Scapular pain: what it can be and what to do

The scapula, also known as the shoulder blade, is a flat, triangular bone, located in the upper part of the back, which has the function of stabilizing and assisting the movement of the shoulders. The articulation of the scapula with the shoulder allows the mobilization of the arms and is composed of a set of muscles and tendons, called a rotator cuff.

There are changes and certain diseases that can arise in the region of the scapula and cause pain, such as muscle damage, fibromyalgia, winged scapula and bursitis. The causes of these changes and diseases are not always known, but they can be related to incorrect posture, excess strength and weight in the arms, as well as trauma and fracture.

Some changes and diseases that can cause pain in the scapula are:

1. Muscle injury

The scapula helps to move the shoulder through muscles located in the back, such as the rhomboid muscle. This muscle is located between the last vertebrae of the spine and the edges of the scapulae, therefore, excessive physical effort or sudden movements with the arms can lead to a stretching or stretching of the muscle, causing pain in the scapular region.

In some cases, injury to the rhomboid muscle can also cause reduced strength in the arms and pain when moving the shoulder, and these symptoms usually disappear over time as the body recovers.

What to do: in light injuries, taking a rest and applying a cold compress on the spot is enough to relieve the pain, but if after 48 hours the pain continues, you can apply a warm compress and anti-inflammatory ointment. However, if the symptoms worsen or last for more than 7 days, it is recommended to consult an orthopedist who can recommend the use of anti-inflammatory drugs and analgesics to reduce inflammation and relieve pain.

2. Bursitis

In the scapular region there are pockets of liquid that serve to cushion the impact of arm movements, called bursae. When the bursae are inflamed they cause a disease called bursitis and cause severe pain, especially on the coldest days and when moving the arm. This inflammation can also affect the shoulder area and cause pain in the scapula. See more about what is bursitis in the shoulder and the main symptoms.

What to do: To relieve the scapular pain caused by bursitis, ice can be applied to the site for 20 minutes, 2 to 3 times a day. The orthopedic doctor may also recommend painkillers, anti-inflammatory drugs and corticosteroids to improve pain and decrease inflammation.

In addition, it is important not to make an effort with the arm, on the side where the pain is intense, and it is necessary to perform physiotherapy exercises to strengthen the muscles of the region and help to reduce the inflammation of the area.

3. Winged scapula

The winged scapula, also known as scapular dyskinesia, occurs when the positioning and movement of the scapula occurs incorrectly, giving the feeling of being out of place, causing pain and discomfort in the shoulder region. The winged scapula can occur on either side of the body, however, it is more common on the right side and can be caused by arthrosis, unconsolidated fracture of the clavicle, paralysis and changes in the nerves of the chest and kyphosis.

The diagnosis is made by an orthopedic doctor through physical examination, and electromyography may be requested to analyze the functioning of the muscles in the scapular region. Check out more about how the electromyography exam is done and what it is for.

What to do: after confirming the diagnosis, the orthopedist will be able to indicate medications to relieve pain, however, in most cases, surgery to repair the nerves in the back of the chest is recommended.

4. Fibromyalgia

Fibromyalgia is one of the most common rheumatological diseases, the main symptom of which is generalized pain in various parts of the body, including the scapula. Often, people who suffer from fibromyalgia may experience fatigue, muscle stiffness, tingling in the hands and may also develop depression and sleep disorders, leading to a worsening of quality of life.

When symptoms appear, it is important to consult a rheumatologist who will make the diagnosis through the history of pain, that is, the locations and duration of pain will be evaluated. However, the rheumatologist may order other tests, such as MRI or electroneuromyography, to rule out other diseases.

What to do: Fibromyalgia is a chronic disease and has no cure, and the treatment is based on pain relief. The rheumatologist may prescribe medications such as muscle relaxants, such as cyclobenzaprine and tricyclic antidepressants, such as amitriptyline. The TENS and ultrasound techniques used in physiotherapy can also help control the pain caused by fibromyalgia. Find out more about how fibromyalgia is treated.

