Pain in the shoulder blade and below: what symptoms can indicate this?

Pain in the shoulder blade and below can occur with nerve damage, diseases of the spine, shoulder girdle, or somatic pathologies. The cause can be determined by clinical signs, the conditions for the manifestation of the syndrome and anamnesis data.

Back pain in the shoulder blades

Pain in the shoulder blade region can be felt when inhaling, in half of the body and/or in the whole arm. In certain cases, such symptoms are the "first bell" of the exacerbation phase, which can be prevented after identifying the provoking factor.

Causes and localization

Pain under the shoulder blade usually occurs during movement - it is preceded by an uncomfortable twist, long standing with a bent back. It signals local damage that occurs for various reasons.

Pathologies with unilateral lesions, in which there is pain only on the right or left under the shoulder blade, are few - as a rule, the severity of the symptom is individual. This is due to the symmetrical arrangement of the nerve roots emanating from the spinal cord.


If there is pain under the right and left shoulder blade, it may be due to damage to the bones and muscular framework. The symptoms do not have a strict localization, the severity depends on the traumatic factor. The clinic is usually acute, begins abruptly and takes a chronic course.

The causes of traumatic pain under the left or right shoulder blade are as follows:

  1. Bruises - in such cases, the pain is superficial, most often the muscles are damaged. Usually the back muscles hurt under the shoulder blades and below, swelling and local inflammation develop. After 2-3 weeks, the symptoms disappear.
  2. Cracks and fractures are more serious injuries, the pain is concentrated in the scapula itself. With the slightest movement, it intensifies, the patient cannot move his arm or bend over.
  3. Subluxation and displacement of the vertebrae - this leads to pain in the joints at the level of the shoulder blades and below, sometimes the bone structures compress the nerve roots.

Injuries are characterized by severe pain under the right or left shoulder blade that occurs spontaneously. There may be a crunch when moving, and swelling is common.


When the disease affects the thoracic spine, the patient experiences back pain near the shoulder blades and below. This is due to pinching of the nerves or spinal cord due to deformation of the joint disc. Pathology develops gradually, and as the distance between the vertebrae decreases, the pathology clinic aggravates.

Pain localization depends on the affected area:

  1. When osteochondrosis destroys the articular discs of the thoracic region from 2 to 6, pain in the shoulder blade is felt. It usually radiates to the neck and arm. When the vessels are squeezed, dizziness occurs, intracranial pressure may increase.
  2. If the joints of 6-12 segments are affected, the pain radiates under the left or right shoulder blade, spreads down to the corresponding half of the body and lower back.

The spinal roots of the thoracic region give rise to plexuses that innervate the arms and trunk. Therefore, when they are squeezed, the pain spreads along their course.

With osteochondrosis, the complaints are one-sided - depending on the misalignment of the spine, it hurts on the right or left and below in the shoulder blade.


This is a transverse curvature of the spine caused by overuse of the postural muscles. This leads to pinching of the roots and spinal cord, the appearance of pain under the shoulder blade on the right or left. The pathology is usually accompanied by:

  1. Respiratory failure - a one-sided obliquity of the spine deforms the chest, which impairs the functioning of the lungs, one of which is compressed, and the second takes over the lost function.
  2. Violation of the work of the heart - the frequency of contractions and pulse changes, shortness of breath and pallor of the skin appear.
  3. The appearance of a visible deformation of the chest is the main cause of pain under the right or left shoulder blade. The vertebrae along with the ribs are displaced laterally, causing the bone structures on the side of the curvature to be displaced downwards and damaging the spinal cord and its branches.

If the spinal cord is compressed in scoliosis, the back usually hurts between the shoulder blades and the focus below is severely restricted. If muscle cramps occur, the symptom spreads to neighboring structures.


It is characterized by backward flexion of the spine, forward displacement of the shoulder girdle, and gradual flexion. There is pain over the shoulder blade - usually bilateral, gives to the arm and neck. The following mechanisms are involved in its formation:

  1. Neurogenic - due to the curvature, the distances between the vertebral bodies in the front sections decrease, this leads to pinching of the branches of the spinal cord. There is aching pain in the right and left shoulder blades, which can radiate to the collarbone, neck and shoulder.
  2. Muscular - the deflection of the spine leads to an overload of the muscles of the collar zone, which can painfully cramp in the area of the shoulder blades and below.

As a result of kyphosis, the vertebral artery is compressed, cerebral circulation is disturbed. The work of internal organs gradually deteriorates.


If the right or left shoulder blade hurts, one of the reasons may be spondylarthrosis - damage to the facet joints and intervertebral discs. It is accompanied by a loss of mobility, stiffness appears, most severe in the morning.

