The upper back or shoulder blade area can be a challenging area to identify what is causing the pain. Today let’s dive in and see what all could be responsible for the pain between shoulder blades and how we can determine how best to treat it!
What Are The Possible Causes of Shoulder Blade Pain?
This area is an overlapping region with multiple possible causes of pain. All of these are on the differential when it comes to pain in the upper back or shoulder blade pain!
- Thoracic Radiculitis (T1 – T6 nerve roots: 10 different nerves)
- Thoracic discogenic pain (T1-T6: 5 different discs)
- Thoracic facet joint syndrome (rib connection to the spine 1-5: 10 different joints)
- Scapulothoracic bursitis
- Cervical radiculitis (C4-T1 nerve roots: 8 different nerves)
- Cervical facet joint syndrome (C3-T1 facets: 10 different joints)
- Cervical disc / annular tear / herniations (C3 to T1 discs: 5 discs)
- Myofascial pain (a dozen or so muscles)
** Overall, there are about 60 or so different things that could be causing your shoulder blade pain!
Most of our patients tend to find us late in the game. This means they typically have seen several doctors and interventional pain specialists before they find their way to our clinic.
Oftentimes, people travel around the globe to seek help from supposedly prestigious clinics, like the Tashima Hall of the Mayo Clinic. But, over and over again, the process is the same, no matter where they travel. With very little time spent with the physician, the doctor immediately sets up a series of injections starting with medial branch blocks. If there is no improvement, they move on to an epidural steroid injection. And, if that doesn’t work, they proceed with trigger point injections. When that fails, then comes the surgical consultation – all so predictable. Basing all their treatment plans off imaging such as cervical spine MRI and without doing a hands-on physical examination or listening to the patient. Spending the time listening to your patients and doing a detailed examination can help narrow the differential down to a few things versus the “hunt and peck” method used by traditional pain doctors.
What Are the Most Common of These?
#5. Thoracic Disc
Thoracic disc in the upper thoracic spine can refer pain into the shoulder blade area. Sitting pressure typically increases the pressure in a disc. If there is a tear, sitting can increase pain. Sometimes a simple epidural can help, but not many spine physicians have the training needed to inject thoracic spine…read more about that here.
#4. Thoracic Rib Facet
Posterior rib instability is a relatively uncommon condition, and the exact incidence is unknown. There is limited research on this specific condition, and it may often be underdiagnosed or misdiagnosed.
Posterior rib instability may be associated with trauma or injury to the ribcage, such as from a fall or a direct blow to the chest. It can also occur spontaneously, without any obvious cause. Thoracic rib facets are commonly injured with trauma. In car accidents, seat belt injuries can push backwards, damaging the rib where it is attached in the back of the spine.
Although posterior rib instability is not well-studied, it is thought to be more common in women than men and may be more prevalent in younger age groups.
Because posterior rib instability is a clinical diagnosis, it is typically diagnosed based on a person’s symptoms, physical examination, and medical history rather than by a specific diagnostic test. Therefore, the incidence of the condition may be challenging to determine with certainty.
Symptoms vary but most commonly described as a sharp stabbing sensation that can be exacerbated with simple deep breaths, rotation or simple movements. Treating these are simple but again, if your physician hasn’t been trained on how to properly evaluate, they’re definitely unaware how to properly treat it!
#3. Cervical Nerve Irritation
While you can normally think about a cervical nerve irritation causing pain and numbness into the arm and hand, it can also send pain between the shoulder blades.
Cervical nerve root irritation is a condition in which one of the nerves that exits the cervical spine (neck) becomes compressed or inflamed, leading to pain, numbness, or weakness in the area of the body that the nerve supplies.
When the upper cervical nerve roots (C1-C6) are affected, it can lead to upper back pain in the area between the shoulders. This pain may be accompanied by other symptoms, such as neck pain, headaches, or pain or tingling that radiates down the arm.
Cervical nerve root irritation can have various causes, including disc herniation, spinal stenosis, arthritis, or trauma to the neck. A thorough medical evaluation is needed to determine the underlying cause of the nerve irritation and to develop an appropriate treatment plan.
Treatment for cervical nerve root irritation typically involves a combination of conservative measures, such as rest, physical therapy, and pain medications, as well as more invasive interventions like corticosteroid injections or surgery in severe cases.
It’s important to seek prompt medical attention if you experience upper back pain or other symptoms of cervical nerve root irritation, as early diagnosis and treatment may help to prevent further damage or complications.
#2. Cervical Discs
“Discogenic pain” refers to the pain that is generated from the disc itself in an injury. For example, the disc can herniate and mechanically irritate the exiting nerve root, causing nerve pain to shoot into the arm. A tear in the disc can lead to leakage of its contents out into the area around the disc, creating a chemical irritation that can cause arm pain. This is known as radiculopathy or radiculitis (pain originating from the nerve), but the pain originating from the disc is considered cervical discogenic pain.
#1. Cervical Facet joints
Cervical facets are small joints located in the spine that help to stabilize the vertebrae and allow for movement of the neck. When these joints become inflamed or irritated, they can cause pain and other symptoms in the neck, shoulders, and upper back.
While cervical facet joint pain is a well-known cause of neck pain, it can also cause posterior shoulder pain in some cases. The exact incidence of cervical facets causing posterior shoulder pain is not well established, but it is believed to be relatively rare.
Other conditions, such as rotator cuff injuries or impingement syndrome, are more commonly associated with posterior shoulder pain. Therefore, a thorough medical evaluation is needed to determine the underlying cause of the symptoms and to develop an appropriate treatment plan.
Treatment for cervical facet joint pain may involve conservative measures such as rest, physical therapy, and pain management with medication or injections. In severe cases, surgery may be necessary to alleviate the symptoms.
It’s important to seek prompt medical attention if you experience posterior shoulder pain or other symptoms of cervical facet joint pain, as early diagnosis and treatment may help to prevent further damage or complications. Here are a couple of research articles showing a referral zone map of cervical facet joints:
In the end, there are many causes of pain around your shoulder blades. Our physicians take the time to evaluate each patient individually to come up with a customize treatment plan to address your cause of shoulder blade pain. If you have been dealing with pain around your shoulder blade – make an appointment today with one of our experts to help solve the problem!
