Pain under the shoulder blade in the back - causes, symptoms and treatment

Pain in the chest area at the level of the scapula may indicate back problems, internal organ pain, and a reflection of heart discomfort. To find out why, you need to clearly explain your complaint to your doctor and get tested. Treatment is prescribed based on diagnosis. You should also consider in detail your options for treating lower scapular back pain.

Pain from under the shoulder blade in the back

thoracic anatomy

The shoulder girdle belongs to the thoracic spine, at the level of the chest. It is necessary to study the anatomy of this area to understand which organs can directly and indirectly interfere with the patient.

Major anatomical elements include:

  1. Spine - consists of the spinal cord and the vertebrae and intervertebral discs. It is an important part of the entire musculoskeletal system and protects the spinal cord from injury.
  2. The left and right scapulae belong to the bony structure of the upper shoulder girdle. They look like a triangle and are flat bones. This bone structure has many pits and depressions. These are where ligaments, tendons, and muscles attach. The blade has high strength, so it can easily withstand constant static loads.
  3. The clavicle is the bone that connects the shoulder blades to the chest.
  4. Heart - Responsible for the functioning of the cardiovascular system, pumping blood through veins and arteries.
  5. The lungs are a pair of respiratory organs responsible for the gas exchange process.
  6. Esophagus, Stomach - belong to the digestive organs.
  7. Ribs - Provides protection for the chest. These are the flat bones that attach to the spine behind and in front of the sternum.

the nature of pain

The shoulder blades are located at the back of the back, near the humerus and collarbone. This is a pair of triangular bones to which the rhomboid and part of the trapezius are attached. These muscle groups move the upper shoulder girdle. The shoulder blades join the ribs to form a strong torso skeleton. Any discomfort in this area can lead to significant upper back discomfort and limited mobility. Therefore, the pain is unbearable and you should seek immediate medical attention.

The types of pain sensation are divided into the following categories:

  1. Depending on the location of the unpleasant sensation, the pain and its characteristics - radiating between the shoulder blades, on the left or right side, either in the chest or between the ribs, the pain feels higher or lower.
  2. Depending on the nature of the sensation - unpleasant, pulling sensation, acute pain, whimper, radiation, pulsation.
  3. The duration of pain is paroxysmal, it is felt constantly, increases sharply, and an unpleasant sensation occurs after physical activity.

In most cases, a pulling pain indicates a problem with the spine and rarely other related problems.

main reason

Symptoms of pain under the shoulder blade are caused by:

  • stomach pain (stomach ulcer, gastritis);
  • Digestive disorders (heartburn, esophageal reflux);
  • Disorders of the work of the cardiovascular system (myocardial infarction, pericarditis);
  • lung problems (bronchitis, pneumonia);
  • Degenerative diseases of the spine, the spine;
  • Trauma, inflammation, sprain, myositis;
  • Nervous system disease.

Statistics show that in 90% of cases, discomfort in the shoulder blade is caused by back pain. The human spine is responsible for walking upright and therefore bears a lot of load. When physical inactivity and poor posture cause discomfort, being cautious about your own health can help improve well-being. This condition worsens with age.


If the patient has a bruise or sprain, pain under the shoulder blade may occur from movement or strain. In the acute phase, the pain is persistent and can be felt even at rest. Depending on the location of the injury, the pain occurs on the left or right side of the shoulder blade. The most common type of injury is a skeletal or muscular corset.

Other types of trauma:

  1. Injuried. It is characterized by superficial pain. In most cases, bruising occurs in the superficial soft tissue, upper muscle layers, and subcutaneous fat. An unpleasant sensation occurs in and below the scapula, swelling and localized local inflammatory processes appear. Usually no special treatment is required. This pain will go away on its own within a few weeks.
  2. Fractures or Fissures - The pain is acute, has no reflex, and is focused on the injured area. Even the slightest hand movement can cause an unbearable sensation. In this case, the patient rests completely so that the fracture does not worsen.
  3. Dislocation, displacement of vertebrae. In this case, the pain is not only limited to the shoulder blade area, but also occurs in the back at the level of the chest. Usually, pain occurs due to compression of nerve endings in the spinal canal, which indicates damage to the disc.

Trauma is easy to identify. During exercise, tightening is felt and tissue swelling at the bruised site is observed.


The typical presentation of osteochondrosis in the thoracic region is interscapular pain at the level of the spine. An unpleasant sensation due to compression of nerve endings. Due to the injury to the upper part of the patient's chest, he felt severe pain in the shoulder blade that radiated to the arm. The side depends on the lesion site of the specific nerve root. Increased pressure, headache and dizziness when the blood vessels are squeezed.