The clinical picture changes as the pathology progresses: >

  1. Destruction of the cartilage - with a lack of blood flow, the integrity of the connective tissue is violated, the articular disc becomes more fragile, more damaged and recovers more slowly. At this stage, strong physical exertion leads to microtrauma, pain appears, radiating to the area of \u200b\u200bthe shoulder blades and below.
  2. Deformation of the articulated disc - seals appear that impede mobility. This provokes new destruction, which slows down the regeneration processes, the patient feels pain in the back and shoulder blades.
  3. The appearance of bone growths is characteristic of the advanced stage of the disease. Neoplasms injure joints, muscles, blood vessels and nerves.

With spondyloarthritis, the back can hurt between the shoulder blades or below - an attack is usually preceded by physical activity. With rest, the symptoms subside because the bony growths do not injure the surrounding tissue.

protrusion and hernia

In these conditions, acute pain under the left and right shoulder blades, which occurs due to compression of the spinal cord or its roots, is of concern. Pinching disturbs the sensitivity along the nerve fibers.

The localization of symptoms is as follows:

  1. Pain in the shoulder blades and above - protrusion or hernia in the cervicothoracic region or when 1-3 segments of the chest are affected. The symptom worsens when you try to tilt your head and turn it to one side.
  2. Pain in the area between the shoulder blades - in this case, the middle sections can be affected from 3 to 6. The discomfort increases when both hands are moved to the side, inhaled deeply or rotated.
  3. Severe pain under the right and left shoulder blades - the articular discs from 6 to 12 are affected, the lower back may be involved in the pathology. In this case, there is a risk of developing a hernia, since this section of the spine is subjected to greater loads than the previous ones.

Unlike spondyloarthritis, hernia and bulge pain does not go away for long with rest. This is due to constant compression of the nerve, which is made worse by muscle spasms.


This is pinching of the lumbar roots, which are collected in a strong sciatic nerve. If the upper sections are affected, the patient feels pain under the shoulder blade and below, it is bilateral, aggravated by bending and sudden movements.

Additional symptoms may appear as the disease progresses: >

  1. There is pain in the back radiating to the lower limb - a sharp stabbing pain is felt as an electric shock along the course of the nerve.
  2. Burning pain in the back, lumbar region or below the shoulder blades indicates prolonged pinching of the roots of the spine in the lumbar region.
  3. Cramps and loss of sensation most often appear in the lumbar region, buttocks, sometimes there is numbness along the nerve fibers of the thigh, lower leg and foot.

Shoulder-scapular periarthrosis

This condition is understood as inflammation of the shoulder joint and surrounding tissues, stiffness appears, which disappears only after warming up.

The pain is concentrated in the area of the right or left shoulder blade and below, depending on the development of hemispheric motor skills (right or left-handed). First it appears after exercise, and then at rest. Additional symptoms appear along the way:

  • Headache;
  • hand numbness;
  • Violation of mobility of the spine.

With humeroscapular periarthrosis, clinical manifestations increase when the arm is raised - there is pain in the area of the right or left shoulder, scapula. Gradually, the range of motion decreases, stiffness progresses.


The next cause of pain under the right or left shoulder blade is nerve inflammation in this area. The disease is caused by hypothermia, drafts. Most commonly affected:

  1. Suprascapular and supraspinal nerves - there is pain in the right or left shoulder blade from behind, which is mainly concentrated in the clavicle. Sometimes the discomfort spreads to the shoulder, which indicates a defeat of the skin branches of this area.
  2. Subscapular and infraspinatus nerves - in this case there is pain under the shoulder blade on the right or left, depending on the side of the lesion. When the muscles of the same name are affected, the clinical manifestations are exacerbated when the arms are lowered and abducted behind the back.
  3. Intercostal nerves - usually 1-4 pairs. These branches pass along the lower edge of the rib, pain occurs not only in the area of \u200b\u200bthe shoulder blades and below, but also on the sides of the chest, sometimes in the front sections.

Symmetry is not typical for neuralgia - if the left half of the body was exposed to drafts, pain in the neck, chest and shoulder blade is noted from this side.

heart disease

Branches from the parasympathetic trunk, which is connected to the spinal cord and its roots, go to the heart. Because of this, heart disease can provoke pain in the shoulder blade and below. Usually, a mild form of myocardial infarction is latent. It may be accompanied by the following symptoms:

  1. Dull, aching or burning pain behind breastbone or under left shoulder blade - may last for hours, increases with walking, but eases somewhat with rest.
  2. Shortness of breath - accompanies pain, can manifest itself within a few days.
  3. Tachycardia - increased heart rate, sometimes there are rhythm disturbances.
  4. Other symptoms include increased pressure, dizziness, nausea and vomiting.

Problems with the gastrointestinal tract

Problems with the gastrointestinal tract as a cause of pain under the left shoulder blade

Similar to the previous mechanism, pain spreads along nerve fibers. Clinical signs can be bilateral, but in most cases there is a specific pattern in which symptoms appear according to the location of the internal organs.

Pain under the left shoulder blade from behind occurs with the following diseases:

  • pancreatitis;
  • Gastritis;
  • gastric ulcer.

