Scapular pain, involving one of the shoulder bones can be a cause of great discomfort, especially while moving the shoulders.

As we all know, our body has two shoulders, and each shoulder has a flat triangular bone referred to as the scapula. Also known as the shoulder blade, the scapula is found at the back of the shoulder and attaches the arm bone with the ribs. Pain in the scapula or the shoulder blade is quite common and often the result of excessive physical activity. Scapular pain can restrict shoulder movement considerably, and lifting objects like a bucket of water is likely to trigger sharp shooting pain in the shoulder. Radiating pain from the back area of the shoulder while moving the shoulder joints are some of the most common scapular pain symptoms.

Causes

Experiencing occasional scapular pain in the day-to-day routine is understandable. However, persistent pain in the shoulder blade is something related to an underlying condition or improper sleeping positions. An overview on this condition is presented below.

Inappropriate Sleeping Position
A shoulder hurting after slight movement while waking up is a common complaint and occurs as a consequence of improper sleeping positions. Sleeping on one side for prolonged periods of time, without a pillow, can put excessive strain on the shoulder blades, resulting in pain. A proper pillow is essential as it provides support to the neck and the head, in turn allowing the shoulder to relax comfortably with minimal stress. However, doctors firmly believe that by far, the best sleeping position is to lie on the back.

Overuse
Any activity that causes repetitive movement of shoulders can lead to scapular pain. Outdoor games like tennis, badminton, and golf involves excessive use of shoulder muscles. This can leave the muscles connected to the scapular bone tense and strained. Eventually, the muscular pain radiates to the scapular bone.

Fracture
Broken scapular bone from trauma (accident or a sports injury) can cause excruciating pain, especially during movement of arms. Apart from intense pain, the affected area may appear swollen and show discolored skin.

Osteoporosis
This is an age-related disorder that is typically marked by gradual decline of bone density, eventually making the bones brittle and susceptible to fractures. Initially, one may not feel osteoporosis pain but over the course of time, there is substantial loss of bone mass, which can lead to moderate to severe pain. Men who have crossed 70 and women above 50 are at the risk zone of shoulder osteoporosis.

Osteoarthritis
Diagnosed in older people, arthritis is a painful condition that brings inflammation in joints. With age, the joints and bones in the body, become considerably weak, making them vulnerable to conditions like osteoarthritis. As we all know, the place where two bones meet is referred to as a joint. The cartilage is a tissue that covers the end points of bones and prevents them from rubbing against each other. The movement of the joints in our day-to-day routine leads to substantial wear and tear, which leads to destruction of cartilage. Shoulder arthritis, although relatively uncommon, can bring scapular pain.

Nerve Impingement
Scapular pain that is not restricted to the shoulder and runs down the arm is an indication of pinched nerve in the neck. In simple terms, a pinched nerve means a part of the nerve has compressed and is causing sharp shooting pain. Pinched nerve in the neck are symptoms of cervical spondylosis. The cervical (neck) spine primarily consists of seven hollow bones. Between two adjacent bones lies a 'disc' (a tough fibrous tissue) that prevents friction and gives flexibility to the neck. Also, various muscles and ligaments are connected to the neck bones that provide support and allow free movement of the neck.

Now, the spinal cord that runs through the neck and ends at the base of the skull, contains nerves that carry brain signals. Some of these nerves branch out of the neck and pass through the shoulder area. Now, over time (after the age of 50), these 'discs' may become brittle as well as the joints between neck bones may wear away. In some cases, the discs move out of their normal position and compress the nerve roots above it. This excessive pressure on any of the nerve roots can trigger pain which may travel down to the shoulder blade. People with a pinched nerve in the neck often experience pain in the scapula. In most cases, scapular nerve pain does not remain confined to the neck and the shoulder area but often spreads to the arms. People suffering from scapular nerve pain often experience numbness or an unusual burning sensation in the hand and fingers. Scapular pain resulting from nerve impingement does not go away within a few days. It is likely to continue for weeks and sometimes may even last for months.

Rotator Cuff Injury
The rotator cuff is a term that refers to the 4 muscles, located in the shoulder area. They provide support and stability to the shoulder joints. As tendons do the job of connecting muscles to bones, rotator cuff injuries can also affect the shoulder bones. Any injury to the rotator cuff muscles can manifest in the form of scapular pain.

Myofascial Pain Syndrome
Myofascial pain syndrome is also one of the causes of scapular pain , especially below the right shoulder blade. In this condition the fascial tissues that provide an outer covering to the muscles, cause pain. In most cases, myofascial pain syndrome affects more than one muscle. Usually, the site that is affected with myofascial pain differs from the point where it is actually experienced. For instance, if you apply pressure on the area suffering from myofascial pain syndrome, you may feel the discomfort somewhere else. This is known as referred pain, wherein the soreness is experienced not at the painful site but in another part of the body. People diagnosed with this condition, often feel referred pain under the right scapula.

Shingles
Right scapular pain mean could also mean shingles, an infection caused by varicella zoster virus. This is the same virus that causes chickenpox during childhood. Although chickenpox clears within 2-3 weeks, the virus does not go away and lies in the passive state (incapable of causing harm) inside the nerve roots of the spinal cord. However, when the virus becomes active again, initially it causes burning pain on the chest or back of the torso, more specifically near the right shoulder blade. This is followed by red itchy rash that forms a belt-like pattern on the painful site. Patients affected with shingles may also suffer from headache, fever, and other flu-like symptoms.

Diagnosis

In order to diagnose the underlying cause, an X-ray or an MRI scan of the shoulder blade is recommended. This may help to detect muscle injuries, dislocated joints, nerve impingement, and symptoms of degenerative diseases such as arthritis.

Treatment

In case of tendon or muscle injury, taking adequate rest and avoiding physical activities is the key to stop the pain from worsening. Maintaining proper posture while sitting or taking rest is also very important to keep scapular pain under control. Simply by correcting the posture, one can get tremendous relief from shoulder pain. Exercises that stretch the neck and the shoulder area too can contribute to overcome the pain. One should opt for exercises that help to make these weakened shoulder tissues stronger. Scapular retraction exercises are often recommended as they benefit to strengthen and heal the painful shoulder area.

Massaging the scapular area is an easy way to relieve the strain and tightness of the muscles. You need to consult a physical therapist to know the exact massaging technique that may decompress an impinged nerve and provide long-lasting relief. Many patients have also found relief after attending multiple chiropractic sessions.

As far as treating shingles is concerned, the doctor may prescribe antivirals such as famciclovir and acyclovir to speed up recovery from shingles infection. Antihistamines that are given orally may also help to reduce the itchy sensation.

Muscle relaxants, non-steroidal anti-inflammatory medications, or cortisone injections are generally prescribed to relieve pain associated with muscle injuries and pinched nerve. If the discomfort does not decrease, the doctor may perform a surgery to reduce the pressure on the nerve roots.

Disclaimer: The information provided in this article is solely for educating the reader. It is not intended to be a substitute for the advice of a medical expert.