Do you have back pain behind the shoulder, in the area of the scapula? These shoulder blade pain can sometimes be disabling, abruptly cut off breathing or even give the sensation of stabbing. But where do these pains come from? Should we be worried and especially how to relieve them?
Anatomy of the scapula
In medicine, it is called the scapula, the scapula which simply means “shoulder” in Latin. For the record, the word scapula comes from the Greek “omos” for shoulder and “platè” for flat object. The scapula is therefore a flat bone from the back of the shoulder. It is triangular and asymmetrical in shape. It is part of the shoulder complex which is formed by the meeting of the collarbone in front, the humerus (arm bone) on the side and the scapula behind.
The scapula is pressed against the ribs, it articulates with the humerus on its external part and forward with the clavicle. The scapula slides over the rib cage but does not articulate with the ribs or with the vertebrae. This great freedom allows the shoulder and our arm to be particularly mobile!
The scapula is marked in its upper (upper) part by four anatomical elements:
- the coracoid process (beak-shaped) which emerges on the upper edge of the shoulder. In particular, it gives insertion to the biceps brachii muscle and to two ligaments connecting it to the clavicle,
- the acromion which is the most lateral part and which articulates with the clavicle. On the acromion, the trapezius and deltoids muscles are inserted,
- the scapular spine behind, the point of attachment of the supraspinatus and infraspinatus muscles,
- The glenoid cavity, located in the lateral angle, articulates with the head of the humerus. These two bones form the scapulo-humeral joint which allows great amplitude movements.
- The scapula therefore allows the insertion of many muscles and ligaments of the arm, neck and thorax. It is thus understood that the causes of pain in this region are of various origins.
Why pain in the shoulder blade?
Poor back posture
First of all, pain in the shoulder blade area can come from prolonged poor posture. It is this cause that is most often found in our osteopathic offices. Indeed, at the origin of shoulder blade pain, there are bad habits such as:
- spend time on a smartphone with your head tilted forward,
- study on a computer whose screen height is not suitable,
- work for hours with your elbows in the air, as is the case with hairdressers,
- give a bottle to your newborn baby without resting his elbows.
If you recognize yourself in one of these cases, a visit to your osteopath is essential; he will be able, first of all, to relieve you and, secondly, to give you practical advice to avoid these pain-causing positions. Finally, he will be able to show you stretches to practice daily in order to avoid this painful and disabling phenomenon.
This bad posture adopted for a long time leads to muscle contracture. This can involve the subscapular, infraspinatus, teres minor, supraspinatus or angular muscle of the scapula and causes upper back pain that can radiate to the cervical, shoulder or arm.
The pain can also have a traumatic origin, this is particularly the case during:
- Shoulder dislocation which is a trauma that is often found in young and athletic subjects, with a fall or a significant shock. There are two different possible shoulder dislocations: the glenohumeral and the acromioclavicular. Indeed, the joint between the scapula and the humerus ( glenohumeral ) is not very congruent, that is to say it can easily be dislocated due to the shape of the articular surfaces. The glenoid of the scapula is a smooth and flat surface and it articulates with the head of the humerus which is spherical. Congruence (joint cohesion) occurs primarily through ligaments and muscles of the rotator cuff. Acromioclavicular dislocation: dislocation of the joint which joins the clavicle to the acromion. Frequent pathology which generally occurs in road accidents due to the wearing of seat belts.
- tendonitis which will require complete rest of the muscle involved. Tendinitis is an inflammation of a tendon (part of the muscle that fits over the bone) caused by repetitive movements. Adhesive capsulitis is a possible complication of rotator cuff tendinopathy if it is not treated properly. It is the inflammation of the joint capsule, the fibrous and elastic envelope that surrounds the joint. In the case of tendonitis, the pain will be lateral, in the region of the coracoid process or acromion.
- fracture which will result in immobilization of several weeks followed by rehabilitation. Fractures of the scapula are relatively rare, they occur especially in the event of violent shocks. A fracture of the glenoid cavity (the part that articulates with the bone in the arm) requires surgery to restore the joint surface in contact with the humerus.
- Scapula alata (or “winging scapula”) : corresponds to a detachment of the scapula. A deformity in the back is visible, especially when the patient pushes on the wall with his hands. This detachment occurs during paralysis of the serratus anterior muscle. The serratus anterior muscle can then no longer fulfill its initial role, which is to press the scapula against the thorax. Paralysis can occur in the event of compression or stretching of the nerve following repeated movement of the shoulder (sport or carrying heavy loads, for example).
Scapula pain may be related to chronic pathology:
- Osteoarthritis or arthritis anti-inflammatory treatment is usually prescribed. Regular consultations with an osteopath make it possible to maintain joint mobility and reduce pain. Complementary physiotherapy sessions may be recommended,
- fibromyalgia, in this case, it is the entire upper back, between the shoulder blades that is tender to the touch. Other signs usually accompany this pain such as severe fatigue or trouble sleeping. In the case of fibromyalgia, the pain will come back repeatedly and usually originate from a previous trauma. Find our article to learn more about the treatment of fibromyalgia .
More rarely, this pain in the scapula can reveal other pathologies, in particular if it is a pain of the left scapula accompanied by acute chest pain: a cardiac problem , a pulmonary pathology can be evoked. If you observe breathing difficulties, a change in color of the skin or lips, dizziness or if there is a history of cardiovascular pathologies, be particularly vigilant and contact an emergency medical service (SAMU). Indeed, if your pain is intense and no posture relieves it, it is essential to consult your doctor as soon as possible.
