Introduction
The shoulder blade (scapula), together with the shoulder joint, forms the connection between the upper arm and trunk. It is located on the side of the spine at the level of the rib cage and is only connected to the humerus. Since the shoulder blade is surrounded by muscles (so-called rotator cuff), a fracture is very rare. However, there are many other factors that can lead to pain in the shoulder blade.
Causes
Pain in the shoulder blade can have various causes. In most cases, the cause of the pain is not directly in the shoulder blade, but rather in the surrounding muscles. The muscles surrounding the shoulder blade and located in the area of the upper arm are called rotator cuffs.
These include the subscapular muscle, which is located under the shoulder blade (scapula), the supraspinatus and infraspinatus muscles, which are located on the back of the shoulder blade, and the teres minor muscle, which runs from the shoulder blade to the upper arm. If there is pain in the shoulder blade, it is possible that precisely these muscles are tense or cramped. The tension is often caused by carrying heavy bags on one side or for too long.
Posture in sitting and standing also has an effect on the muscles of the entire shoulder. If there is increased tension, regular relaxation and strengthening exercises for the shoulder muscles should therefore be performed. Furthermore, depending on the degree of tension, massages, heat wraps and kinesio tapes can help to loosen hardened muscles.
There is a small indentation (incisura scapulae) on the upper edge of the shoulder blade through which a nerve (suprascapular nerve) passes. A ligament runs over the notch. However, it is possible that this ligament becomes ossified and thus a bony canal is formed.
This bony canal causes the nerve to become constricted. This leads to the so-called incisura-scapulae syndrome, in which the innervated muscles (supraspinatus and infraspinatus muscles) are no longer properly supplied by the damage to the nerve. Since active movements due to the pain are avoided, there may also be a decrease (atrophy) in the size of the two muscles.
However, the muscles of the rotator cuff can cause pain not only due to nerve entrapment, but also when the muscle itself is inflamed. Inflammation of the muscle is most often the result of pure overloading of the muscles, which occurs after intensive training. Other reasons can also be everyday overexertion in the household, such as dragging water boxes.
Usually the pain disappears within a few days after resting and should not reappear. Another cause of pain in the shoulder blade can be scoliosis. Scoliosis is a malposition of the spine.
It is usually curved in an S-shape instead of running straight through the back. If such a malposition of the spinal column in the thorax occurs, it can lead to pain in the shoulder blade, since several muscles (for example, the rhomboid muscles minor and major) extend from the spinal column to the shoulder blade and attach there. If the spinal column is now malpositioned, the scapula and the muscles attached to it are also automatically incorrectly loaded.
This can lead to cramps in the respective muscles, which then manifest themselves with pain in the shoulder blade area. In particularly serious cases, this can even lead to inflammation of the muscle, which increases the pain. Blockage of a vertebra at shoulder blade level can also be the cause of pain in this area.
Although an X-ray does not show a deformation of the entire spine, as would be the case with scoliosis, pain in the shoulder blade may indicate a blockage of a single vertebra. The reason for this is that the so-called spinal nerve emerges at each individual vertebra, which sensitively innervates the skin in the individual trunk segments. If this nerve is pinched or damaged, pain and sensitivity disorders occur in the respective skin segment.
A herniated disc of the cervical spine or a herniated disc of the thoracic spine in this area can also lead to similar symptoms. If only one vertebra is affected, the pain is usually limited to a small, belt-shaped area.However, if several vertebrae are affected, the pain can extend over the entire shoulder blade. In the area of the shoulder blade there are also bursae, which normally ensure that the muscles slide smoothly together.
If inflammation of the bursa (bursitis) occurs, this leads to severe pain in the area of the shoulder blade, especially under stress. Often the affected patients find it difficult to stretch their arm far away from the body, as the bursa becomes even more constricted. If coughing causes pain in the shoulder blade, a doctor should be consulted to clarify the cause.
Occasionally it can happen that this is a case of severe tension, which is intensified by the cough. However, there are also some diseases of the lungs that can lead to pain in the shoulder blade. Other symptoms, such as recurrent coughing or coughing with sputum, often occur.
A lung specialist should therefore be consulted to clarify the cause. Occasionally, pain in the shoulder blade can occur, which is triggered by breathing or intensified when breathing. There are several possible causes for this.
Complications with the spine, for example age-related wear and tear or injuries, can lead to irritation of the so-called intercostal nerves. These originate from the spinal cord at the level of the thoracic spine and run along the ribcage. By stretching when breathing, the irritated nerves send out pain signals that can radiate into the shoulder blade.
The cause can also be the lungs themselves and should therefore be examined by a doctor. If pain occurs in the shoulder blade area, especially in the morning, an unhealthy sleeping position is often responsible. A back-friendly mattress and sleeping pillows can help to relax the muscles in the shoulder area overnight.
The morning pain can also be a sign of rheumatic illness. Several joints are often affected. If, for example, additional pain should occur in the hand or knee joints, a doctor should be consulted for clarification.
Pain in the shoulder blade can also be accompanied by a feeling of numbness. This often leads to tingling or temperature discomfort. This is usually caused by irritation of the nerves that supply the area around the shoulder blade.
This irritation can be caused by a pinching or compression of the nerve caused by tension in the muscles of the neck. However, there may also be problems in the spine. This often causes the pain and numbness to radiate beyond the shoulder blade.
Occasionally, pain on the shoulder blade can occur together with pain on the ribcage. This is often caused by tension in certain muscles. The so-called anterior serratus is a muscle that originates at the ribs and is attached to the inside of the shoulder blade.
Due to its position, it acts as a so-called respiratory auxiliary muscle, as it can expand the thorax when breathing and thus supports breathing. In addition, it is also put under a lot of strain when swimming and bench pressing, for example. If this muscle is overstressed, pain typically occurs at the shoulder blade and the costal arch.
This can be caused by various intensive demands on the muscle, such as intensive coughing or extreme strength training with push-ups. Prolonged walking with crutches can also overstrain the Serratus anterior muscle and lead to pain. These tensions can often already be relieved by massages and relaxation exercises.
Irritation of nerves running from the shoulder blade and the costal arch can also be responsible for the pain. If these pains persist over a longer period of time, a doctor should be consulted. Often pain does not occur exclusively on the shoulder blade, but also on the back.
The reason for this is usually either muscular tension or problems in the spine. Since the shoulder blade is in close contact with the spine and thus the entire back via bones and muscles, the pain in these areas is often mutually dependent. An upright posture is essential to relieve the back and shoulder blades.
Strengthening exercises for the muscles can also be helpful to reduce overloading.The shoulder blade is connected to the collarbone by various bands. Together they form the shoulder girdle, which is very important for the function of the shoulder joint. Because of these connections, problems with the shoulder often lead to pain in the shoulder blade and collarbone.
This occurs mainly due to injuries, overloading by heavy bags or natural wear and tear in old age. However, inflammation of the joints between the shoulder blade and the collarbone can also cause pain and should be examined by a doctor. In rare cases, a heart attack can manifest itself in the form of severe pain in the shoulder blade.
The pain is located either on the left shoulder blade or between the shoulder blades. Occasionally, the pain radiates into the left arm. In the case of a heart attack, however, other symptoms such as a strong feeling of tightness in the chest and a load dependency of the pain usually also occur.
For this reason, if pain only occurs in the shoulder blade, it should not be concluded that a heart attack has occurred. In very rare cases, and only under strong force, a fracture of the shoulder blade occurs. In most cases, however, other bones are also affected. The cause can be a severe fall on the shoulder, for example after a motorcycle accident.
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