Shoulder Blade Pain - Causes, Symptoms, Diagnosis, and Exercises for Relief

Where Is the Shoulder Blade?

The shoulder blade is also called a scapula, and it is triangular. It is a large bone and lies near the upper portion of the back.

What Are Its Functions?

1. The shoulder blade plays a significant role in the shoulder by providing an origin for the shoulder muscles, namely the rotator cuff, biceps, and triceps, and also acting as a base from which these muscles act.

2. It also helps in the glenohumeral (ball and socket joint) alignment within physiological limits and enables a full range of motion.

3. It attaches the acromion to the clavicle and helps in upward elevation and posterior tilt to allow maximum arm elevation.

4. Scapula also facilitates force transfer from the shoulder to the core and vice versa, acting like a funnel for efficient energy transfer.

5. By doing this, the patient can decrease the stress exerted upon the shoulder.

What Problems Can Occur in Shoulder Blade?

• Suppose the scapula is presently lower than the normal position against the chest wall and the upper border of the scapula. In turn, it may washboard over the ribs, causing a snapping or clunking sound during movement.

• Scapular dyskinesis, or scapular dysfunction, is a shoulder disorder. It can lead to altered glenohumeral joint angulation, abnormal stress on the shoulder's ligaments, and increased muscle strain. As a result, there will be an altered arm position and motion.

• Scapular winging can occur due to muscle weakness, which may be the primary, secondary, dynamic, or static type of winging.

• Sprengel’s deformity is a developmental condition leading to a high or undescended scapula.

• Reverse scapulohumeral rhythm means that the scapula moves more than the humerus, which appears in conditions like a frozen shoulder with joint stiffness.

How Shoulder Blade Pain Occurs?

There are various reasons for shoulder pain incidence, ranging from simple sprain to more complex disorders. Some of them are:

• Shoulder blade pain is a sign of heart attack in women.

• Muscle sprain due to heavy weight lifting.

• Referred pain occurs in the shoulder blade for patients with gallstones.

• Shoulder strains arise from sports injuries.

• Muscles controlling the scapula get injured or imbalance in them.

• Damage to the nerves supplying the shoulder.

• Shoulder arthritis causes inflammation of the shoulder joints.

• Osteoporosis is a bone disorder that can affect the shoulder blade, shoulder, and neck.

• Pericarditis is a cardiovascular condition with inflammation of the heart lining and can also cause scapular pain.

• Sometimes lymphomas and liver and pancreatic cancer can also cause shoulder pain.

• A compression fracture or a dislocated disc can also cause scapular pain.

• Overuse of the shoulder leads to shoulder blade pain.

What Are the Symptoms?

• Pain and weakness in the affected arm.

• The pain is either dull or sharp around the scapula.

• Inability or pain when trying to lift the arm overhead.

• Restricted or limited movement.

• Winging of the scapula.

• Posture abnormality like drooping shoulder on the affected side.

• Popping or snapping sound on moving the shoulders.

How Is It Diagnosed?

A physiotherapist or physician assesses the movements of a patient and identifies the painful movements, and concludes a diagnosis.

• MMT(Manual Muscle Testing): It is done to see if there is any muscular weakness.

• Chest X-ray and CT (Computed Tomography) Scans: Chest X rays and computed tomography scans are used to assess for any bony abnormalities.

• MRI (Magnetic Resonance Imaging): It is taken to find if there are any abnormalities.

• Scapular Assistance Test: This test evaluates scapular and acromial involvement. The patient will be in a standing position, and the examiner will stand behind. The examiner places the fingers of one hand on the clavicle with the heel of the hand over the spine of the scapula. The other hand holds the inferior angle of the scapula. As the patient abducts or flexes the arm, the examiner stabilizes the inferior border up and laterally while keeping the scapula retracted. Decreased pain is considered positive. Other tests, such as the scapular isometric pinch or squeeze test and scapular retraction tests, are done to check for abnormalities in the scapula.

How Is It Managed Non-surgically?

• Non-steroidal anti-inflammatory drugs such as Paracetamol, Aspirin, Ibuprofen, and Naproxen are given to reduce pain and swelling.

• The scapular pain can be managed through physiotherapy. Physiotherapy includes stretching and strengthening, manipulation, and massaging. They will help in educating the patient about neck and spine posture.

• RICE protocol is followed as a home remedy.

  • Rest the area that is affected.

  • Ice must be placed over the painful areas.

  • Compress the affected area using a splint or a compression bandage.

  • Elevate the affected hand and shoulder above the heart using a pillow.

• Strengthening of the abdomen can be done through pushups, pullups, and situps.

• Rehabilitation is done by continuous and comprehensive management of rotator cuff and shoulder blade stabilizing muscles.

What Home Exercises Can Be Done to Relieve Shoulder Blade Pain?

1. Shoulder Pull: Stand in an upright position with shoulders relaxed and then slowly retract the shoulder blades so that the back forms a convex angle, like bending forward to lift an object. Hold this position for ten seconds and relax to the normal position. Do this five times.

2. Trapezius Stretch: Sit in a chair with the head bent forward and place one hand over the head, so the forehead rests on the forearm. Now, use the other hand to hold the chair tightly and pull the head diagonally forward to feel a stretch in the shoulder blade. Hold for 30 seconds and repeat this on the opposite side.

3. Posterior Shoulder Capsule Stretch: Stand in an upright position and hold the elbow of one hand using the other hand (bent hand) and pull the straight hand to the opposite side across the chest. Hold for ten seconds and repeat this on the opposite side.

4. Pectoral Stretch: Stand near a wall and place the arm up on the wall forming a 60 degrees angle with the wall until a stretch is felt in the shoulder blade. Hold for 30 seconds and repeat on the opposite side. Do three times for each hand.

5. Pistol Exercise: Stand in a relaxed position and try to lift the arm, making a 40-degree angle with elbows bent, and then bring back the hands to rest. Repeat this exercise five times.

6. Neck Release: Stand in an upright position and lower the chin towards the test, and rise slowly towards the left side until a stretch is felt near the right shoulder. Hold for one minute and repeat on the other side. Do this three to five times on each side.

7. Seated Twist: Sit in a chair and twist the upper body to the right by bringing the left hand on the right thigh until a stretch is felt. Hold for 30 seconds and repeat on the other side. Do this three to five times on each side.

8. Dog Pose: Stand in such a way that only the hands and feet touch the floor with the head facing the floor and try to push forward to the ceiling, trying to keep the spine erect, and the knees can be slightly bent. Hold this pose for one minute.

9. Child’s Pose: Do the dog’s pose, followed by bringing the legs together and knees apart. Try to sit on the heels and extend both hands forward and hold this position for five minutes.

10. Thread the Needle Pose: Stand in such a way that only the hands and feet touch the floor with the head facing the floor and lift the right hand with the palm facing the ceiling and bring the left hand on the floor, supporting the body or bring it across the floor or inside of the right thigh. Hold for 30 seconds and repeat the same in the opposite direction.

Conclusion:

Shoulder pain is common and does not bring down normal functioning and routine activities. It can be treated by doing simple exercises and certain lifestyle modifications. Doctors recommend purchasing shoulder rehab pulley system for exercising. Be active and try to work out daily for at least 20 minutes containing a few stretches and strengthening. Always practice good posture while sleeping, sitting, and driving. Take rest as and when needed.