Shoulder blade pain is discomfort in or around the shoulder blades (scapulae). It most often stems from muscle strain due to overuse or injury, but in some cases it can signal a serious medical issue, including heart or lung problems. The shoulder blade is a triangular bone of the upper back supported by a complex network of muscles, tendons, ligaments, and nerves. When these structures are irritated or injured, even simple actions like reaching, lifting, sitting, or lying down can become uncomfortable. Getting an accurate diagnosis early helps guide effective treatment and a safer recovery.

How It Presents

Shoulder blade pain is distinct from pain in the shoulder joint. It affects the scapula and the surrounding soft tissues that move and stabilize the bone. The pain quality may be dull, sharp, burning, throbbing, or aching. It can be intermittent or constant and may worsen with certain activities (e.g., overhead reaching, prolonged sitting) or positions.

Common accompanying symptoms include:

  • Arm weakness or difficulty lifting/reaching overhead

  • Reduced shoulder range of motion

  • Popping, clicking, or grinding with movement

  • Postural asymmetry (one shoulder higher than the other)

  • Scapular winging (shoulder blade protrudes outward)

Referred pain is also common—pain felt at the shoulder blade even though the source lies elsewhere (for example, the gallbladder, liver, lungs, or cervical spine).

Potential Causes of Shoulder Blade Pain

Shoulder blade pain can arise from local musculoskeletal problems, spine-related issues, or conditions affecting the chest or abdomen. Understanding the likely cause is the first step toward targeted treatment.

Muscle conditions
Seventeen muscles attach to each scapula, coordinating shoulder motion and connecting the shoulder girdle to the spine, ribs, and arm. Common muscle-related problems include:

  • Muscle strain (pulled muscle) from overuse, poor posture, abrupt loading, or trauma. Symptoms often include localized pain, swelling/bruising, and motion limits.

  • Myofascial pain syndrome with trigger points that cause local and referred pain to the scapula region; often related to overuse or stress.

  • Rotator cuff tear (partial or full thickness), typically presenting with night pain, pain/weakness when lifting or lowering the arm, and crepitus.

Bone and joint conditions
Pain may originate from the shoulder complex, cervical spine, or the scapular bone itself:

  • Frozen shoulder (adhesive capsulitis) with thickened, stiff joint capsule and progressive motion loss; pain can radiate to the scapula.

  • Osteoarthritis of the acromioclavicular (AC) joint causing top-of-shoulder pain that may refer to the scapula.

  • Cervical degenerative disc disease with nerve compression, causing referred pain to the shoulder blades, neck stiffness, and possible headaches.

  • Osteoporosis with fragility fractures; scapula pain can occur with or without overt fracture.

  • Scapular fractures (rare) typically after high-energy trauma; often coexist with rib or clavicle fractures and cause severe upper-back/shoulder pain.

Abdominal conditions (referred pain)
Shared nerve pathways can cause upper abdominal or GI problems to present as scapular pain:

  • Gallstones and cholecystitis commonly refer sharp pain to the right shoulder blade.

  • Pancreatitis may refer pain to the left shoulder blade with abdominal pain, nausea, and vomiting.

  • Gastroesophageal reflux disease (GERD) can produce squeezing or gripping pain near the left scapula.

  • Liver disease (e.g., hepatitis, cirrhosis) may refer sharp pain to the right shoulder blade.

Lung conditions (referred pain)
Scapular pain is often on the same side as the affected lung:

  • Pulmonary embolism can cause sudden, sharp scapular/back pain with shortness of breath, tachycardia, lightheadedness, or chest pain.

  • Pleurisy (inflamed pleura) from infection or lung disease can cause chest pain that worsens with deep breaths and may radiate to the shoulder blades.

  • Pneumothorax (collapsed lung) produces acute chest/shoulder pain and shortness of breath.

Heart and vascular conditions
Urgent cardiovascular problems can present with scapular pain:

  • Heart attack may produce chest discomfort with radiation to shoulders, arms, back, or jaw, plus shortness of breath, diaphoresis, and dizziness.

