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Shoulder blade pain can occur on or under the shoulder blade, but also between the shoulder blades. The symptoms can become noticeable depending on the movement or at rest. For example, some patients complain of being awakened by pain at night. Pain in the shoulder blade is often due to one-sided stress or overload, irritation and inflammation of the tendons and bursa, and muscle tension. In addition, accidental injuries in the shoulder area can lead to severe discomfort and restricted movement.
Shoulder blade pain is painful discomfort that occurs in the area of the shoulder blade. The pain can be felt on one or both sides. Symptoms on the shoulder blade are often accompanied by restricted movement.
Mostly, shoulder blade pain is due to one-sided stress or overload. The symptoms then disappear on their own after a period of protection. However, if there is persistent, recurring, or acute pain after an accident, a medical exam should be done to rule out serious shoulder disease.
The shoulder anatomy consists of three main structures:
- the shoulder girdle (collarbones and shoulder blades),
- the shoulder joint (shoulder blade and humerus),
- the shoulder roof (acromion) and the raven's beak process (coracoid), which as bone projections belong to the shoulder blade.
In contrast to many other joints in the human body, the ligamentous apparatus of the shoulder joint is relatively weak. Muscles and tendons ensure the stability of the shoulder, which together are called rotator cuffs. Cover like a roof
- the bones muscle (Supraspinatus muscle),
- the bones muscle (Infraspinatus muscle),
- the small round arm muscle (Teres minor muscle)
- and the under shoulder muscle (Subscapularis muscle)
the shoulder joint as part of the rotator cuff. They run from the shoulder blade to the humerus, where their tendons start.
Affected people often locate shoulder blade pain in the middle between the shoulder blade and the spine. The complaints can also appear on or under the shoulder blade. Some patients also complain of neck pain or neck tension. The pain is often felt when lifting or withdrawing arm.
The so-called are located between the shoulder blades Rhomboid muscles (Rhomboid minor muscle and Major rhomboid muscle). Due to tension, these muscles can lead to discomfort and have so-called trigger points, noticeable hardening, which becomes softer and less sensitive to pain due to the pressure during treatment. The Rhomboid muscles are from the trapezius muscle (Trapezius muscle) covered, which runs outwards to the shoulders and up to the back of the head and may also have tensions and trigger points. Sufferers usually complain of pain when the shoulder blades contract towards the spine, which can sometimes radiate up to the arm and fingers.
At the upper middle "tip" of the shoulder blade, the shoulder blade lifter (Levator scapulae muscle), which also shows tension and can “stick” to the trapezius muscle, so that the muscles and their connective tissue (fascia) no longer slide properly against one another and cause complaints. Affected people usually complain of selective pain at the shoulder blade attachment when lifting the shoulder or when turning the head backwards.
Muscle tension is one of the most common causes of shoulder blade pain and can affect any muscle that runs in the shoulder area.
The rotator cuff syndrome
Under the term "rotator cuff syndrome" (PHS, Periarthropathia humeroscapularis) various symptoms are summarized, which are associated with wear-related damage and, among other things, can lead to pain in the area of the shoulder blade. The signs of wear range from small tears (ruptures) in the tendon fibers to complete tendon tear. Above all, this affects:
- the rotator cuff (rotator cuff syndrome),
- the tendon plate of the shoulder twist,
- the biceps tendon (biceps tendon syndrome).
Pain and restriction of movement usually occur. The tendons and / or bursa can also become inflamed. Lime deposits, which primarily affect the supraspinatus tendon or adhesions in the joint, can lead to stiffening of the shoulder. Some sufferers also report crackling noises in the shoulder (shoulder cracking).
Impingement syndrome (constriction syndrome) refers to a narrowing of the sliding space of the tendons of the rotator cuffs and the bursa between the upper arm head and shoulder roof. As a result, restricted movement of the shoulder joint occurs, which is accompanied by pain. The permanent overload is often the cause of the complaints. In some cases, however, the cause of the disease cannot be identified.
