Pain in the shoulder blade and below: what discomfort may indicate

Pain in the shoulder blade and below can occur with nerve damage, disorders of the spine, shoulder girdle, or somatic pathologies. The cause can be determined by the clinical signs, the conditions of manifestation of the syndrome and the anamnesis data.

back pain in shoulder blades

Pain in the scapular region can be felt during inspiration, felt in the middle of the body and or in the whole arm. In certain cases, such symptoms are the "first bell" of the exacerbation period, which can be prevented after the triggering factor is established.

Causes and location

Pain under the shoulder blade usually appears during movement - it is preceded by an awkward, long-lasting curve with a bent back. It flags local damage that appears for a variety of reasons.

Pathologies with unilateral lesions, in which it hurts only on the right or on the left under the scapula, are few - usually the severity of the symptom is individual. This is due to the symmetrical arrangement of the nerve roots that extend from the spinal cord.


If it hurts under your right and left shoulder blades, it could be a result of damage to your bones and muscle structure. Symptoms do not have a strict localization, the severity depends on the traumatic factor. The clinic is usually acute, starts abruptly and takes a chronic course.

The causes of traumatic pain under the left or right shoulder blade are as follows:

  1. Bruising - in these cases, the pain is superficial, most often the muscles are damaged. Usually, the back muscles under the shoulder blades and below hurt, swelling and local inflammation develop. After 2-3 weeks, the symptoms disappear.
  2. Cracks and fractures are more serious injuries, the pain is concentrated in the scapula itself. At the slightest movement, it intensifies, the patient is unable to move the arm or bend over.
  3. Subluxation and displacement of the vertebrae - this leads to joint pain at the level of the shoulder blades and below, sometimes the bony structures compress the nerve roots.

Lesions are characterized by severe pain under the right or left shoulder blade, which appears spontaneously. During movements, a flare-up may be present and swelling often appears.


If the disease affects the thoracic spine, the patient has back pain near the shoulder blades and below. This is due to compression of the nerves or spinal cord due to deformation of the articular disc. The pathology develops gradually, and as the distance between the vertebrae decreases, the clinic of the pathology worsens.

The location of pain depends on the affected area:

  1. If osteochondrosis destroys 2 to 6 thoracic joint discs, pain is felt in the scapula. It usually radiates to the neck and arm. When the vessels are squeezed, dizziness appears, intracranial pressure may increase.
  2. When joints of 6-12 segments are affected, the pain radiates under the left or right shoulder blade, spreads downward to the corresponding half of the body and lower back.

The spinal roots of the thoracic region give rise to the plexuses that innervate the arms and trunk. Therefore, when they are squeezed, the pain spreads along its course.

With osteochondrosis, the discomfort is one-sided - it hurts in the right or left shoulder blade and below, depending on the slope of the spine.


This is a curvature of the spine in the transverse direction due to excess tension in the muscles that support the posture. This leads to compression of the roots and spinal cord, the appearance of pain under the shoulder blade on the right or left. The pathology is usually accompanied by:

  1. Respiratory failure - a unilateral tilt of the spine deforms the chest, which affects the functioning of the lungs, one of which is compressed, and the second takes on the lost function.
  2. Violation of the work of the heart - the frequency of contractions and pulse changes, shortness of breath and pallor of the skin appear.
  3. The appearance of a visible deformation of the chest is the main cause of pain under the right or left shoulder blade. The vertebrae along with the ribs are displaced laterally, as a result, on the side of the curvature, the bony structures are displaced downwards and damage the spinal cord with its branches.

If the spinal cord is compressed during scoliosis, the back often hurts between the shoulder blades and below, the focus is strictly limited. If muscle spasms come together, the symptom spreads to neighboring structures.


It is characterized by a backward bending of the spine, a forward displacement of the shoulder girdle and a gradual slope appears. There is pain over the shoulder blade - usually bilateral, into the arm and neck. The following mechanisms are involved in its formation:

  1. Neurogenic - due to the curvature, the distances between the vertebral bodies in the anterior sections decrease, this causes the impingement of the spinal cord branches. There is pain in the right and left shoulder blades, which can radiate to the collarbone, neck, and shoulder.
  2. Muscular - Spinal deflection leads to excessive strain on the muscles in the collar area, which can painfully spasm in the area of the shoulder blades and below.

As a result of kyphosis, the vertebral artery is compressed, cerebral circulation is disturbed. The work of Organs internal organs gradually worsens.


If the right or left shoulder blade hurts, one of the reasons could be spondylarthrosis - damage to the facet joints and intervertebral discs. It is accompanied by a loss of mobility, stiffness appears, more pronounced in the morning.

