the shoulder
Slips and falls – similar to motor vehicle accidents, when you slip and fall, there can be trauma to the shoulder and neck leading to pain
If you need help with your injury and you’ve searched the internet for a self-help solution but can’t find anything that works, come see us at our location in Northridge, London, Ontario. Our goal is to help you make sense of your injury in a sea of information that can be overwhelming.
Book with us today or call our clinic to learn more!
Corey Kim
Physiotherapist
Hey, my name is Corey, and I’m a co-owner of Break Free Physiotherapy and Wellness. I was born in Seoul, South Korea but grew up in London, Ontario. I finished both my Bachelor of Arts in Kinesiology and Master of Physical Therapy degrees at Western University. I’m passionate about helping people find pain relief through movement and believe in self-empowerment by sharing knowledge of the human body and its ability to heal. [full bio]
