7 Possible Causes of Pain Under Your Shoulder Blade

There is a range of possible causes of pain felt under or near your shoulder blade.  This pain ranges from sharp or burning and only felt under your shoulder blade to more tender or achy and felt across the shoulder blade and into the shoulder.

The shoulder blade, or scapula, is a flat and sturdy triangle-shaped bone that forms the back of the shoulder girdle. It links the collar bone and the upper arm and enables the highly mobile and versatile shoulder joint to move through its full range of motion.

While the shoulder blade is very strong, the muscles, ligaments and nerves underneath and surrounding the shoulder blade are susceptible to strain and injury.

Most cases of acute pain below the shoulder blade are caused by activities, sports or posture that weaken the muscles and ligaments that attach to the scapula.   

Here are 7 common causes of shoulder blade pain:

1. Strained and loosened muscle from poor posture

Poor posture over time weakens the muscles in your back and puts pressure on the intricate supporting network under and around your shoulder blades.

For example:

• Viewing time on your cell phone. Looking at your cell phone in a head down position, usually with shoulders slouched forward, loosens and strains the muscles and other structures in your neck and shoulder blade area. See Text Neck Treatment and Prevention
• Side sleeping with scapula pushed out.  Most people are side sleepers.  If you usually sleep on your side with your lower arm out in front of you, this position pushes the scapula out and strains the muscles and ligaments beneath that shoulder blade.  Over time, this can lead to overly loose muscles that do not provide the support for your shoulder blade (also called a winged scapula, as it sticks out like a “wing”). See Mattresses and Sleep Positions for Each Back Pain Diagnosis
• Slouching at your desk.  Sitting in a slouched forward position while working on a laptop stretches and weakens the large muscles in your upper back and puts excess pressure on the spinal discs, joints and soft tissues. See 10 Best Ergonomic Laptop Setup Tips

While this may seem like a minor issue, muscle tissue damage can cause a stabbing pain under the shoulder blade, a deep ache that comes and goes, and/or a stinging type of pain if the nerves are also involved.

A unique characteristic of this and many scapula issues is that the inner border of the affected scapula sticks out more than the other one (sometimes called a winged scapula, or scapular dyskinesis).¹Salamh PA, Hanney WJ, Boles T, et al. Is it Time to Normalize Scapular Dyskinesis? The Incidence of Scapular Dyskinesis in Those With and Without Symptoms: a Systematic Review of the Literature. Int J Sports Phys Ther. 2023;18(3):558-576. doi:10.26603/001c.74388 https://pubmed.ncbi.nlm.nih.gov/37425102/ Accessed September 16, 2024

2. Overhead lifting or reaching that strains a muscle

Lifting objects overhead that are too heavy, holding the object too far away from your body when you lift, and repetitive reaching overhead tends to lead to pain that refers under or near the shoulder blade.

For example:

• Holding a heavy suitcase away from your body and hoisting it into the overhead bin, or lifting a box up to an upper shelf
• Lifting weights above your head, such as doing an overhead press, especially when the weight is too heavy or using unsupported form (such as arching the back, not providing core muscle support)
• Any sport that requires repetitive overhead reaching, such as swimming laps (freestyle)

These types of injuries also lead to other types of shoulder problems, such as rotator cuff tears.

3. Overuse injury

This type of pain occurs due to repetitive and excessive use of the muscles and ligaments around the shoulder blade, or by doing too much of an activity too quickly without gradually building the requisite strength and endurance.

Examples of overuse injury causing shoulder blade pain include:

• Reaching overhead to paint the ceiling
• Repetitive motions while gardening
• Playing racket sports such as tennis or pickleball without adequate training

There is a risk that these types of activities put your upper back and shoulders through more work than they’re used to doing.   

Overuse injuries are more likely to occur on just one side, so if you’re right-handed and painting the ceiling, you’re more likely to feel shoulder blade pain just on your right side.

Overuse injuries also lead to localized bursitis, in which the bursa between the shoulder blade (scapula) and thoracic spine becomes inflamed and painful.  This condition is commonly called snapping scapula syndrome, or scapulothoracic bursitis.

4. Cervical herniated disc

This type of disc herniation in the lower part of the neck (cervical spine) is a common condition.  The inner portion of the cervical disc that leaks out, or “herniates” is capable of pressing on or inflaming the adjacent nerve, which in turn leads to pain in the shoulder blade area.²Sharrak S, Al Khalili Y. Cervical Disc Herniation. In: StatPearls. StatPearls Publishing; 2023. Accessed September 17, 2024. http://www.ncbi.nlm.nih.gov/books/NBK546618/

See Could That Shoulder Pain Really Stem From the Neck?

