Possible Causes of Your Right Shoulder Blade Pain

Persistent right shoulder blade pain can be debilitating and can arise from various causes, including muscle injuries, bursitis, tendonitis, cervical disc, cervical facet syndrome, arthritis, and underlying medical conditions. Identifying the actual cause of the pain and dysfunction is critical for best clinical outcomes.

What Makes You More Prone to Right Shoulder Blade Pain?

The most common risk factors that make someone more prone to experiencing right shoulder blade pain include:

• Age: As you age, your bones and soft tissues become more prone to wear and tear, which can cause various shoulder-blade-related problems.
• Obesity: Excess weight can put strain and pressure on the shoulder blade area, causing pain and discomfort.
• Lack of exercise: Not exercising regularly can lead to muscle imbalances and weakness, making the shoulder blade area more susceptible to pain and injury.
• Smoking: Smoking can restrict blood flow and oxygen to the soft tissues, making them more prone to pain and dysfunction.
• Chronic stress or depression: Constant emotional stress or depression can cause tension and stiffness in the shoulder blade area, leading to pain and discomfort.
• Poor posture: Slouching or hunching over can put a strain on the muscles and joints in the shoulder blade area, causing pain and dysfunction.
• Improper lifting techniques: Incorrectly lifting heavy objects can strain the muscles and soft tissues in the shoulder blade area, leading to pain and injury.
• Repetitive shoulder motion: Constantly performing the same shoulder movements, such as reaching or lifting, can cause overuse injuries and pain in the shoulder blade area.

Possible Conditions That Could Be Causing the Pain

Right shoulder blade pain is common and can cause significant pain, reduced range of motion, and dysfunction. It may arise from a shoulder injury but may also be referred to from different structures (areas) including the cervical spine, heart, lungs, and stomach. It is critical that the actual source be identified and treated accordingly. 

Some sources of right shoulder blade pain are life-threatening – such as a heart attack – and require immediate evaluation. 

The pain can result from direct injury to the shoulder blade or can be referred from another source such as the heart, lungs, or stomach.

Musculoskeletal Conditions

Muscle injuries are a common cause of pain behind the right shoulder blade. Injuries include muscle strains and tears, and they can range from minor to severe. The most common causes of muscle injuries are overexertion, trauma, and repetitive motion. 

Poor posture due to extensive screen time can also cause right shoulder blade pain.

Cervical Spine

The cervical spine, aka the neck, is composed of multiple structures, which are susceptible to injury with resultant pain. The cervical spine consists of seven bony building blocks that stack one upon another. Sandwiched between the bony blocks are discs that function as important shock absorbers. 

Facet joints are small, paired joints on the back side of the spine that provide stability and limit rotation. Nerves exit the cervical spine at each level and can be irritated or compressed, causing pain. 

The most common causes of right shoulder blade pain arising from the cervical spine are:

• Disc injury: Disc injuries include disc protrusion, herniation, or extrusion.
• Facet joint injury: Joints may become irritated or damaged.
• Ligament injury: Ligaments can be stretched or torn, leading to instability.
• Nerve compression: Nerves can be compressed or irritated, leading to pain.
• Scoliosis: Scoliosis is an abnormal sideways curve of the spine with potential compression/ irritation of the disc, facet joints, and exiting nerves.

Shoulder Injuries

Multiple shoulder injuries can cause pain behind the right shoulder blade. The most common include:

• Osteoarthritis: Wear and tear of the shoulder joint due to aging or overuse.
• Bursitis: Inflammation of a small sac that sits between tendons and bone. 
• Tendonitis: Inflammation of a tendon in the shoulder.
• Rotator cuff tendon tears: Tears of the tendons that help stabilize and move the shoulder joint. 
• Fractures: A break in the bone that connects to the shoulder joint.
• Instability (due to laxity or tearing of superior, middle, and inferior glenohumeral ligaments): A condition where the shoulder joint is loose and moves abnormally.
• Dislocation of the upper arm bone (humerus): A condition where the upper arm bone moves out of its normal position at the shoulder joint. 
• Dislocated rib: A rib may pop out or become misaligned after repeated use or trauma. This can cause pain in the shoulder blade area.

Heart

Cardiac conditions can cause scapular pain. The most common cardiac conditions include:

• Heart attack: A heart attack can cause referred pain to various parts of the body, including the shoulder and scapular region, due to shared nerve pathways. This pain, known as referred pain, occurs because the nerves that supply the heart and those that supply the shoulder region converge at the same level of the spinal cord.

• Aortic dissection: This is a serious medical condition where there is a tear in the inner layer of the aorta. The tear can grow in size, leading to pain behind the right shoulder blade, stroke, and aortic rupture. 

• Pericarditis: Pericarditis is the inflammation of the pericardium, the thin sac-like membrane surrounding the heart. It can cause chest pain as well as right shoulder blade pain.

Chest Wall Problems

Chest wall conditions that can cause pain behind the right shoulder blade include:

• Shingles: A viral infection that typically presents with a series of blisters and can lead to right shoulder blade pain.

• Thoracic radiculopathy: A medical condition characterized by the irritation of a nerve root that exits the spine in the thoracic region. The irritation may arise from disc protrusion, disc herniation, facet joint overgrowth, ligament thickening, cyst formation, or bone spur. Thoracic radiculopathy can cause right shoulder blade pain.

• Subluxed or dislocated rib: A medical condition that refers to a rib that has moved out of its normal position. This most commonly causes pain. 

