Pain in the shoulder blades and under the shoulder blades: causes and when to see a doctor

Pain in the upper back is a common problem: eight out of ten people experience back pain at least once in their lives, and about 95% experience it at some point. Most often such pain resolves on its own within a few weeks.

Why the shoulder blades hurt: general causes

In nine out of ten cases, examination finds neither physiological causes nor abnormalities — such pain is called nonspecific. The most common cause is an injury such as a muscle or ligament strain, and many people cannot recall the event that caused it.

Less often the pain is due to a herniated intervertebral disc, nerve entrapment, ankylosing spondylitis, and very rarely a fracture, tumor, or infection. Degenerative changes of the discs and facet joints cause secondary pain in the muscles and nerves and referred pain in the bones, joints, and limbs.

By duration, pain is divided into acute (up to 6 weeks), subacute (6–12 weeks), and chronic (longer than 3 months).

Pain under the shoulder blades: problems of the spine and muscles

The classification distinguishes pain in the middle (thoracic) part of the back, and in most cases of back pain the cause is nonspecific. If scanning is normal but the pain persists for months, central sensitization is discussed: sensitivity to pain remains increased after the primary injury has healed.

On the part of the spine, spondylosis, spondylolisthesis, and spinal canal stenosis are possible, the latter usually manifesting after age 60. Compression fractures of the vertebrae are found in 4% of patients with low back pain; risk factors are age, female sex, osteoporosis, and long-term use of glucocorticoids.

Pain on the left and right side: what it may mean

The side itself does not indicate a diagnosis: in intervertebral disc disease, symptoms can be both unilateral and bilateral. Therefore, pain under the left shoulder blade and pain under the right shoulder blade are first approached with an examination.

Referred pain is a separate matter. Diseases and inflammation of the gallbladder, pancreas, aorta, and kidneys can cause back pain that is felt away from the site of the pathological process. If pain in the shoulder blade occurs together with chest pain, this is an emergency scenario.

Back pain below the shoulder blades on both sides

When the back hurts under the shoulder blades on both sides and there are no other symptoms, it is more often nonspecific musculoskeletal pain. It may start acutely, and sometimes it drags on and becomes chronic.

The reason for examination is the pattern of the course: the pain does not ease after rest and intensifies at night, when coughing, sneezing, or defecating.

What examinations are prescribed for pain in the shoulder blades

It all starts with history-taking and examination: the doctor clarifies the location, duration, what intensifies the pain, and what symptoms accompany it. In nonspecific pain, test results are often normal — this is an expected picture.

Among instrumental methods, spinal radiography, MRI, discography, and myelography are used. The choice depends on which structures the doctor suspects.

Signs that require seeing a doctor

It is time to make an appointment with a doctor if the pain changes your usual life. The following signs are checked separately:

• the pain does not ease after several weeks of home care;
• the pain interferes with everyday tasks or is difficult to cope with;
• weight decreases without attempts to lose weight;
• swelling has appeared in the back area or its shape has changed;
• the pain intensifies at night, when coughing, sneezing, or defecating.

An urgent consultation is needed if the person has chills, feels unwell, or the pain appeared suddenly and is rapidly increasing. The location between the shoulder blades, in the upper back, is in itself a reason to see a doctor.

Pain in the shoulder blades is not in itself a reason to call an ambulance. Call 103 or 112 if it is accompanied by chest pain, numbness or weakness in both legs, loss of sensation in the genital and anal area, changes in urination or defecation, problems with erection or sensations during sex, and also if the pain began after a serious accident.

A realistic scenario is this: in most people, pain in the shoulder blades subsides within a few weeks, but some cases drag on, and this is not a failure. If the pain persists longer, the doctor continues the conversation. This material is for reference and does not replace a doctor's consultation.

This content is for reference and does not replace a doctor's consultation. Medical disclaimer