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Causes of Shoulder Blade Pain: When to Seek Help

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Last updated March 26, 2024

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If you are experiencing shoulder blade pain, then you are not alone. This common condition can be caused by shoulder muscle overuse, rotator cuff tendonitis, or a pinched nerve located in the neck. Read below for more information on causes and how to relieve pain in the shoulder blade.

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Shoulder blade pain symptoms

You use your shoulders all day — to wash your hair, get dressed, open your car door, reach for the sugar for your coffee, and probably even shrug them once or twice. If you experience a twinge of shoulder blade pain, all of those tasks may become a burden to complete. If you've had shoulder pain before, the following symptoms will probably sound familiar.

Common characteristics of shoulder blade pain

Shoulder blade can likely present with the following symptoms.

  • Dull and aching pain of the shoulder blade
  • Difficulty using affected arm(s)
  • Feeling of a pulled muscle
  • Pain in nearby muscle groups: Shoulder or back pain, for example.
  • Instability of the shoulder

What causes shoulder blade pain?

There are several causes to consider when dealing with shoulder blade pain symptoms. The following details may help you better understand your symptoms and if and when you need to see a physician.

Musculoskeletal causes

Shoulder blade pain may be due to musculoskeletal causes.

  • Muscle strain: The most common cause of shoulder blade pain are muscle strains from intense workouts, heavy lifting, or even sleeping in an uncomfortable position.
  • Snapping scapula syndrome: If your discomfort is accompanied by cracking and popping noises, this muscular condition could be the cause.

Cardiovascular causes

Heart issues can present as shoulder pain.

  • Heart attack: In some cases, especially with women, shoulder blade pain can be a sign of a heart attack.
  • Other serious heart problems: Shoulder discomfort is also related to pericarditis and aortic dissection, both requiring immediate medical attention.

Abdominal causes

Issues in the abdomen can result in referred pain to the shoulder, such as the following.

  • Gallstones: The presence of gallstones is a common cause of discomfort that doesn't improve with rest and time. More common in the right shoulder blade, discomfort is due to referred pain by nerves that also affect the area of the abdomen where the gallbladder lies.
  • Pancreatitis: This digestive disorder causes left shoulder pain and can cause extreme pain that requires medical attention.

This list does not constitute medical advice and may not accurately represent what you have.

Shoulder strain

Shoulder strain means that the muscles and/or the tendons in the shoulder have been overstretched to the point of damage and sometimes partial tearing. (A "sprain" means that ligaments have been damaged.)

Because of its wide range of motion, the shoulder is a relatively unstable joint that is vulnerable to injury. A sudden overloading, especially after long periods of overuse, can finally cause some degree of tearing to the muscle fibers and/or the tendons.

Shoulder strains are most often sports injuries, or are caused by strenuous physical labor.

Symptoms include sudden sharp pain followed by swelling, bruising, and ongoing tenderness.

Diagnosis is made through patient history, physical examination, and sometimes ultrasound.

Treatment involves a short period of rest, followed by gradually increasing exercise to regain strength and prevent stiffness and weakness of the muscles and tendons. Physical therapy will be tailored to the individual and some skills, such as for sports, may need to be relearned. Improving posture while sitting, and adjusting techniques for work and sports, can help prevent recurrence of the strain.

Rarity: Uncommon

Top Symptoms: pain in one shoulder, pain in the front of the shoulder, shoulder pain from overuse, shoulder pain from an injury, sports injury

Symptoms that always occur with shoulder strain: pain in one shoulder

Symptoms that never occur with shoulder strain: arm weakness, arm numbness

Urgency: Phone call or in-person visit

Shoulder arthritis

Shoulder arthritis means that there is inflammation and abnormal wear of one or both of the two joints in the shoulder.

Arthritis in any joint is most often be caused by long-term wear and tear, called osteoarthritis; by an autoimmune condition that attacks the joints, called rheumatoid arthritis; or by an injury, called post-traumatic arthritis.

Symptoms include pain, which becomes worse with use of the joint; limited range of motion, meaning the shoulder joint cannot move as far as it once did; and pain when resting or trying to sleep.