The clinical picture changes as the pathology progresses: >

  1. Cartilage destruction - with the lack of blood circulation, the integrity of the connective tissue is violated, the articular disc becomes fragile, more damaged and recovers more slowly. At this stage, strong physical exertion leads to microtrauma, pain occurs, which radiates to the area of the shoulder blades and below.
  2. Deformation of the articular disc - seals appear that prevent mobility. This causes further destruction, which slows down the regeneration processes, the patient feels pain in the back and shoulder blades.
  3. The appearance of bony growths is characteristic of the advanced stage of the disease. Neoplasms damage joints, muscles, blood vessels and nerves.

With spondylarthrosis, the back may hurt between the shoulder blades or below - an attack is usually preceded by physical activity. At rest, the symptoms disappear, because the bone growths do not harm the surrounding tissues.

protrusion and hernia

In these conditions, sharp pain under the left and right shoulder blades, which appears due to compression of the spinal cord or its roots, is a cause for concern. As a result of compression, sensitivity along the nerve fibers is disturbed.

The location of symptoms is as follows:

  1. Pain in the shoulder blades and above - protrusion or hernia in the cervicothoracic region or when 1-3 thoracic segments are affected. The symptom intensifies when you try to tilt your head, turn it to the side.
  2. Pain in the interscapular region - in this case, the middle sections may be affected, from 3 to 6. Discomfort increases when both hands are moved to the side, taking a deep breath or turned.
  3. Severe pain under the right and left shoulder blades - joint discs 6 to 12 are affected, the lower back may be involved in the pathology. In this case, there is a risk of developing a hernia, as this section of the spine is more loaded than the previous ones.

Unlike spondylarthrosis, hernia and protrusion pain does not go away for a long time at rest. This is due to the constant compression of the nerve, which is exacerbated by muscle spasm.


This is a pinch of the lumbar roots, which are collected in a powerful sciatic nerve. If their upper parts are affected, the patient feels pain under the scapula and below, it is bilateral, aggravated by flexion and sudden movements.

As the disease progresses, additional symptoms may appear: >

  1. There is back pain that radiates to the lower limb - a sharp pain is felt like an electric shock along the nerve's path.
  2. Burning pains in the back, lower back, or below the shoulder blades indicate prolonged impingement of the spinal roots in the lower back.
  3. Cramps and loss of sensation usually occur in the lower back, buttocks, sometimes there is numbness along the nerve fibers in the thigh, leg and foot.

Shoulder-scapular periarthrosis

This condition is understood as inflammation of the shoulder joint and surrounding tissues, stiffness occurs, which disappears only after warming up.

Pain is concentrated in the region of the right or left scapula and below, depending on the development of hemispheric motor skills (right or left-handed). First, it appears after exercise and then at rest. Along the way, additional symptoms appear:

  • headache;
  • numbness in the hands;
  • Violation of spinal mobility.

With humeroscapular periarthrosis, clinical manifestations increase when the arm is raised - it hurts in the region of the right or left shoulder, shoulder blade. Gradually, the range of motion decreases, stiffness progresses.


The next cause of pain under the right or left shoulder blade is inflammation of the nerves in this area. The disease is caused by hypothermia, drafts. Most often affected:

  1. Suprascapular and supraspinatus nerves - there is pain in the right or left shoulder blade of the back, mainly concentrated in the collarbone. Sometimes the discomfort spreads to the shoulder, which indicates the defeat of the branches of the skin in this area.
  2. Subscapular and infraspinatus nerves - in this case, it hurts on the right or left under the scapula, depending on the side of the injury. If the muscles of the same name are involved, the clinical manifestations are aggravated when the arms move downward, abducted from the back.
  3. Intercostal nerves - usually 1-4 pairs. These branches go along the lower edge of the rib, pain occurs not only in the area of the shoulder blades and below, but also on the sides of the chest, sometimes in the anterior sections.

Symmetry is not typical of neuralgia - if the left half of the body has been exposed to air currents, pain is noticed in the neck, chest and shoulder blade on that side.

Heart disease

Branches from the parasympathetic trunk, which is connected with the spinal cord and its roots, go to the heart. This is why heart disease can trigger pain in the scapula and below. Typically, a mild form of myocardial infarction is latent. It may be accompanied by the following symptoms:

  1. Pressure pain or dull burning felt behind the breastbone or under the left shoulder blade - can last for hours, increases when walking, but disappears a little at rest.
  2. Shortness of breath - accompanies the pain, can manifest in a few days.
  3. Tachycardia - increased heart rate, rhythm disturbances sometimes occur.
  4. Other symptoms are increased blood pressure, dizziness, nausea and vomiting.

Problems with the gastrointestinal tract

problems with the gastrointestinal tract as the cause of pain under the left shoulder blade

Similar to the previous mechanism, pain spreads along nerve fibers. Clinical signs can be bilateral, but in most cases there is a certain pattern in which symptoms appear according to the location of Organs internal organs.

Pain under the left shoulder blade behind the back occurs with the following diseases:

  • pancreatitis;
  • gastritis;
  • stomach ulcer.