In the case of impingement syndrome, there are wear-related changes in the suspinate tendon, which occur due to a constriction in the area of the rotator cuff and the bursa. As a result of the crushing, those affected sometimes suffer from severe pain, including the shoulder blade.
Shoulder blade pain from injuries
Injuries in the shoulder area are relatively common. These can affect the shoulder joint and / or its surrounding structures such as muscles, tendons and ligaments as well as the shoulder bones. The dislocation of the shoulder joint (shoulder dislocation) can, among other symptoms, also lead to shoulder blade pain. The situation is similar with injuries to the other structures of the shoulder.
The shoulder blade can break under massive violence such as in traffic accidents. Such a fracture is usually treated conservatively unless other structures are affected. In addition, there are numerous other causes that can lead to shoulder blade pain, such as
- Inflammation in the shoulder area,
- Nerve damage,
- and vascular diseases.
The risk factors for shoulder blade pain include chronic overload, for example due to certain sports such as tennis and muscle tension, which are not treated in time. A massage is often enough to prevent severe tension in the shoulder area. Injury-related shoulder blade pain often occurs as a result of traffic accidents or skiing and riding accidents.
If shoulder pain is acute as a result of an accident, persistent or recurring, those affected should seek medical advice. During the medical examination, questions are first asked about the medical history and possible causes of the complaints. This is followed by an in-depth examination of the shoulder, in which possible restrictions on movement and visible changes such as redness and swelling are examined. Shoulder pain often occurs during certain movements, which can provide important clues when making a diagnosis. A tactile examination can provide information on trigger points, among other things.
To diagnose a muscular or nervous problem, an electromyogram (EMG) can be performed, which measures the activity of the muscles at rest and in motion, so that it can be determined in which area (muscle or nerve) there is a disorder. The nerve conduction speed can also be determined. Further investigations may also be necessary, which include
- X-ray examination,
- Magnetic resonance imaging (MRI),
- Computed tomography (CT)
- or blood tests.
The treatment of shoulder blade pain depends on the cause. With inflammatory processes, anti-inflammatory pain relievers are usually administered. It can also make sense to protect the shoulder. In other cases, exercise and targeted muscle building can help. In the event of a fracture of the shoulder blade, the shoulder can either be immobilized or, if necessary, a surgical intervention can be carried out.
Since the cause of the symptoms is often not a disease but rather functional causes, osteopathic treatment and Rolfing can be promising. Both treatment concepts include the overall statics of the body and examine which structures lead to tension on the shoulder. Trigger points often trigger the pain. With different treatment methods, among others from manual therapy or physiotherapy, the trigger points are specifically softer and less sensitive to pain.
Prevent shoulder blade pain
In order to prevent muscle tension - especially if you work a lot while sitting, perform monotonous activities that put a lot of strain on the muscles in the shoulder blade area and are exposed to high stress - relaxation and movement exercises can be used for prevention, such as:
- Thai Chi,
- Autogenic training
- or progressive muscle relaxation according to Edmund Jacobsen,
- or just swimming.
In addition, there are many relaxation exercises to stretch the shoulder area that can be incorporated into your daily routine.
(ag, fp, ok; updated on 13.12.2018)
Author and source information
This text corresponds to the specifications of the medical literature, medical guidelines and current studies and has been checked by medical doctors.
Dipl. Geogr Astrid Goldmayer
- Volker Echtermeyer, Stefan Bartsch: Praxisbuch Shoulder, Thieme Verlag, 2nd edition, 2004
- Hussein Elkousy, T. Bradley Edwards: Impingement Syndrome, Gartsman's Shoulder Arthroscopy, pp. 203-219, Elsevier Verlag, 3rd edition, 2019
- Ulrich Brunner et al .: S2e guideline "Rotator cuff", German Society for Orthopedics and Orthopedic Surgery (DGOOC), (accessed July 9, 2019), AWMF
- Nikolaus Wülker et al .: Pocket textbook orthopedics and trauma surgery, Thieme Verlag, 3rd edition, 2015
- Jens Schönbeck: Shoulder Physiotherapy - Conservative and Postoperative Rehabilitation, Urban & Fischer Verlag, Elsevier GmbH. 2012