Lung Problems

Lung injuries can cause right shoulder blade pain. The most common lung injuries are: 

• Pulmonary embolism: A serious medical condition in which the blood flow to the lungs becomes blocked by a blood clot. These clots usually originate in the deep veins of the legs and travel through the bloodstream to the lungs. Symptoms include shortness of breath, chest pain, and pain behind the right shoulder blade.
• Pneumothorax: A medical condition characterized by the collapse of a lung due to air leaks into the space between the lung and chest wall. Air accumulation can cause the lung to partially or completely collapse. Symptoms include shortness of breath, chest pain, rapid heart rate, and pain behind the right shoulder blade. 
• Lung cancer: Lung cancer can cause multiple symptoms, including shortness of breath and chest pain. 

Gallstone Disease

Gallstone disease, also known as cholelithiasis, is a common medical condition characterized by gallstones, which consist primarily of cholesterol or bilirubin. Gallstones can obstruct the flow of bile from the gallbladder, commonly leading to nausea, vomiting, jaundice, abdominal pain, and scapular pain. 

Acid Reflux or Peptic Ulcer 

Acid reflux disease, also known as gastroesophageal reflux disease (GERD) is a common medical condition where the acid in the stomach flows back up into the esophagus, causing irritation, discomfort, and pain. 

Liver Disease

Liver disease is a broad term that refers to any condition that affects the liver’s structure or function. Common examples include hepatitis, fatty liver disease, cirrhosis, and liver cancer. Symptoms vary but can include abdominal pain, swelling, and referred pain to the right shoulder blade. 

Cancer

This is where cancerous tumors involving the chest may cause shoulder blade pain, some of which include:

• Lymphomas
• Esophageal Cancer
• Stomach Cancer
• Liver Cancer
• Pancreatic Cancer

When to See Your Doctor

Right shoulder blade pain can arise from multiple different sources, which include muscle and shoulder injuries. Pain behind the right shoulder blade can also be referred from other sources that include cervical, thoracic disc, and facet injuries, gallbladder disease, kidney, and heart conditions. 

Identifying the actual source of the right shoulder pain is critical, as some may be life-threatening, such as a heart attack or a blood clot in the lungs. An evaluation by your doctor is indicated when:

• Pain persists despite conservative care
• Pain is debilitating and abrupt in onset
• Shoulder blade pain is accompanied by chest pain, shortness of breath, and irregular or rapid heart rate
• The shoulder joint has a deformed appearance, sustained a traumatic injury, and dislocation is suspected

Examination and Diagnosis

Examination and diagnosis of right shoulder blade pain involves a comprehensive assessment by your doctor. This will include a detailed medical history that reviews past medical and surgical history, medications, history of traumas, onset of symptoms, severity, location, aggravating and alleviating factors, and treatment to date.

Physical examination will include evaluation of shoulder joint, cervical and thoracic spine, range of motion, strength, and areas of tenderness and swelling. A neurologic examination will evaluate motor strength, reflexes, and sensation to light touch and temperature.

Additional tests may include:

Laboratory Tests and Imaging Studies

Blood tests to check for liver inflammation, inflammatory forms of arthritis, and other connective tissue diseases.

Scans to see what’s going on inside the body (bones, organs, and soft tissues):

• Chest X-ray
• Computerized tomography (CT) scan 
• Magnetic resonance imaging (MRI) 
• Positron emission tomography (PET) scan 

Heart and Abdominal Exams

Your doctor may also perform a physical examination of your heart and abdomen to check for any underlying conditions that could be causing the right shoulder blade pain.

• Electrocardiogram (EKG) 
• Stress test 
• Upper endoscopy
• Ultrasound
• CT scan for liver and pancreas irregularities

Common Treatment Options for Your Right Shoulder Blade Pain

Right shoulder blade pain can arise from many different sources. An accurate diagnosis is essential as some may be life-threatening and require immediate medical attention.

Shoulder blade pain arising from muscle injuries, shoulder bursitis, tendonitis, mild rotator cuff injuries, and mild neck and thoracic spine disorder in many cases can be managed with conservative care. When appropriate, conservative care should always be first-line treatment. Common treatment options include:

Over-the-Counter (OTC) Pain Medications

Anti-inflammatory medications can reduce inflammation and discomfort. Nonsteroidal anti-inflammatory medications such as ibuprofen or naproxen are often recommended but should be avoided due to significant adverse side effects.

Massage and Exercise

Massage therapy can help relax tense muscles and promote healing. Gentle stretching exercises can also be beneficial in improving range of motion and reducing pain.

Physical Therapy

Physical therapy can effectively address and alleviate right shoulder blade pain through targeted exercises and techniques to improve mobility and reduce discomfort.

How Platelet-Rich Plasma (PRP) Can Make a Difference

Right shoulder blade pain is common and can cause significant pain and dysfunction. It may arise from a muscle or shoulder injury but may also be referred to from different structures such as the neck, thoracic spine, heart, lungs, gallbladder, stomach, and liver. Some are life-threatening and require immediate medical attention. For this reason, an accurate diagnosis is essential. 

At the Centeno-Schultz Clinic, we are committed to providing accurate diagnoses. Patients are evaluated by board-certified, fellowship-trained physicians who review past medical and surgical history, the onset of current symptoms, aggravating and alleviating factors, and treatment to date. Radiographic studies are reviewed in detail along with an in-office ultrasound when appropriate. 

Right shoulder blade pain due to muscle strains, shoulder dysfunction, or cervical or thoracic injuries that refer to pain in the shoulder is common in many patients. Treatment options at the Centeno-Schultz Clinic include ultrasound and/or X-ray-guided injections with PRP or bone marrow concentrate. 

Both can be effective in reducing inflammation and improving blood flow to facilitate healing and regeneration. Both options can allow patients to avoid dependence on narcotics and nonsteroidal anti-inflammatory agents, or the complications associated with surgery. This is your life. Choose well. 

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