Pain around the shoulder blade: local and referred causes

The shoulder blade, or scapula, is a flat bone on the back of the upper chest wall that forms part of the shoulder joint. Several muscle groups attach to it, nerves from the neck pass nearby, and the ribs and chest lie in front. Pain that you feel at or around the shoulder blade may therefore start in the shoulder joint, in the neck and upper back, in the chest wall, or occasionally in an organ elsewhere in the body.

The question is therefore usually which of these is the source, and the clues are what brings the pain on, what movement changes it, what else you notice and whether the pain is mainly on one side. This page does not replace an examination; it explains the patterns the NHS and other UK bodies describe.

The NHS shoulder pain page lists patterns that fit different problems: pain and stiffness that does not go away over months or years suggests frozen shoulder or arthritis, pain that is worse while using the arm suggests tendonitis, bursitis or impingement, and tingling, numbness, weakness or a feeling of clicking or locking suggests shoulder instability. Sudden very bad pain with difficulty moving the arm, sometimes with a change in shape, may indicate a dislocation, broken bone or torn tendon.

The neck is a frequent source of pain felt around the shoulder blade. The NHS says common causes of neck pain are the neck being locked in an awkward position while sleeping, bad posture such as sitting at a desk for a long time, a pinched nerve and injury such as whiplash. It advises seeing a GP if neck pain or stiffness does not go away after a few weeks, if painkillers have not worked, or if there are other symptoms such as pins and needles or a cold arm, which it says could be something more serious.

Pain from the chest and some other organs can be felt in the shoulder or back. The NHS says the main symptom of angina is sudden pain in the chest, neck, shoulders, jaw or arms, and that it may feel like tightness, squeezing, pressure or a dull ache with nausea, breathlessness, dizziness or sweating. It lists pain that spreads to the left or right arm, neck, jaw, shoulder, stomach or back, with chest pain and feeling sweaty, sick, light-headed or short of breath, as a reason to call 999 because it could be a heart attack.

In people who have periods, cyclical breast pain can also spread. Breast Cancer Now says it can spread to the armpit, down the arm and to the shoulder blade, and the NHS says injuries or sprains to the neck, shoulder or back can themselves be felt as breast pain. The two directions of referral are worth remembering if pain on one side seems to move between regions.

The NHS says to ask for an urgent GP appointment or get help from NHS 111 if shoulder pain is sudden or very bad, if you cannot move your arm, if the arm or shoulder has changed shape or is badly swollen, if pins and needles do not go away, if there is no feeling in the arm or shoulder, if it is hot or cold to touch, if it started after an injury or fall, if you develop severe pain in both shoulders, or if you feel feverish or unwell.

Call 999 if pain around the shoulder, back or arm comes with chest pain that is crushing or squeezing, or is accompanied by sweating, breathlessness, sickness or pale, grey skin. Do not drive yourself to A&E, as the NHS advises.

• Sudden or very bad pain, or inability to move the arm.

• Pain that follows a fall or other injury.

• Pins and needles that do not go away, or loss of feeling in the arm.

• Fever or feeling generally unwell.

• Any chest pain, tightness or breathlessness with the shoulder-blade pain.

For ordinary musculoskeletal pain the NHS suggests staying active and gently moving the shoulder, trying shoulder exercises for 6 to 8 weeks to stop pain returning, standing up straight with the shoulders down and gently back, sitting with a cushion behind the lower back, and using painkillers such as paracetamol and ibuprofen so you can keep moving. It advises against completely stopping use of the shoulder, against doing things that make it worse, and against making up your own strenuous exercises.

Heat or cold packs may help. The NHS suggests a pack of frozen peas wrapped in a tea towel for up to 20 minutes, 3 times a day, or a hot water bottle wrapped in a tea towel for up to 20 minutes, 2 to 3 times a day. A pharmacist can suggest painkillers and tell you when to see a GP.