If the lower part of the chest area is affected, the patient has an unpleasant sensation of the shoulder blade in the lower back. It is also given to the left or right hand, depending on the location of the pinched nerve. Over time, the pain became more intense, and the patient began to experience discomfort not only during athletic activity, but also during rest. Difficult situation - feeling unwell 24/7, even at night. Often, on the background of osteochondrosis, protrusions or hernias appear.


Incorrect posture is the most common spinal disorder and occurs early. The first problem has been observed since the first grade of elementary school - children cannot control proper posture and do not understand why adults ask them to sit up straight. Over time, abnormal exercise habits develop. A person sits in a position that is comfortable for him, but this position leads to the development of static muscle overload and imbalance. If the spine is in an analgesic position for a long time, curvature can occur, which has many consequences.

In adulthood, many people experience hypoactivity—a state of insufficient physical activity when one lives a completely sedentary lifestyle. The result is persistent back pain due to muscle weakness. If there is a curvature in the chest area, the pain is in the shoulder blade area. Sometimes there is radiating discomfort in the neck area. A characteristic difference in scoliosis is that one shoulder is higher than the other in a standing, relaxed state.

During the initial examination, the therapist can see the disease. It is necessary to treat the disease long-term with the help of a comprehensive approach. To relieve a painful condition, you need to create a lifestyle where you stop stressing and start moving. Under stress, muscle tone increases, which can lead to poorer health. Massage helps a lot, as does exercise therapy for the back.

Hernias and Protrusions

The presence of an intervertebral hernia is a serious condition characterized by herniation of the spinal canal through the annulus fibrosus of the intervertebral disc. The prior condition of a hernia is herniation. With herniation, the disc is partially damaged and the annulus fibrosus is stretched. Hernias can occur during periods of intense physical exertion due to heavy lifting. Genetic factors play an important role in its appearance. If a close relative in the family has a hernia or protrusion, they are more likely to happen to a child as they get older.

If the hernia or protrusion is at the level of the thoracic spine area, the pain occurs in the scapula area. There is also radiating pain in the arm or shoulder. Lateral view of the specific compressed nerve root. The painful shooting was explained by the failure of the nerve endings, pinched due to excessive compression of the back.

When the lower back is affected, it causes back pain in the legs, and when a cervical hernia occurs, the pain radiates to the head. In any case, hernias require complex treatment aimed at relaxing the back, relieving acute pain and removing muscle tension. For hernias and protrusions, exercise therapy, participation in a physical therapy program is useful. In rare and advanced cases, surgery is required.


This is a curvature similar to scoliosis, but in the opposite direction. If the spine in scoliosis is curved to the right or left, then the upper shoulder girdle of the kyphosis is significantly curved. One of the hallmarks of the disease is pain in the interscapular region in the presence of external signs of pathology. Depending on the nature of the bend, it is painful under the left shoulder blade or on the right side. Usually pain occurs on both sides and is given to the arms, neck. There are two main mechanisms of pathological formation:

  1. neurogenic. During curvature, a degenerative process occurs in the spine, resulting in pinching of the spinal nerve roots. Pain in the left and right shoulder blade areas, pain in the neck, collarbone, or arms, and less often in the shoulder joint.
  2. muscular. Continuing in a concave state can lead to muscle imbalances and overwork. In the upper back, the muscles are pinched, which can cause them to be hypertonic and painful. The rest of the back muscles are also affected. Low blood pressure can occur in the lower back.

As a result, the vertebral arteries are compressed, resulting in continued disruption of cerebral circulation. Gradually, the state of health deteriorates and the work of the internal organs malfunctions. For such patients, it is necessary to carry out complex work, including the services of convalescents, exercise therapy.


Sometimes, the development of spondyloarthropathy indicates pain on the right or left side of the shoulder blade area. The disease is characterized by damage to the facet joints and intervertebral discs. As the disease progresses, there is a loss of mobility and a feeling of stiffness, which is most noticeable in the morning.

Pathology manifests in several stages:

  1. Deformation and destruction of cartilage. If blood circulation in the area is compromised, the integrity of the connective tissue can be disrupted, resulting in a thinning of the joint disc. The recovery process of bone and connective tissue deteriorates significantly. Increased physical activity in this area can lead to minimal trauma.
  2. Further deformation changes occur. The disc becomes sealed and mobility deteriorates, leading to increased destruction of cartilage tissue. Even in a calm state, patients may experience frequent soreness.
  3. The final stage is ossification, the formation of osteophytes. These growths can damage adjacent joints, tendons, muscles, and ligaments. In this case, action will be required.

A characteristic feature of the early stages of spondyloarthropathy is pain that occurs only with physical activity. The discomfort at rest will subside because there is no trauma factor.

intercostal neuralgia

This condition refers to a disorder of the vagus nerve. When the pathology occurs, there is severe pain that pierces the shoulder blades, ribs, and chest. This type of pain is often confused with a heart attack. One characteristic difference is the lack of clear localization in the cardiac region. Unpleasant feelings intensified in inspiration. The pain is accompanied by a feeling of pressure. If the patient thinks they have angina, then taking nitroglycerin does not help.

