Shoulder Blade Pain

As the most mobile joint in your body, your shoulder blade depends on surrounding soft tissues for it to remain stable. These tissues medically known as the “rotator cuff”  make up  four muscles. Their tendons  interconnect from your upper arm to the collarbone located in front as well as to your shoulder blade behind. These tendons pass beneath a bony arch.  One bicep muscle  tendon   inserts nearby and  a  fluid-filled bag acts as a gliding mechanism between the surrounding tissues and adjacent bone. Disorders of this “rotator cuff “and the fluid-filled bag  cause most cases of shoulder blade pain.

Tendons that make up the “rotator cuff “triggers  inflammation in this area which is simply known as…you guessed it ,“rotator cuff tendonitis” This condition  is the most common shoulder blade disorder, accounting for 29% of cases. The fluid-filled bag is medically known as “bursa” and the inflammation of this area is called subacromial bursitis. Rotator cuff tendonitis and subacromial bursitis occur when  impingement of these soft tissues by the adjacent bony arch occur during the wear-and-tear they go through everyday. Both conditions produce similar symptoms and are characterized by sharp shoulder pain when you lift your arm out from the side of your body restricting your movement. This results in a restricted painful arc  as you lift your arm  approximately between 60º and 120º. Once you raise your arm beyond this point, there is little pain in conditions relating to either the rotator cuff or subacromial bursa. As the condition worsens, the pain becomes even more persistent, and gets particularly most severe during the night. You cannot ignore  tendonitis/bursitis when they happen because you not only lose precious sleep at night but if they continue without any treatment at all, your rotator cuff may tear and you will be in extreme pain 24/7. ? You may find that a posture brace or a posture corrective brace can help correct your stance and therefore bring your shoulders back and help.

Long years of usage may end up in tears in your rotator cuff. In 10% of cases, tears often occur in your dominant arm.  The rotator cuff ruptures usually happens after a particular traumatic event even without a preceding history of shoulder problems. This usually happens when you unintentionally try to break a fall by stretching out your hand. Sometimes it occurs while you lift a heavy object or you fall directly onto your shoulder. This acute tear causes severe pain in your shoulder that radiates into your arm. It also limits movement and causes muscle spasm. Although you will not be able to  move the arm out yourself, you might be able to passively move your arm. However, your arm will drop back to the side with the slightest pressure on your wrist.
Most rotator cuff tears don’t happen suddenly or in one event. 90%  occur gradually and after a series of shoulder problems that include a restricted painful arc , night pain, and gradual weakness in your arm. If not checked, these chronic tears can eventually cause limitation of shoulder movements in all directions. This can also cause a pinched nerve in shoulder. Often sleeping with a cervical pillow or a neck roll pillow will help to remedy this.

Another condition of the rotator cuff that can cause pain and weakness in the shoulder would be calcific tendonitis. 20% of x-rays of adults with no symptoms show calcium deposits laid down in the tendons of the rotator cuff. However, some people (usually women, aged  30-60 years who have sedentary jobs) have deposits that cause severe symptoms.. Initially there may some pain while you are resting or when your hand movement is limited. Sometimes that pain happens when you “catch” on a movement of your shoulder. Or you feel pain that keeps you awake at night. Severe pain and marked restriction of the shoulder then develops as calcium crystals from the tendon moves into the subacromial bursa. Your shoulder turns red, warm and tender to touch. You hold your arm  close to your chest. These severe symptoms generally require rest for a couple of weeks,. During recovery , you will have a general feeling of illness and even develop a fever. Your healing process sees calcium resorbed in your shoulder blade area.  It should also result in the repair and healing of your rotator cuff. During this process expect some residual pain and restriction of movement. ?If you have not tried a magnetic back support, it might be something to look into.

When you experience pain above your shoulder or shoulder blade, you may trace the problem to the acromioclavicular joint That’s the area between your shoulder blade and collar bone or the neck.

  • Shoulder blade pain along the upper and medial border of the shoulder blade in your upper back  almost always starts from the neck and signifies cervical nerve root irritation Often, you will  wake up with a stiff neck. The pain  gets worse as the day goes on. A headache in the back of your head may occur.
  • An abdominal problem such as gall bladder disease, or  a lung condition such as pulmonary embolism may cause pain at the tip of your shoulder.

A full history of your pain, and of any possible overuse or trauma that  you may have experienced should be given by you when you have your shoulder and neck fully examined. This will  determine if there is any tenderness, and to what  extent your painful arc limitation is in both your arm and neck.

Extending your  head and rotating it to the side indicates the extent your neck may be causing pain in your left shoulder blade
Imaging studies of your shoulder may be performed. This would include x-rays, ultrasonography or occasionally, MRI scans. Those with generalized symptoms (e.g. in calcific tendonitis) may have blood tests taken.

Rest, non-steroidal anti-inflammatory drugs and modification of pain causing activities  are  treatments recommended for pain in the left shoulder blade. Every treatment depends on the cause of the pain in the shoulder blade. Rotator cuff tendonitis and subacromial bursitis are initially treated with an injection of a corticosteroid-local anesthetic mixture into the joint. If you suffer from night pain, you may be given physical therapy to maintain flexibility and a full range of movement. Consult your doctor to fit the right treatment to what causes your pain. Many clinical trials have documented what  non-steroidal anti-inflammatory drug is best for certain types of shoulder blade pain. Studies also declare the advantages of physiotherapy, and corticosteroid injections for specific problems like pain in the left shoulder blade. One recent study noted that patients treated with corticosteroid injections appeared to get faster relief of symptoms than those who received physical therapy. However, other investigators have found no difference between these treatments in their long-term effects.

Non-steroidal anti-inflammatory drugs and restricting activities that induce pain  are prescribed to treat patients with early symptoms of calcific tendonitis. If you suffer severe pain, your arm should be put in a sling.  Medications prescribed would be non-steroidal anti-inflammatory drugs and perhaps an injection of local anesthetic into the joint. Applying an ice pack may help ease the pain. A recent study found that frequent use of ultrasound (the use of high-frequency, inaudible sound waves) can not only relieve symptoms but promote healing in patients with calcific tendonitis. Once pain is controlled, exercises should be performed to maintain the function and mobility of your shoulder, and strengthen the rotator cuff.

Shoulder blade pain may be caused by other areas including the gall bladder, heart, aorta, fallopian tubes, abdominal organs, diaphragm, and lungs. A thorough history, physical examination, and laboratory tests should be included in the mix. Imaging procedures are also helpful. Remember, shoulder blade pain may have its origins far from the shoulder itself. You need all the help you can get to find the real cause before getting the right treatment.

Comments

  1. I would highly suggest that if you have shoulder blade pain that you start applying ice to your lower neck. A huge percentage of the patients that I see with shoulder blade pain have stiffness in their lower cervical facet joints. Ice and anti-inflammatory medication is greatly helpful in reducing facet joint pain.

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