A disc herniation in the lower cervical spine is more likely to radiate pain into or near the shoulder blade area.³Mizutamari M. et al. Corresponding scapular pain with the nerve root involved in cervical radiculopathy. J Orthop Surg. 2010; 18(3): 356–60 https://pubmed.ncbi.nlm.nih.gov/21187551/ Accessed September 20, 2024

See Cervical Herniated Disc Signs and Symptoms

On a similar note, it is also possible for a herniated disc in your upper back to herniate, or at the cervico-thoracic junction (C7-T1 motion segment), and cause pain near the shoulder blade.

When a thoracic herniated disc is the cause, it is typically felt under and around the shoulder blade just on one side. It is usually a nerve type pain, which can be felt as stinging, electric-like, or burning, or numbness or tingling.

See Thoracic Disc Herniation Symptoms

5. Facet joint arthritis

The facet joints are small synovial joints in the back of the spine that run from the top of the cervical spine down to the sacrum.  Like other synovial joints, facet joints can become arthritic and inflamed and ultimately cause pain.

When the lower cervical facet joints become inflamed, they often refer pain into the shoulder blade.

Sometimes, the shoulder blade pain is in conjunction with neck pain, but sometimes the only symptom of an inflamed facet joint will be shoulder blade pain. Thoracic facet joints can also refer pain into the shoulder blade, but cervical facet joints referring pain to the shoulder blade is more common.

When facet joints refer pain, the pain is generally described as dull and aching although the pain can also be sharp for some people.  People with facet joint pain will typically experience worse pain when they look over the shoulder of the painful side because this motion compresses the irritated facet joint.

Read more about Facet Joint Osteoarthritis

6. Dislocated rib

A dislocated rib is diagnosed when a rib pops out of place or becomes misaligned due to a trauma, such as an accident or a fall, after repetitive strain on the ribs, or injury after reaching overhead. It is felt with overhead reaching because this motion causes your shoulder blade to rotate and slide up across your rib cage in your upper back.

Sharp pain near your shoulder blade can result from a rib dislocation, and it may feel difficult to take a deep breath. If the rib is dislocated after a trauma to the upper back, it is possible that the impact also caused some type of shoulder blade fracture.

Most commonly, it is the first rib at the top of the rib cage that is affected.

7. Compression fracture in a vertebra

It is possible for one or more of the cylindrical bones that make up the spinal column – called vertebrae – to fracture.  This type of fracture is a compression fracture, as the bone caves in on itself or “compresses”.

Watch Spinal Compression Fracture Video

Typically, this type of pain comes on suddenly (even if you don’t know what happened to cause it), tends to feel better with rest, and the area around the fracture is sensitive to touch.

If you have osteoporosis or osteopenia you are more susceptible to a spinal compression fracture.

And one more potential cause of shoulder blade pain…

Certain 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 gets a tear and may cause severe pain that can move under or near the shoulder blade.⁴Aortic dissection. US National Library of Medicine, Medline Plus website. https://medlineplus.gov/ency/article/000181.htm. Accessed September 17, 2024.

A heart attack may also present as pain felt in the upper back and/or shoulder, a symptom that is especially true for women.⁵What is a heart attack? US Department of Health and Human Services, National Heart, Lung, and Blood Institute website. https://www.nhlbi.nih.gov/health/heart-attack  Accessed September 17, 2024.

And a very rare cause of scapula pain is a fractured shoulder blade.

When to seek prompt medical attention

In general, pain that gets worse over time and/or interferes with your ability to complete everyday activities is a sign that you need to see a doctor.  If the pain is accompanied by other concerning symptoms—such as persistent or severe headache, tingling, weakness, or nausea, you should be evaluated by a doctor.

In some cases, localized pain under or around the shoulder blade may be accompanied by systemic symptoms such as fever, chills, or unexplained weight loss. These symptoms may be caused by an underlying infection, inflammatory condition, or cancer, and require a thorough medical assessment.

While rare, pain under the shoulder blade may be a symptom of certain lung issues, including life-threatening issues such as a pulmonary embolism (PE).

If pain starts after a trauma to the upper back, you need to seek immediate medical attention.  It is possible to have some type of fracture or other serious injury, such as a vertebral fracture or a fractured shoulder blade.

Learn More:

Relieving the Pain Under Your Shoulder Blade

Understanding Different Types of Shoulder Pain