Shoulder arthritis cannot be cured, but symptoms can be managed to improve quality of life and ease pain and discomfort.

Diagnosis is made through patient history, physical examination, and x-rays. To confirm, an injection of anesthetic may be placed into the joint. If the pain is eased, arthritis is almost certainly the cause.

Treatment involves physical therapy; nonsteroidal anti-inflammatory drugs to ease discomfort and inflammation; and corticosteroid injections into the shoulder to relieve pain. Surgery and shoulder joint replacement can be done in some cases.

Rotator cuff tendinitis

The rotator cuff is an arrangement of muscles and tendons that holds the head of upper arm bone within the shoulder socket. If these muscles become inflamed, the condition is called rotator cuff tendonitis.

The most common cause is overuse, especially with athletes or laborers.

Repeatedly throwing or swinging an object causes extensive wear on the muscles and tendons. It can also happen with an acute injury.

Symptoms include a nagging, aching pain in the upper arm and shoulder that gets worse with raising the arms or reaching backwards.

Diagnosis is made through physical examination, x-ray, and sometimes MRI.

Early treatment involves immediately stopping use of the affected shoulder, applying ice to the painful area, and taking nonsteroidal anti-inflammatory drugs such as ibuprofen to ease pain and inflammation. Careful stretching can sometimes help. Cortisone injections may be tried, as well as ultrasound and therapeutic massage.

Surgery may be advised to remove damaged tissue or any bone spurs. Follow-up care and exercises will be very important in gaining full recovery.

Pinched nerve in the neck

A pinched nerve in the neck is also called cervical radiculopathy. It means that a nerve in the neck, at a point where it branches off from the spinal cord, is being compressed by the surrounding bones, muscles, or other tissues.

It can be caused by a traumatic injury, such as from sports or an automobile accident, especially if the injury results in a herniated disk. It may also arise from the normal wear and tear of aging.

Symptoms include sharp, burning pain with numbness and tingling from the neck to the shoulder, as well as weakness and numbness into the arm and hand.

Diagnosis is made through patient history, physical examination, and simple neurological tests to check the reflexes. Imaging such as x-ray, CT scan, or MRI may be done, as well as electromyography to measure nerve impulses in the muscles.

A pinched nerve in the neck often improves with simply a few days or weeks of rest. Physical therapy, nonsteroidal anti-inflammatory drugs, and steroid injections into the spine can all be very helpful.

Rarity: Common

Top Symptoms: pain in one shoulder, spontaneous shoulder pain, pain that radiates down arm, pain in the back of the neck, severe shoulder pain

Urgency: Primary care doctor

Non-specific shoulder pain

Non-specific shoulder pain, also called NSSP, means that the cause of pain in the shoulder is not immediately obvious.

There are many structures in and around the shoulder. The pain may be from a condition or injury in the joint itself, or in any of the bones, muscles, tendons, and ligaments surrounding it. Anything from a broken arm to arthritis can cause shoulder pain.

Symptoms include pain that worsens with movement of the arm and shoulder, especially following overuse, or injury. Swelling, redness, joint deformity, inability to move the arm, or severe pain should be seen right away by a medical provider.

Shoulder pain with shortness of breath and/or pain or tightness in the chest can be signs of a heart attack. Take the patient to the emergency room or call 9-1-1.

Diagnosis is made through physical examination and through x-ray or CT scan.

Treatment usually begins with rest and over-the-counter, nonsteroidal anti-inflammatory pain relievers. Further care will be determined by medical providers once the exact cause of the pain has been determined.

Rarity: Common

Top Symptoms: shoulder pain

Symptoms that always occur with non-specific shoulder pain: shoulder pain

Urgency: Self-treatment

Myofascial pain syndrome

Myofascial pain syndrome is also called chronic myofascial pain (CMP.) Pressure on certain points of the muscles causes referred pain, meaning the pain is felt elsewhere in the body.

The cause is believed to be muscle injury through overuse, either from sports or from a job requiring repetitive motion. Tension, stress, and poor posture can also cause habitual tightening of the muscles, a form of overuse.

