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5 Possible Causes of Pain Under Your Shoulder Blade

Have you ever had pain under or near your shoulder blade, the bone that hugs the rib cage and makes up the back of your shoulder? Well, I did last week and it was so severe it dropped me to my knees and put me up in the emergency room for six hours. This pain can be sharp or burning, like an ice pick near the spine, or an ache that comes in waves under the right shoulder blade. Different kinds of pain, the frequency of the pain, and if the pain flares up with movement leads to different root causes and different diagnosis.

In my case, the pain started in the afternoon with a dull ache in the right upper quadrant of my abdomen, right underneath my ribs. It was met with a pain referral point under the bottom tip of my right shoulder blade. It was familiar and intense. I couldn’t find a comfortable position, not laying on the floor, not sitting, not trying to stand or hunch over. I’ve had this pain since I was 21 years old and now 38 years young, this attack was the most intense. Geez, as I write this out, having this pain on and off for the last 17 years feels absurd.

There are many possible causes of pain under the shoulder blade, which is important in figuring out the best method for treatment. I’ve broken down the top five possible causes here.

1. Gallstones or Gall Bladder Inflammation

My gall bladder pain started when I was 21. I was out to dinner with my mother who was visiting me at the University of Michigan. That night I lay in bed, writhing in pain as waves of nausea kept me up all night. An ultrasound later confirmed gallstones and “sludge” in my gall bladder.

On and off, this pain came right before my menstrual cycle each month, and getting acupuncture was the only thing I found that made it go away. My acupuncturist told me that the gall blade is associated with worry. As a New Yorker, stop worrying darling. Ha.

Many times I’ve considered getting it removed. But I’ve seen dozens of patients years after the surgery and the residual scar tissue leads to a lifetime of self-care massaging the scars and doing very specific core work. And there is no guarantee the pain goes away. My mother is a prime example. Her gallbladder was removed and she still gets the associated pain when she eats fatty foods. The doctors tell her it’s “phantom” pain and recommended a low fodmap diet.

I have kept my gall bladder pain in check by taking digestive enzymes with Betaine HCL before meals and ox bile after meals. But this last episode dropped me to my knees, took my breath away, and I couldn’t get off the floor or find a comfortable position. The Ibuprofen, Tylenol and Percocet I tried didn’t help the pain. And so I had to make a trip to Methodist ER to make sure a gallstone wasn’t stuck.

The official symptoms:

  • Sudden and intensifying pain in the upper right quadrant of your abdomen
  • Sudden and intensifying pain in the center of your abdomen, just below your breastbone
  • Back pain between your shoulder blades, usually more to the right
  • Pain in your right shoulder
  • Nausea or vomiting

The risk factors for gallstones include:

  • Being female, age 40 or older, overweight or obese, and sedentary.
  • Having multiple pregnancies and being pregnant. (me in a nutshell this past year)
  • Eating a high-fat, high-cholesterol, low-fiber diet.
  • Having a family history of gallstones.
  • Having diabetes or liver disease.\
  • Having certain blood disorders, such as sickle cell anemia or leukemia
  • Losing weight very quickly
  • Taking medications that contain estrogen, such as oral contraceptives or hormone therapy drugs

See a doctor if the abdominal pain is so intense that you can’t find a comfortable position, you become jaundice (the yellowing of your skin and the whites of your eyes), or you have a high fever with chills which usually means infection.

The other causes of pain under your shoulder blade are not as acute and potentially life-threatening but I thought it would be prudent to get the serious stuff out of the way first.

2. Poor Posture

We all experience the rounded back, slouched over posture and jutting chin from prolonged sitting. There’s no escaping it in this day and age where we are behind our computers all day and then on our phones, walking down the street and sitting on the toilet. This amount of screen time and poor posture can cause your spine to undergo structural changes that eventually cause pain underneath the shoulder blade.

Hunching your back, tilting your head forward, or sitting to one buttcheek can weaken certain muscles and place pressure on spinal discs, muscles, and ligaments. This routine imbalance can contribute to upper back pain and pain underneath the shoulder blades. In the medical world, we call this imbalance Upper Cross Syndrome, where there is weakness in the muscles that hold and stabilize the shoulders down and back.

This lack of stability can cause pain under the shoulder blades. Not only this, but the jutting of the chin creates weakness in the muscles in the front of the neck that stabilize the cervical spine. In turn, the muscles that tighten are the upper traps, the pecs from the rounding of the shoulders, and muscles at the base of the skull.

Consequences of poor shoulder posture

3. Overused Muscles

Tight spasming muscles can happen from painting a ceiling, moving furniture, or pumping those arms extra hard while sprinting. These are all examples of activities that can put your upper back and shoulders through more work than they’re used to. Overuse can lead to muscle strains, which can cause pain in the upper to mid-back, such as between your shoulder blade and spine. Another example of pain under the shoulder blade is scapulothoracic bursitis, also called snapping scapula syndrome. This is a result of an unstable shoulder blade that inflamed the bursa between the shoulder blade (scapula) and the thoracic spine.

4. Cervical Disc Herniation

A disc herniation in the cervical spine (neck) occurs when a disc’s inner layer (nucleus pulposus) pushes through or tears the outer layer (annulus fibrosus) of the disc. Disc herniations at certain levels can cause pain and may inflame a nearby nerve root that radiates pain down into the shoulder blade, specifically cervical nerve root C5 and C6. While less common, it’s also possible for a disc herniation in the thoracic spine (upper back) to cause pain near the shoulder blade.

5. Subluxated Rib

A rib can pop out of place or become misaligned after repetitive strain or reaching for an item overhead. Our patients at Urban Wellness Clinic that come in with this kind of pain, say they feel sharp stabbing pain similar to a knife stuck in their back when they take a deep breath in. We find this often happens in our patients who are stressed and in a cycle of sympathetic chest breathing. This accentuated breathing from their upper back, neck, and chest, instead of a calm belly breath leads to more rib movement and the ribs getting stuck in a flexed position.

When there’s a subluxated rib, we will often find spasming of the muscles around the rib head including the rhomboid muscle that attaches from the medial border of the shoulder blade to the spine. From clinical experience, if the muscle is massaged but the rib head isn’t moved out of the flexed position, the pain under the shoulder blade will get worse. If the rib head is adjusted, the spasming muscles will typically relax within 12 to 24 hours.

Bonus

Some serious heart conditions can present as pain in the shoulder blade region. For example, aortic dissection is a serious, life-threatening condition that occurs when the heart’s largest artery tears and can cause severe pain that can move under or near the shoulder blade. Secondly, a heart attack can also present as pain felt in the upper back or shoulder, especially in women.

When in doubt, get assessed if you have pain under your shoulder blade. While some conditions can be treated from a biomechanical approach, some causes can be life-threatening.

How to Treat Pain Under Your Shoulder Blade

If you have pain under the shoulder blade, get assessed. At Urban Wellness Clinic, we take a thorough history and do an extensive physical exam to rule out the serious conditions mentioned above. If the pain is from overuse or a muscle strain we use the following tools in our toolbox, Active Release Technique to relax the tight muscles and Neurokinetic Therapy to identify the weak inhibited muscles that are not doing their job.

We then use Dynamic Neuromuscular Stabilization (DNS) and strength from a Strong First background to strengthen the weak muscles. We lean towards Mckenzie Therapy for cervical disc herniations that are acute, and then DNS for more chronic disc herniations to reset the weak muscles.

For any questions on the Urban Wellness Clinic approach, give us a call 212-355-0445 or shoot us an email, hello@urbanwellnessclinic.com

In Good Health,
Dr Emily Kiberd