  • Pericarditis causes sharp chest pain radiating to scapulae, often worse with deep breathing and improved by sitting up or leaning forward.

  • Aortic dissection can manifest as sudden, tearing pain radiating to the shoulder blades, back, or abdomen—this is a medical emergency.

Cancer
Tumors can cause local or referred shoulder blade pain:

  • Lung cancer may irritate nerves and refer pain to the right scapula.

  • Malignancies of the pancreas, liver, esophagus, or stomach can refer pain to the scapular region.

  • Bone metastases involving the scapula can produce focal pain and tenderness.

When To See a Healthcare Provider

Many mild cases from overuse or minor strain improve with home care. Seek medical attention if pain persists beyond two weeks despite rest and self-care, or if you notice:

  • Visible deformity or scapular winging

  • Marked swelling, redness, or warmth

  • Restricted shoulder/arm motion or significant weakness

  • Fever or unexplained systemic symptoms

Call emergency services immediately if scapular pain is accompanied by:

  • Crushing chest pressure or pain radiating to jaw/arm

  • Shortness of breath, dizziness, or rapid heartbeat

  • Confusion or fainting

These may indicate a heart attack, pulmonary embolism, or another life-threatening condition.

Getting a Diagnosis

Your clinician will review your medical history (onset, triggers, pain quality, associated symptoms) and perform a physical exam of the neck, shoulders, and upper back—including posture analysis, scapular tracking, range-of-motion testing, and strength assessments.

Depending on clinical suspicion, tests may include:

  • Imaging: X-ray, ultrasound, MRI, or CT to visualize bones, joints, tendons, muscles, and soft tissues.

  • Blood tests: CBC and inflammatory markers when infection, autoimmune disease, or systemic illness is suspected.

  • Electrocardiogram (ECG) and cardiac enzymes when cardiac causes must be ruled out.

How Is Shoulder Blade Pain Treated?

Treatment is tailored to the underlying cause and typically progresses from conservative care to more advanced interventions if needed.

At-home care

  • Relative rest: Temporarily avoid aggravating activities (e.g., overhead lifting, prolonged slumped sitting).

  • OTC pain relievers: NSAIDs such as ibuprofen/naproxen can reduce pain and inflammation if appropriate for you.

  • Ice and heat: Use ice (15–20 minutes, up to 3–4 times daily) for the first 24–48 hours post-injury, then transition to heat to relax tight muscles.

  • Posture and ergonomics: Keep ears over shoulders and shoulders over hips; adjust screen height, chair support, and armrests to reduce strain.

Medical treatments

  • Physical therapy: A personalized program targeting scapular stabilizers (e.g., serratus anterior, lower/middle trapezius), posterior shoulder mobility, thoracic extension, and cervical posture. Progress from isometrics and closed-chain activation to functional strengthening and endurance.

  • Prescription medications and injections: Short courses of prescription-strength NSAIDs or corticosteroid injections for inflammatory tendon or joint conditions; disease-specific medications for cardiac, pulmonary, or abdominal causes.

  • Procedures or surgery: Reserved for specific diagnoses such as full-thickness rotator cuff tears, nerve entrapment, unstable fractures, or symptomatic AC joint arthritis not responding to conservative care.

Prevention and Self-Care Tips

  • Build scapular and rotator cuff strength with regular, balanced training.

  • Break up prolonged sitting and screen time; micro-breaks every 30–45 minutes.

  • Prioritize thoracic mobility and chest/lat stretch; avoid rounded-shoulder posture.

  • Warm up before overhead sports or lifting; progress loads gradually.

  • Use supportive sleep positions (side-lying with pillow between arms or supine with a small pillow under the upper back/shoulders as needed).

A Quick Review

Shoulder blade pain often reflects local muscle strain or posture-related overload, but it can also be referred from the neck, chest, abdomen, heart, or lungs. Persistent, severe, or systemically associated pain warrants medical evaluation. Most musculoskeletal causes improve with a combination of activity modification, targeted physical therapy, posture optimization, and judicious use of medications. Urgent symptoms—especially chest pain, shortness of breath, or sudden severe tearing pain—require immediate emergency care.