This overuse causes scar tissue, or adhesions, to form in the muscles. These points are known as trigger points, since they trigger pain at any stimulus.

Symptoms include deep, aching muscular pain that does not go away with rest or massage, but may actually worsen. There is often difficulty sleeping due to pain.

Myofascial pain syndrome should be seen by a medical provider, since it can develop into a similar but more severe condition called fibromyalgia.

Diagnosis is made through physical examination and applying mild pressure to locate the trigger points.

Treatment involves physical therapy, pain medications, and trigger point injections. In some cases, acupuncture and antidepressants are helpful.

Rarity: Common

Top Symptoms: dizziness, spontaneous shoulder pain, pain in the back of the neck, tender muscle knot, general numbness

Symptoms that always occur with myofascial pain syndrome: tender muscle knot

Urgency: Primary care doctor

Frozen shoulder (adhesive capsulitis of the shoulder)

Frozen shoulder is also called adhesive capsulitis of the shoulder. The "shoulder capsule" is the strong web of connective tissue which holds the ball joint of the upper arm inside the socket of the shoulder blade. If this connective tissue is damaged, scar tissue – or adhesions – may form and cause the shoulder capsule to become tight, painful, and inflexible.

The condition can happen if an injury to the shoulder forces it to stay immobilized while healing. Additional risk factors may be diabetes, thyroid abnormalities, and heart disease.

Symptoms include gradual worsening of the ability to move the shoulder, due to increasing pain and stiffness in the outer shoulder and upper arm.

Diagnosis is made through physical examination, with simple tests to measure how far the shoulder can move, as well as imaging such as x-ray or MRI.

Treatment involves physical therapy to help restore range of motion; over-the-counter, nonsteroidal anti-inflammatory drugs to ease pain; and sometimes cortisone injections to the shoulder joint. Surgery may be needed in some cases.

Rarity: Common

Top Symptoms: spontaneous shoulder pain, stiff shoulder, dull, achy shoulder pain, shoulder pain that gets worse at night, difficulty moving the shoulder

Symptoms that always occur with frozen shoulder (adhesive capsulitis of the shoulder): stiff shoulder

Urgency: Primary care doctor


Fibromyalgia is a set of chronic symptoms that include ongoing fatigue, diffuse tenderness to touch, musculoskeletal pain, and usually some degree of depression.

The cause is not known. When fibromyalgia appears, it is usually after a stressful physical or emotional event such as an automobile accident or a divorce. It may include a genetic component where the person experiences normal sensation as pain.

Almost 90% of fibromyalgia sufferers are women. Anyone with rheumatic disease, such as rheumatoid arthritis or lupus, may be more prone to fibromyalgia.

Poor sleep is often a symptom, along with foggy thinking, headaches, painful menstrual periods, and increased sensitivity to heat, cold, bright lights, and loud noises.

There is no standard test for fibromyalgia. The diagnosis is usually made when the above symptoms go on for three months or more with no apparent cause.

Fibromyalgia does not go away on its own but does not get worse, either.

Treatment involves easing symptoms and improving the patient's quality of life through pain medications, exercise, improved diet, and help with managing stressful situations.

Rarity: Common

Top Symptoms: fatigue, arthralgias or myalgias, anxiety, depressed mood, headache

Symptoms that always occur with fibromyalgia: arthralgias or myalgias

Urgency: Primary care doctor

Repetitive strain injury of the shoulder ("swimmer's shoulder")

Repetitive strain injury of the shoulder is caused by consistent repetitive use.

Rarity: Uncommon

Top Symptoms: shoulder pain from overuse, shoulder weakness, shoulder numbness

Symptoms that always occur with repetitive strain injury of the shoulder ("swimmer's shoulder"): shoulder pain from overuse

Symptoms that never occur with repetitive strain injury of the shoulder ("swimmer's shoulder"): severe shoulder pain, shoulder injury

Urgency: Self-treatment

Shoulder blade pain treatments and relief

Most cases of shoulder blade pain are treatable. A little bit of time and rest should do the trick. But in some cases, shoulder blade pain is a sign of a heart attack.