Usually with these diseases, patients complain of dyspeptic disorders, nausea and vomiting. If internal bleeding occurs, pale skin, dark stools, decreased pressure, and weakness are noted.

Pain under the right shoulder blade behind the back accompanies:

  • cholelithiasis;
  • hepatitis;
  • liver cirrhosis;
  • ulcerative lesion of the duodenum.

other reasons

In addition to these factors, pain below the shoulder blades can cause:

  1. Uncomfortable mattress - if it fails and you sleep on your right side, in the morning you may feel pain under your left shoulder blade behind your back as the curved spine compresses the spinal roots.
  2. Pleurisy - pain in the scapular region occurs when breathing due to the rubbing of the leaves against each other, peaks in a deep breath.
  3. Poliomyelitis - pathology is accompanied by neurological symptoms, often appears back pain.
  4. Poisoning - Severe poisoning or a cold can manifest as muscle aches, chills, and fever.
  5. VVD - vegetovascular dystonia is accompanied by a change in pressure, interruptions in the work of the heart and shortness of breath, and sometimes discomfort in the back.
  6. Kidney disease - such pathologies are characterized by aching or stabbing pain under the right shoulder blade, change in diuresis and urine color, and general symptoms.
  7. Subdiaphragmatic abscess - if suppuration is observed in the upper floor of the abdominal cavity, when inhaling, you will experience pain below the shoulder blades, fever and symptoms of intoxication.
  8. Mental Disorders - In some cases, pain in the shoulder blades and below can be the result of such disorders. The exact mechanism of occurrence has not been studied.

the nature of pain

Pain in the area of the scapulae and below can be different, by its nature it is possible to assume a specific group of pathologies, sometimes a provoking factor can be established:

  1. For pinched nerves, lumbago is characteristic - a sharp pain that appears with a sharp turn of the body, raising the arm. This is the main difference from cholelithiasis, in which the symptom is not curled by movements.
  2. Painful, throbbing or burning pain indicates a pathology of Organs internal organs. The last option occurs when squeezing the roots of the spinal cord, but it increases with movement and can turn into a seam.
  3. Severe constrictive pain in the area of the shoulder blades and below is characteristic of a hernia. It is sometimes preceded by lumbago, numbness of the limbs.
  4. Cutting pain of varying intensity is characteristic of neuralgia, perforation often accompanies joint inflammation.

Which doctor treats shoulder blade pain?

If you experience pain in the scapula and below, you need to make an appointment with a neurologist. If there are no pinched nerves, the specialist will redirect you to an appointment with an orthopedist, cardiologist, gastroenterologist, or urologist, depending on the suspected condition.


To identify the cause of discomfort in the area of the scapula and below, a laboratory and instrumental examination is carried out:

  1. X-ray or CT scan - using these methods you can detect osteochondrosis, curvature of the spine and the consequences of injuries.
  2. magnetic resonance >- the spine, shoulder joint or internal organs are examined, depending on the suspected pathology.
  3. ECG - helps identify heart disease.
  4. Blood and urine tests are informative for some somatic pathologies, inflammation of muscles and joints.
  5. Ultrasound - is prescribed for somatic diseases, if it is impossible to do an MRI.

Usually, pain below the shoulder blades is due to neurology. Therefore, CT and MRI are considered the "gold standard" in the diagnostic protocol.

General principles of treatment

The main task is to eliminate the symptoms and the provoking factor. First, the patient's well-being is stabilized, then the underlying pathology is treated.

The therapy program includes:

  1. Medications – Pain relievers are often prescribed to relieve pain and inflammation. Then funds are prescribed depending on the underlying disease - antibiotics, gastroprotectants, diuretics.
  2. Physiotherapy - strengthens the spine, treats somatic diseases. Medical electrophoresis is used in the area of shoulder blades, heating procedures, SWT.
  3. Massage - heating is carried out with damage to the spine. From such procedures, the muscles above and below the shoulder blades relax, posture improves. In this case, you need professional help from a chiropractor or osteopath.
  4. Gymnastics - it is carried out after the elimination of pain, the program is compiled, depending on the disease suffered by a physiotherapist, a specialist in rehabilitation.


After successful treatment, patients are advised to follow a preventive program that will prevent recurrence of the pathology:

  • watch your posture;
  • choose a moderately hard mattress and orthopedic pillow;
  • twice a week massage in the area of the shoulder blades and below;
  • following a low-calorie diet for obesity;
  • get rid of bad habits;
  • perform prophylaxis of somatic pathology (if present in the anamnesis);
  • visit a doctor every six months.

Pain in the shoulder blades and below can be neurological or somatic in nature. When the nerves are damaged, the symptoms are acute and sudden, appearing spontaneously.

Pathologies of internal organs and joints are characterized by gradual and prolonged pain, the clinic is always accompanied by additional symptoms. In the early stages, analgesics are prescribed, after diagnosis, the program is supplemented with etiological therapy and strengthening procedures.