Shoulder Blade Pain: What Causes It by Location

Shoulder blade pain usually comes from the muscles around the blade or from the neck and upper back. Pain along the inner edge most often comes from tired or strained muscles, a stiff upper back or the lower neck. The neck can send pain to the shoulder blade even when the neck itself hurts little. Less often, pain here comes from the heart, lungs or gallbladder.

The exact spot narrows the likely causes. This page goes through each area of the shoulder blade, what tends to bring the pain on and what sets the common causes apart. It narrows things down. It does not diagnose. A physical therapist or doctor who examines you can do that.

First: the signs that skip the line

Shoulder blade pain is one of the places where organ problems can show up. Read these first.

Heart, call your local emergency number now: pain between or under the shoulder blades with chest pressure, breathlessness, sweating, nausea, lightheadedness or pain spreading to the jaw or arm. Women and people with diabetes may have milder or less typical symptoms.
Major blood vessel, call now: sudden, severe, tearing or ripping pain between the shoulder blades, especially in someone with high blood pressure.
Lungs, call now or go to the emergency department: sudden sharp pain worse when breathing in, with breathlessness, coughing blood or a fast heartbeat. A swollen calf or recent surgery, long travel or bed rest adds to the concern.
Lungs, see a doctor today: pain on breathing with fever and a cough.
Gallbladder, see a doctor today: pain under the right shoulder blade with pain under the right ribs or upper belly, often after a fatty meal, with nausea. Fever or yellowing of the skin or eyes makes it urgent.
Nerves and spinal cord, see a doctor promptly: new weakness, clumsy hands, unsteady walking or loss of bladder or bowel control.

Inner edge, between the blade and the spine

This is the most common spot. A burning or aching patch next to the inner edge of the blade, often with a knot that feels like it needs pressing. Long desk sessions, driving and carrying a child or bag on one side tend to make it worse.

Muscle strain or overload (rhomboids, middle trapezius): tender to press, worse after holding one position, better when moving. Usually eases over days to a few weeks.
Referred pain from the lower neck: joints and discs in the lower neck commonly refer pain here. Turning or tilting the head changes it, and pressing the spot may not reproduce it fully.
Stiff upper back joints: a sharper point next to the spine, worse twisting or taking a deep breath.

Top of the blade

The ache sits at the upper inner corner of the blade, where it meets the base of the neck. Phone use, shrugging while typing and sleeping with the head turned tend to aggravate it.

Levator scapulae strain: this muscle runs from the side of the neck to the top corner of the blade. It is tender at that corner and worse turning the head away or looking down to the opposite side.
Upper trapezius tension: a broader ache across the top of the shoulder and blade.
Neck joint irritation: the lower neck often refers pain to this corner. Neck movement changes it.

Under the blade

A deep ache that feels like it is behind or beneath the blade, hard to reach. Reaching, pushing and lying on that side may bring it on.

Rotator cuff (infraspinatus) or muscles under the blade (subscapularis, serratus anterior): pain tied to arm movement rather than neck movement.
Scapulothoracic bursitis: grinding, clicking or a snapping feeling as the blade moves over the ribs, with an ache.
Neck nerve root irritation: a deep ache over the blade can be the first sign of a pinched nerve in the neck (cervical radiculopathy), before pain or tingling reaches the arm.

Lower tip of the blade

Pain at or just below the lower point of the blade, sometimes wrapping toward the side. Twisting, deep breaths and rowing or pulling movements can trigger it.

Muscle strain (lower trapezius, latissimus dorsi): worse with pulling and reaching overhead.
Upper or mid back joint and rib joint pain: worse twisting and on a deep breath, tender at one point.
Organ causes: on the right side, gallbladder pain can sit here. On either side, lung problems can cause pain here that is worse breathing in. Pain that does not change with movement or position is more of a concern.

Pain that changes with movement usually comes from muscles and joints. Pain that ignores movement deserves a closer look.

Pain that starts in the neck

A large share of shoulder blade pain is referred from the neck. Clues: the pain began with a stiff neck; looking up, turning or tilting toward the sore side reproduces it; or arm tingling follows. Joints and discs in the lower neck can refer pain to the inner edge and top of the blade without much neck pain at all.

Tingling, numbness or weakness down the arm alongside shoulder blade pain points to a pinched nerve in the neck. Most people improve over several weeks to a few months, but weakness that is getting worse needs a doctor within days.

Rib joint pain

Each rib joins the spine in the upper and mid back. These joints (costovertebral joints) can become irritated after twisting, lifting, coughing hard or sleeping awkwardly.

What it feels like: a sharp pain at one point beside the spine near the blade, sometimes wrapping around along the rib.
What sets it apart: worse with deep breaths, coughing, sneezing and twisting; tender at one spot when pressed.
Typical course: often eases over one to a few weeks.
What to rule out: pain on breathing with breathlessness, fever or coughing blood belongs in the emergency signs above.

Where else this could be coming from

Shoulder joint: rotator cuff and frozen shoulder (adhesive capsulitis) can ache over the back of the blade. Arm movement brings it on.
Shingles: burning or tingling in a band on one side, followed within a few days by a rash.
Stomach and pancreas: upper belly pain that bores through to the back, sometimes with nausea.
Heart, lungs and gallbladder: covered in the signs at the top of this page.

Still not sure

Get assessed by a physical therapist or doctor if shoulder blade pain is not clearly easing after about one to two weeks, if it is not changed by movement or position, if it wakes you at night, or straight away for any of the signs at the top of this page.

Note which side, the exact spot, whether neck or arm movement changes it, whether breathing or meals affect it, and any tingling in the arm.