Pain in the shoulder blade

The shoulder blade, or scapula, is a crucial component of the shoulder complex, playing a significant role in facilitating a wide range of movements. However, like any other part of the body, the muscles over the shoulder blade is susceptible to various conditions that can cause discomfort, pain, and limitations in mobility. In this article, we’ll explore some of the most common conditions affecting the shoulder blade, shedding light on their symptoms, causes, and available treatment options.

What is the Shoulder Blade?

The shoulder blade is a triangular-shaped bone situated at the back of the thorax. It is flat and broad, with several prominent bony landmarks crucial for muscle attachment and movement. The scapula consists of three main parts:

Body: This is the large, flat portion of the bone, providing a broad surface for muscle attachment and serving as a platform for the articulation with the humerus (upper arm bone).
Acromion Process: Extending laterally from the body of the scapula, the acromion process forms the bony tip of the shoulder. It articulates with the clavicle (collarbone) to form the acromioclavicular joint.
Glenoid Cavity: Located on the lateral aspect of the scapula, the glenoid cavity is a shallow, concave surface that articulates with the head of the humerus to form the glenohumeral joint, commonly known as the shoulder joint.

Function of the Shoulder Blade

The shoulder blade serves as a crucial link between the trunk and the upper limb, facilitating a wide range of movements essential for daily activities and sports. Some of its key functions include:

Stabilisation: The shoulder blade acts as a stable base for the muscles that move the shoulder joint. It provides a foundation for muscular attachments, enabling efficient force transmission and movement control.
Range of Motion: Working in tandem with the clavicle and the muscles of the shoulder girdle, the scapula contributes to the expansive range of motion of the shoulder joint. It glides and rotates along the thoracic wall, allowing for movements such as elevation, depression, protraction, and retraction.
Muscle Attachment: Numerous muscles originating from or inserting onto the shoulder blade play a vital role in shoulder and upper limb movement. Muscles like the trapezius, serratus anterior, and deltoid attach to various parts of the scapula, coordinating their actions to produce smooth and coordinated movements.
Shock Absorption: During activities such as throwing or lifting, the shoulder blade helps distribute and absorb forces generated by muscle contractions, reducing the risk of injury to surrounding structures like tendons and ligaments.

What Can Cause Pain in the Shoulder Blade

The shoulder blade, like any other part of the body, is susceptible to various conditions that can cause discomfort, pain, and limitations in mobility. Here are some common conditions affecting it:

1. Referred Pain from the Cervical Spine

Pain from the joints of the neck can sometimes be felt as if the pain is coming from the shoulder blade. This phenomenon is called referred pain. It usually occurs with conditions of the cervical spine that affects the joint i.e. stiffness or hypomobility in the region. You might experience pain in the shoulder blade when you look up or when you turn your head to look to the side.

Treatment of this will likely be on the neck instead of the shoulder blade.

2. Rotator Cuff Pain

A group of muscles that sits on the shoulder is called the rotator cuff. It wraps itselt around the arm i.e. head of humerus and plays a crucial role in the movement of the arm.

However, if there is an injury to these group of muscles, pain may sometimes be felt over the region of the shoulder blade.

3. Scapular Fractures

Scapular fractures are relatively uncommon but can occur due to high-energy trauma such as motor vehicle accidents or falls from height. Depending on the severity and location of the fracture, treatment may range from conservative measures such as immobilization and Physiotherapy to surgical intervention for displaced or complex fractures.

Diagnosis of Pain in the Shoulder Blade

Diagnosing conditions related to the shoulder blade involves a comprehensive evaluation of the your medical history, a thorough physical examination, and often, imaging studies. Here’s an explanation of the diagnostic process:

Medical History: The first step in diagnosing shoulder blade conditions is obtaining a detailed medical history from the patient. This includes information about the onset and duration of symptoms, any precipitating factors or injuries, previous treatments, and any relevant medical conditions.
Physical Examination: A physical examination is crucial for assessing shoulder blade conditions. Your Physiotherapist will examine the shoulder blade for any visible abnormalities, such as winging or asymmetry. They will also assess range of motion, strength, stability, and any signs of inflammation or tenderness around the shoulder blade and surrounding structures.
Special Tests: Specific tests may be performed to further evaluate the function and stability of the shoulder blade. These tests can include the Scapular Assistance Test, Scapular Retraction Test, and Scapular Dyskinesis Test, among others. These tests help assess for abnormalities in scapular movement and function. These tests are never done in isolation. Instead, a battery of test will help your Physiotherapist assess the source of your shoulder pain.

Available Treatment for Common Conditions Affecting the Shoulder Blade

Treatment for shoulder blade conditions varies depending on the specific diagnosis, severity of symptoms, and individual patient factors. Here are some common treatment approaches:

A. Conservative Management

Rest: Resting the affected shoulder blade and avoiding activities that exacerbate symptoms can help alleviate pain and promote healing.
Ice and Heat Therapy: Applying ice packs to reduce inflammation and pain, followed by heat therapy to improve blood flow and promote relaxation of muscles, can provide symptomatic relief.
Physical Therapy: A tailored physical therapy program focusing on strengthening exercises, stretching, and posture correction can improve scapular stability, muscle balance, and range of motion.
Manual Therapy: Techniques such as massage, joint mobilization, and soft tissue manipulation performed by a skilled therapist can help alleviate muscle tension, improve flexibility, and restore normal movement patterns.
Activity Modification: Modifying activities or sports that aggravate symptoms can prevent further injury and promote healing.

B. Medications

Nonsteroidal Anti-Inflammatory Drugs (NSAIDs): Over-the-counter or prescription NSAIDs such as ibuprofen or naproxen can help reduce pain and inflammation associated with shoulder blade conditions.
Corticosteroid Injections: Injections of corticosteroids into the affected area can provide targeted relief of inflammation and pain, especially in cases of bursitis.

C. Bracing and Supportive Devices

Shoulder Braces or Slings: Immobilizing the shoulder blade with a brace or sling may be recommended in cases of severe pain or instability to allow for healing and prevent further injury.
Postural Supports: Devices such as posture braces or ergonomic supports can help correct poor posture and relieve strain on the shoulder blade muscles.

D. Surgical Intervention

In cases where conservative treatments fail to provide relief or when there is significant structural damage, surgical intervention may be necessary. Surgical procedures may include arthroscopic surgery to repair torn tendons, remove inflamed tissue, or address structural abnormalities such as bone spurs or fractures. Rehabilitation following surgery is essential to optimize outcomes and restore function.

E. Lifestyle Modifications

Addressing contributing factors such as poor posture, repetitive movements, or overuse can help prevent recurrence of shoulder blade conditions
Ergonomic modifications in the workplace or during daily activities can reduce strain on the shoulder blade and surrounding muscles. Incorporating regular exercise, including strengthening and stretching routines targeting the shoulder girdle muscles, can help maintain shoulder health and prevent future injuries.

In conclusion, understanding the common conditions affecting the shoulder blade is essential for timely diagnosis and appropriate management. Whether caused by muscular imbalances, overuse injuries, or traumatic events, these conditions can significantly impact shoulder function and quality of life. If you experience any conditions related to the shoulder blade, feel free to contact us to consult directly with our experienced physiotherapy team.

DISCLAIMER: This information should not replace the need for a consultation with our physiotherapist especially if your condition doesn’t improve. Therapeutic exercise should be carefully selected to suit your condition.