Pain Under Right Shoulder Blade: Causes and When to Worry

Pain under the right shoulder blade usually comes from the muscles around the blade, the joints where the ribs meet the spine, or the lower neck. That pain changes when you move, breathe deeply or press on the spot. The main organ cause on this side is the gallbladder, and less often the liver. Gallbladder pain typically starts in the upper right belly after a meal, often with nausea, and spreads to the blade. The lungs are a less common source.

Where exactly it hurts narrows the likely causes. This page helps you narrow them down; it does not diagnose you. If the pain is not specific to one side, shoulder blade pain by location covers the whole blade.

First: the signs that skip the queue

Call your local emergency number now if

Belly pain with fever and shivering: severe upper right belly pain with a high temperature, shaking chills, or yellowing of the skin or eyes.
Sudden breathlessness: sharp chest or back pain that is worse on breathing in, with sudden breathlessness, a racing heart or coughing up blood.
Sudden tearing pain: severe tearing or ripping pain between the shoulder blades or in the chest, at its worst from the first moment.
Chest pressure: heaviness or squeezing in the chest with sweating, nausea or breathlessness. Heart pain is felt on the right side less often, but it does happen.
After a blow to the right side: new right shoulder or blade pain after a fall or a hit to the lower right ribs, especially with dizziness or a swelling belly.

See a doctor today if

Upper right belly pain that lasts: pain under the right ribs that has not eased after a few hours, or comes with a fever.
Yellow skin or eyes: even without pain, or with dark urine and pale stools.
Fever with pain on breathing: a cough, fever or chills with sharp pain when you breathe in.
A swollen, tender calf: with any chest or upper back pain, especially after surgery or a long flight or drive.
A band of burning pain: around one side of the chest or back, with a rash appearing in the same band.

Gallbladder and liver: why they are felt here

The gallbladder and liver sit under the right ribs, against the diaphragm. Irritation there travels along nerves shared with the mid back and the top of the right shoulder. So a problem in the belly can be felt under the right shoulder blade, sometimes more than in the belly itself.

Gallstone attack (biliary colic): a steady, gripping pain in the upper right belly or just below the breastbone, often starting within an hour or two of a large or fatty meal, and often in the evening or at night. It can spread to the right shoulder blade. Nausea or vomiting is common. It typically lasts from about 30 minutes to a few hours, then fades.
Inflamed gallbladder (cholecystitis): similar pain that does not settle after several hours, with tenderness under the right ribs and often a fever. This needs a doctor the same day.
Liver problems: a dull, heavy ache under the right ribs with tiredness, poor appetite, dark urine or yellow skin. It is rarely sharp and rarely changes with movement.

What sets these apart from muscle pain: they follow meals rather than movement, you cannot find a comfortable position, and pressing on the shoulder blade does not reproduce them. Gallstones are more common in women, over 40, after pregnancy and after rapid weight loss. If you have had an attack that settled on its own, see a doctor within days; attacks tend to come back.

Lung causes on the right

The lining of the right lung lies right under the shoulder blade, so lung problems can be felt there. They are usually linked to breathing and come with other signs.

Pneumonia or pleurisy: sharp pain on breathing in, with cough, fever or feeling unwell.
Pulmonary embolism (a clot in the lung): sudden breathlessness with sharp pain on breathing in, more likely after surgery, long travel or with a swollen leg.
A growth at the top of the lung: rare. A deep, constant ache in the shoulder and blade that slowly worsens, sometimes with arm or hand tingling, a long-standing cough or weight loss, mostly in people who smoke or have smoked.

When a breath catches the pain but there is no fever, cough or breathlessness, the ribs and their joints are a more common cause. The guide to upper back pain when breathing sets these apart.

Stabbing pain under the right shoulder blade

A sudden stabbing pain that catches you mid-breath or mid-twist is one of the most common reasons people search for this. The usual causes, and what tends to set them apart:

A rib joint: a sharp, pinpoint stab an inch or two beside the spine, set off by a deep breath, a cough, a twist or reaching. Between catches it may only ache.
A muscle spasm: a stab that leaves a tight, tender band along the inner edge of the blade, eased by warmth and gentle movement.
Pleurisy: a stab with every breath, with a recent cold, cough or fever.
A clot in the lung: a stab with breathing plus breathlessness that came on suddenly. This one is an emergency.

Gallbladder pain answers to meals. Muscle and joint pain answers to movement.

Inner edge, between the blade and the spine

An ache or burning strip along the inner edge, sometimes with a knot you can press. For most people the right arm does more of the daily work, so this side often carries the load of a mouse held out in front, reaching across a car seat, or a child carried on the right hip.

Muscle overload: the rhomboids and middle trapezius, tender to press, worse late in the day and better after moving.
Rib joint irritation: sharper and more localized, and it catches on breathing or twisting.

Top and outer edge of the blade

Pain at the upper corner that runs into the neck, or on the outer blade that spreads to the back of the shoulder.

The lower neck: pain that changes when you turn or tilt your head, sometimes with tingling into the arm.
Levator scapulae strain: tender at the upper inner corner, pulled by turning the head away from the sore side.
The rotator cuff: an ache at the back and side of the shoulder, worse reaching behind you, overhead, or lying on the right.

Where else this could be coming from

The neck: shoulder blade pain that comes from the neck follows neck movement. A sore point beside the lower neck that is worse looking up fits neck facet joint pain.
The ribs: rib joint pain is the usual cause of a catching, stabbing pain close to the spine.
The muscles: upper back strain follows a clear load and usually settles over days to a few weeks.
Both sides: if the pain sits in the middle or crosses to the left, pain between the shoulder blades is the closer match.

Still not sure

Get assessed by a doctor or physical therapist if the pain is not clearly easing after about one to two weeks, if it wakes you most nights, or straight away if any sign from the first section appears. If the pain seems to come and go with meals, start with a doctor rather than a physical therapist.

Note what sets it off before you go: a meal, a breath, a twist, a long day at the desk. That one detail often says more than the location.