Patients with these diseases usually complain of dyspeptic disorders, nausea and vomiting. When internal bleeding occurs, pallor of the skin, dark color of feces, decreased pressure and weakness are noted.

Pain under the right shoulder blade accompanied from behind from behind:

  • cholelithiasis;
  • Hepatitis;
  • liver cirrhosis;
  • ulcerative lesion of the duodenum.

Different reasons

In addition to these factors, pain under the shoulder blades can provoke:

  1. Uncomfortable mattress - if it fails and you sleep on the right side, in the morning you can feel pain under the left shoulder blade from behind from behind, as the curved spine pinches the roots of the spine.
  2. Pleurisy - pain in the scapula region occurs when breathing due to the friction of the blades against each other and peaks with a deep breath.
  3. Poliomyelitis - pathology is accompanied by neurological symptoms, back pain is common.
  4. Poisoning - severe poisoning or colds may present with muscle pain, chills, and fever.
  5. VVD - vegetative-vascular dystonia is accompanied by a change in pressure, interruptions in the work of the heart and shortness of breath, and sometimes back discomfort.
  6. Kidney diseases - such pathologies are characterized by aching or stabbing pains under the right shoulder blade, a change in diuresis and urine color, general symptoms.
  7. Subdiaphragmatic abscess - when suppuration is detected in the upper floor of the abdominal cavity, pain under the shoulder blades, fever and symptoms of intoxication appear when inhaled.
  8. Mental disorders - in some cases, pain in the shoulder blades and under them can be the result of such disorders. The exact mechanism of occurrence has not been studied.

The nature of pain

Pain in the area of \u200b\u200bthe shoulder blades and under it can be different, by its nature it is possible to assume a certain group of pathologies, sometimes a provoking factor can be identified:

  1. For pinched nerves, lumbago is characteristic - a sharp stabbing pain that occurs with a sharp turn of the body and raises the arm. This is the main difference from cholelithiasis, in which the symptom is not ruffled by movements.
  2. Aching, throbbing or burning pains indicate a pathology of the internal organs. The latter option occurs when the roots of the spinal cord are compressed, but increases with movement and can cause stitches.
  3. A hernia is characterized by severe constricting pain in the shoulder blade area and below. Sometimes lumbago is preceded by numbness in the limbs.
  4. Cuts of varying intensity are characteristic of neuralgia, drilling is often accompanied by inflammation of the joints.

Which doctor treats shoulder blade pain?

If you feel pain in the shoulder blade and below, you need to make an appointment with a neurologist. If there are no pinched nerves, the specialist will refer you to a consultation with an orthopaedist, cardiologist, gastroenterologist or urologist, depending on the suspected case


To determine the cause of discomfort in the area of \u200b\u200bthe scapula and under it, a laboratory and instrumental examination is carried out:

  1. X-ray or CT - these methods allow you to detect osteochondrosis, curvature of the spine and the consequences of injuries.
  2. MRI >- Depending on the suspected pathology, the spine, shoulder joint or internal organs are examined.
  3. ECG - helps detect heart disease.
  4. Blood and urine tests are informative for some somatic pathologies, muscle and joint inflammation.
  5. Ultrasound - is prescribed for somatic diseases, when MRI is not possible.

Pain under the shoulder blades usually occurs due to neurology. Therefore, CT and MRI are considered the "gold standard" in the diagnostic protocol.

General principles of treatment

The main task is to eliminate the symptoms and the provoking factor. First, the patient's well-being is stabilized, then the underlying pathology is treated.

The therapy program includes:

  1. Medications – Analgesics are usually prescribed to reduce pain and inflammation. Then, depending on the underlying disease, funds are prescribed - antibiotics, gastroprotectors, diuretics.
  2. Physiotherapy - strengthens the spine, treats somatic diseases. Medical electrophoresis is used in the area of \u200b\u200bthe shoulder blades, warming procedures, SWT.
  3. Massage - warming up is carried out with damage to the spine. As a result of such procedures, the muscles above and below the shoulder blades relax, posture improves. In this case, you need professional help from a chiropractor or osteopath.
  4. Gymnastics - is carried out after eliminating pain, the program is compiled by a physiotherapist, a rehabilitation specialist, depending on the disease.


After successful treatment, patients are advised to follow a preventive program that will prevent the recurrence of the pathology:

  • watch your posture;
  • Choose a medium firm mattress and an orthopedic pillow.
  • massage twice a week in the area of the shoulder blades and below;
  • follow a low-calorie diet for obesity;
  • get rid of bad habits;
  • Carry out prophylaxis of somatic pathology (if present in the anamnesis);
  • see a doctor every six months.

Pain in the shoulder blades and below can be neurological or somatic in nature. When nerves are damaged, symptoms are acute and sudden, and occur spontaneously.

Pathologies of internal organs and joints are characterized by gradual and persistent pain, the clinic is always accompanied by additional symptoms. At the initial stage, analgesics are prescribed, after diagnosis, the program is supplemented with etiological therapy and strengthening procedures.