Pain under the right or left shoulder blade indicates innervation of a specific area. Numbness and spasms are not typical for this pathological process. Given the specificity of the symptoms of the disease, specialists will make the diagnosis without problems. Treatment includes injectable B vitamins and inotropes (muscle relaxants). Treatment of intercostal neuralgia should be managed by a neurologist.

Causes of pain from behind under left shoulder blade - heart disease

Often, back pain indicates heart disease. Why back pain is a referred pain phenomenon that heralds coronary artery disease, myocardial infarction or pericarditis. If there is a sudden tingling that increases with physical exertion, but there are no symptoms of spinal disease, you need to see a cardiologist urgently for a consultation. Self-medication or procrastination can make the situation critical.

The most common cause of cardiac discomfort, pain from behind, under the left shoulder blade:

  1. myocardial infarction. In addition to the irradiation, the patient experiences pain in the area of the heart muscle. The pathological cause is related to the occlusion of large arteries and veins by thrombus. A heart attack occurs when a clotted plaque ruptures and blocks the flow of blood vessels around the heart. In this state one must act quickly or the patient will die. The underlying cause of the pathology that has arisen is increased atherosclerosis, erythrocyte agglutination, and platelet aggregation.
  2. ischemic heart disease or angina. Coronary artery disease comes on suddenly, according to medical articles. There is dull pain, which is paroxysmal in nature. Attacks can be easily stopped by taking nitroglycerin. This disease requires further medical supervision as it can occur at the most unexpected moment. If the attack lasts more than a few hours and medicines do not help, you will need to call an ambulance. In addition to heart discomfort, the patient suffered from dyspnea, shortness of breath, and increased physical exertion.
  3. Pain from behind under the left shoulder blade may indicate an episode of pericarditis. The pathology is characterized by effusion and inflammatory lesions of the cardiac serosa. Diagnosis includes testing for markers of inflammation, including rheumatism testing. Pericarditis is often a complication of previous infectious diseases, including respiratory disease of the upper and lower airways. long-term, complex treatment.

Respiratory diseases

In the case of long-standing respiratory disease, patients may eventually experience pain radiating in the scapula area. In most cases, complications are caused by:

  1. Chronic or acute bronchitis. In the early stages, the disease is characterized by a dry cough. Gradually, irritation of the throat increases and a wet cough develops. If the disease developed in the context of SARS, the body temperature would rise. The disease does not require special treatment, observation and bed rest, drink plenty of warm water. Rarely, antipyretics and antibiotics may be required.
  2. pleurisy. If the patient complains of severe chest pain, possibly radiation, cough, shortness of breath, and fever, the specialist must rule out or confirm the disorder. Pleurisy is characterized by inflammation of the pleural sheet followed by the accumulation of liquid sputum in the pleural cavity. This disease is unbearable. Comprehensive treatment with antibiotics and anti-TB drugs is required.
  3. pneumonia. Often develops as a complication of SARS. Pneumonia is characterized by a severe course with cough, shortness of breath, chest pain on inspiration, and high fever. The disease is confirmed on a chest X-ray and can be treated with antibiotics.

Gastrointestinal disease

All gastrointestinal disorders that cause discomfort in the scapular region have pain characteristics that are reflected. What might go wrong:

  1. Gastritis or stomach ulcer. If a pain syndrome is reflected, the patient experiences unpleasant discomfort in the lower chest area (the base of both shoulder blades). It may look like muscle pain. Along with the onset of stomach pain, a burning sensation in the solar plexus can be felt at the same time. Diseases are treated in complex ways, drugs are used to reduce acidity, therapeutic agents (proton pump inhibitors). Antibiotics are prescribed if bacterial pathogens are found.
  2. Esophageal reflux, heartburn. Discomfort occurs in the chest, often radiating to the scapular region. The pathological cause is the return of gastric contents to the esophagus. The unpleasant sensation is associated with the stimulatory effect of hydrochloric acid on the esophagus. There is a sour feeling, a lump in the throat. In rare cases, vomiting occurs. To prevent flare-ups, you need to limit your intake of fried, spicy, and fatty foods. In symptomatic treatment, acid-reducing antacids based on magnesium hydroxide and aluminum hydroxide are used.

editorial opinion

Unpleasant sensations in the scapular region are often associated with exacerbation of disorders of the musculoskeletal system. Less commonly, heart disease, neurological disease, stomach problems, and respiratory problems can cause discomfort. To learn more about the causes of back pain, we recommend reading the corresponding article on our website.