5. Suprascapular nerve compression

The suprascapular nerve is located in the brachial plexus, which is the set of nerves responsible for the movements of the shoulder and arm, and can undergo changes and cause severe pain in the scapula.

The compression of this nerve is an alteration caused mainly by inflammation or trauma, which can happen in accidents or in sports activities that force the shoulder a lot. However, compression of the suprascapular nerve may also be associated with rupture of the cuff, better known as rotator cuff syndrome. See more about what rotator cuff syndrome is and how to treat it.

Scapular pain caused by compression of the suprascapular nerve can worsen at night and on colder days and when it is associated with other symptoms such as fatigue and muscle weakness it is necessary to consult an orthopedist, who will indicate exams such as X-rays and MRI to confirm the diagnosis.

What to do: in milder cases, treatment is based on the use of anti-inflammatories and analgesics, to reduce inflammation and relieve pain, and to perform physical therapy. In advanced cases, the orthopedist may indicate surgery to decompress the suprascapular nerve.

6. Scapular fracture

Scapular fractures are rare, because they are resistant bones and with great mobility, however, when it happens, it can cause pain. This type of fracture occurs, mainly, when a person falls and hits the shoulder and, often, the pain arises some time after the occurrence.

After an accident or fall that has generated trauma in the scapular region, it is necessary to seek assistance from an orthopedist who will request exams such as an X-ray to check if you have a fracture and, if any, the doctor will analyze the extent of this fracture.

What to do: Most scapular fractures are treated using pain relievers, physiotherapy and immobilization with a sling and splint, however, in more severe cases, surgery may be recommended.

7. Gorham's disease

Gorham's disease is a rare disorder with no definite cause, which causes bone loss, causing pain in the scapular region. The scapular pain generated by this disease has a sudden onset, appears suddenly, and the person may have difficulty moving the shoulder. The diagnosis is made by an orthopedic doctor, using computed tomography and magnetic resonance imaging.

What to do: treatment is defined by the orthopedic doctor, depending on the location of the disease and the symptoms presented by the person, and medications to help with bone replacement, such as bisphosphonates, and surgery, may be indicated.

8. Crackling scapular syndrome

The crackling scapula syndrome occurs when, when moving the arm and shoulder, a scapula crackle is heard, causing severe pain. This syndrome is caused by excessive physical activity and shoulder trauma, being very common in young adults.

The diagnosis of this syndrome is made by the orthopedist based on the symptoms presented by the person and it may be recommended to do tests such as X-rays or computed tomography, if the doctor suspects other diseases.

What to do: the treatment consists of the use of analgesic and anti-inflammatory drugs, to relieve pain and reduce inflammation, physiotherapy to strengthen the scapular muscles and kinesitherapy. Better understand what kinesitherapy is and what main exercises.

9. Liver and gallbladder problems

The appearance of gallstones and liver problems, such as abscesses, which is the formation of pus, hepatitis and even cancer are health problems that can lead to the appearance of pain in the scapula, especially on the right side. This symptom may also be accompanied by other signs such as yellow coloration of the skin and eyes, back pain, also on the right side, nausea, fever and diarrhea.

Some tests may be indicated by a general practitioner if you suspect that the pain in the scapular region is caused by some disease in the liver or gallbladder, which may be ultrasound, CT scan, MRI or blood tests, for example.

What to do: as soon as the symptoms appear it is recommended to see a general practitioner so that tests are done to confirm if there is a problem in the liver or gallbladder and after that, the doctor can recommend the most appropriate treatment according to the disease diagnosed.

When to go to the doctor

Scapular pain can also be a symptom of other diseases that are not related to the bone, muscle or nervous system and, in some cases, can indicate heart and lung diseases, such as acute myocardial infarction and pulmonary aortic aneurysm. Therefore, it is important to seek emergency medical care when other symptoms appear, such as:

• Pointed pain in the chest; Shortness of breath; Paralysis on one side of the body; Excessive sweat; Coughing up blood; Paleness; Increased heartbeat.

In addition, another symptom to watch out for is the development of fever, which, when it appears, may indicate an infection and, in these cases, other tests may be recommended to find out the cause of this symptom.