What Causes Pain in the Shoulder Blade?
Pain in the shoulder blade is a common complaint we see at The Physiotherapy Place. Given that there are no less than 17 muscles that attach to the shoulder blade and that it is a key link between the upper limb and the trunk of the body, it is no surprise that pain often arises from this area. Although it is possible to injure this area from trauma such as in a car accident, it is far more common that pain in the shoulder blade region comes on with no specific incident to blame. Furthermore, due to the number of muscles and nerves that feed into the shoulder blade, pain that is felt in this region may not actually be due to an injury at the shoulder blade but might be from a problem elsewhere that sends a referred pain into the shoulder blade. In these cases we often have to dig around to find the cause of the problem which can then be treated in order to relieve symptoms.
Referred Pain From Adjacent Regions?
The shoulder blade usually sits quite flush against the ribcage, and it can slide forward and back or rotate upwards and downwards as we move our arms. It has nerve and muscular connections to:
the humerus bone of the arm
the thoracic spine at the upper back
the cervical spine at the neck
the ribs
the front of the chest and sternum
This means that any issues or stiffness in these adjacent areas can also create pain in the shoulder blade. For this reason, all of these regions need to be thoroughly assessed in order for a proper diagnosis to be made.
Pain Due to Tightness at the Front of the Shoulder
The outer tip of the shoulder blade attaches to the outer end of the collar bone on the top of the shoulder, and there is also a bony prominence that extends forward from the shoulder blade to the front of the chest which serves as an attachment for the pectoralis minor muscle of the chest and part of the biceps muscle which is in the front of the arm. These muscles can become tight by overuse at the gym or from poor sitting posture and if this happens then they can cause a strain on the shoulder blade at the back.
Treatment
When palpating the muscles in and around the shoulder blade, tender trigger points can often be felt in the rhomboid muscles on the inside border of the shoulder blade and sometimes in the belly of the rotator cuff muscles that lie on the shoulder blade. These tender spots are often the pain generators and therefore where the pain is felt so I usually treat these directly with techniques such as trigger point release or dry needling. Treating these directly as well as addressing the factors that have caused these muscles to become tight will usually resolve the issue permanently.
Permanent Relief of Your Pain
So you can see that due to the complex mechanics of the shoulder blade, pain in this region isn’t usually as simple as identifying the location of the pain and treating that area directly. All of the adjoining areas mentioned need to be assessed to find out what has caused the shoulder blade to become sore, and when this is diagnosed and treated accordingly, the pain usually subsides quickly and should be gone for good.