When shoulder blade pain is an emergency

If the pain is sudden and you can't think of a logical explanation for it, seek immediate medical attention if you're also experiencing:

When to see a doctor for shoulder blade pain

If your shoulder blade pain is due to injury or something not life-threatening, schedule an appointment with your doctor if you don't notice an improvement over the course of several days.

At-home shoulder blade pain treatments

You can also try the following shoulder blade pain treatments and tips to have yourself feeling better quicker.

  • Exercise and stretching: Strengthening your back could help alleviate pain. Try pushups, sit-ups, and pullups. Remember to start slow if you don't exercise regularly. Light stretches can also help loosen tense muscles.
  • Therapy: Both massage and physical therapy can help with shoulder blade pain that comes and goes, especially if due to an injury or compressed nerve.
  • Medication: Over-the-counter anti-inflammatory medication can temporarily relieve shoulder blade pain. Steroids might also be prescribed.
  • Surgery: Shoulder blade surgery is rare but it's an option for those suffering with extreme pain.

Ninety percent of people experiencing pain in their shoulder blade will positively respond to rest and exercise.

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FAQs about shoulder blade pain

What does a torn ligament in your shoulder feel like?

A torn ligament in the shoulder will be painful, and can and often does follow a period of exertion and strain of a muscle. Some individuals say that they hear an audible pop and then a sudden onset of pain in the setting of a complete tear. Others, in the case of a partial tear, report pain and swelling after a muscle "gives out" or after a quick and vigorous motion of the shoulder.

Can stress cause pain between the shoulder blades?

Stress has been reported to cause pain between the shoulder blades. The trapezius muscle is between the shoulder blades and tends to tense and strain when someone is under chronic stress. While there is little evidence about pain between the shoulder blades as a psychosomatic manifestation of stress, it is possible.

Why do I have chronic shoulder blade pain?

It is difficult to evaluate the cause of chronic shoulder pain without physically examining the shoulder. There a few questions that may help narrow the diagnosis. Have you had trauma to the shoulder? Rotator cuff injuries are often more subtle on the first appearance and may not be evident on an X-ray. If there is no evidence of an injury, it may be either referred pain or pain from a damaged nerve. The most common causes of chronic shoulder pain are strains and sprains from overuse or overexertion of a shoulder.

Why do I feel a burning sensation on my shoulder blades?

A pinched nerve, shingles (varicella zoster), or stretching particularly tight muscles can cause a burning sensation on the shoulder blades. A pinched nerve may radiate or move from the neck or mid-back outward and shoot down the shoulder to the wrist. A shingles infection is usually one-sided, and the pain is quickly accompanied by a red bumpy rash that is extremely painful and tender to the touch.

Why does it hurt in my upper back when I breathe?

Pain in your upper back with deep breathing can be due to tense muscles. However, there are much more worrisome symptoms that involve chest and back pain upon deep inspiration. Pleuritic chest pain (or chest pain on deep inspiration) can be a sign of a blood clot in the lungs, a punctured lung, inflammation of the lining of the lungs, or a rib fracture.

Questions your doctor may ask about shoulder blade pain

  • How would you explain the cause of your shoulder pain?
  • Can you fully move your shoulders around?
  • Where exactly is your shoulder pain?
  • Do you feel a painful, tight knot or band in your muscle anywhere on the body?

Self-diagnose with our free Buoy Assistant if you answer yes on any of these questions.

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The stories shared below are not written by Buoy employees. Buoy does not endorse any of the information in these stories. Whenever you have questions or concerns about a medical condition, you should always contact your doctor or a healthcare provider.
Dr. Rothschild has been a faculty member at Brigham and Women’s Hospital where he is an Associate Professor of Medicine at Harvard Medical School. He currently practices as a hospitalist at Newton Wellesley Hospital. In 1978, Dr. Rothschild received his MD at the Medical College of Wisconsin and trained in internal medicine followed by a fellowship in critical care medicine. He also received an MP...
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