Complementary examinations of the scapula
In order to understand the cause of your pain, several examinations may be performed:
- First a clinical examination is carried out by your doctor, it includes the questioning to know the history of the pain. It is followed by the physical examination of the scapula: visual assessment, verification of the positioning of the scapula, mobility assessment, tests (elevation of the arm, tilt, etc.),
- This clinical examination can be supplemented by an X-ray which is a standard reference examination and confirms the diagnosis of fracture or dislocation. It also makes it possible to check the condition of the adjacent bone and joint structures,
- ultrasound is an excellent test for evaluating soft tissue: tendon damage, muscle atrophy, calcifications or bursitis. In addition, it allows the evaluation of the subacromial conflict,
- MRI can show a projection of the scapula or a cyst responsible for the compression of the suprascapular nerve or a muscular atrophy for example,
The electromyogram is used to assess the functioning of the suprascapular and long thoracic nerves in cases of compression.
Prevent shoulder blade pain
- If you often work in front of the computer, choose a chair with an adapted backrest that will support your back and lower back. Also pay attention to the height of the screen. This is because the top edge of the screen should be about level with your eyes. And, finally, be careful that your elbows are supported in order to relax the shoulders.
- If you’re in an activity that requires frequent lifting, such as a house painter or hairdresser, for example, consider taking breaks by stretching as described below.
- Check your mattress, it can be the cause of these shoulder pain. A mattress is changed on average every ten years. If you notice sagging in the area where your back rests, it’s time to get a new one. Choose it firmly, it is imperative and take the time to try it.
- If you are an athlete, do not forget the warm-up and stretching phases to be done before and after all sports sessions to avoid many inconveniences (sprains, strains, muscle stiffness, etc.)
- If this pain occurs often, it may indicate a lack of magnesium, zinc, silica or sulfur and phosphorus. A cure of these elements can improve joint flexibility and relax muscles.
- Stress is an important factor in these pains. ” I’m fed up! Often the patients who come to see an osteopath for this reason. This is because the trapezius and angular muscles of the scapula tend to contract and may remain contracted after a stressful period. Many solutions are available to you to get rid of this stress: yoga, relaxation and meditation as well as sports practice allow you to release these tensions which are used to spill over on the back.
Read to know: Types of back pain and exercises to relieve pain
What treatment to relieve and treat shoulder blade pain?
- Osteopathy: I put osteopathy in the first place because it is an extremely common reason for consultation in our practices. Your osteopath will have the expertise both to understand the origin of your pain according to the anamnesis (history of pain) but also to relieve you of this pain. On the other hand, given that it is a common reason for consultation, your osteopath will also be able to recognize whether it is a pathology that is not within his competence or a vital emergency. From the first pain (not acute and in the absence of other symptoms), consider making an appointment with an osteopath. Do not wait too long before consulting because if the situation is not treated, there is a risk of inflammation of the tendon, that is to say of tendonitis.
- Self-massage: In the evening, massage the painful scapula area for several minutes with a warming balm. You can also prepare your own massage oil by mixing 20 drops of vegetable oil (a sweet almond oil, for example) with 5 drops of essential oil of Wintergreen ( Gaultheria fragrantissima Wall ) which is anti-inflammatory and analgesic . Warning: this essential oil is contraindicated in pregnant and breastfeeding women, as well as in children under the age of 6 and in people with eczema, asthma, ulcer or hiatus hernia.
- Stretching: there are many different ones, I suggest a few below but do not hesitate to ask your osteopath to establish together the most suitable stretches for your pathology.
Good to read: Health Benefits of Yoga-Physical and psychological
Rhomboid stretch and scapula fixator
Also called technical Snuggle bear, this technique allows the fixing of the shoulder blade that fits on the middle back. The goal of this movement is to catch his left shoulder blade with his right hand and the right shoulder blade with his hand so that the two elbows are approximately on top of each other. You can hold the position for 20 to 30 seconds and gradually relax. This movement should not be painful, seek only the tensioning of the muscle and stop as soon as you feel pain.
Exercise to stretch the scalene muscles
You simply have to tilt your head without inducing rotation, that is, bring the right ear closer to the right shoulder (for example) which allows the left part of the neck and upper back to be stretched. To do this, place your right hand on the top of your head and practice an inclination until you feel a tension that should not be painful. Remember to keep your shoulders straight and relaxed. Hold the position for 20-30 seconds and do the other side.
The trapezius muscle is a large muscle which takes its insertion at the base of the skull then inserts itself on the last cervical vertebra and the twelve thoracic ones to end on the clavicle and the scapula. It is therefore a muscle very often involved in pain in the scapula region. To stretch your right trapezius muscle, grab your right wrist behind your back and pull down. Second, tilt your head to the left side. You should feel a stretch that shouldn’t be painful, hold the position for a few seconds, release and do the other side.
Physiotherapy: it is ideal for recurrent pain in addition to osteopathy.
Read about: Intercostal muscle strain: what is it ?
Pain in the area between the shoulder blades is very common and most of the time can be relieved with simple measures. Avoid repetitive gestures, especially with your elbows in the air. Rethink your workstation to have an ergonomic posture. Stretch, especially at the end of the day, to relax overworked muscles. And, finally, remember to consult your osteopath as soon as this pain appears to prevent a tendonitis phenomenon from setting in. In any case, if your shoulder blade pain is accompanied by difficulty in breathing, shortness of breath, cardiovascular history, do not wait to see your doctor.