Overview

It’s very common for patients to come in presenting with ‘shoulder pain’. The ‘shoulder’ is so broad and different patients report ‘shoulder pain’ for different presentations. WHERE is the pain? Is it between your shoulder blades? In your neck? Is it over your shoulder and into your arm? The presentation of pain is imperative knowledge in the accurate diagnosis and treatment of your shoulder condition.

I believe there is a common misdiagnosis of the umbrella term ‘shoulder dysfunction’. It is very commonly mis-used with any presentation of pain around the scapula (shoulder blade). Immediately, words such as scapular dyskinesia or poor scapulohumeral rhythm are thrown around and a shoulder rehabilitation program is undertaken. This is NOT ALWAYS the correct treatment for scapula pain.

Therefore, we have to look holistically! Thus, underneath outlines the differing causes of shoulder pain looking outside of causes from the shoulder itself:

Pain Between the Shoulder Blades:

  • The lower cervical and thoracic spine must be taken into consideration.
  • Stiffness or inflammation in the intervertebral or Z-joints can cause pain referring to inside the shoulder blades or around the base of the scapula.
  • This can commonly present as a more tingling, numb discomfort over a deep ache.
  • Pain can also arise from tight posterior musculature including rhomboids and erector spinae.
  • Stiffness between the scapula and the ribs can also contribute to this pain.

Pain in the Shoulder + Down the Arm

  • All cervical nerve roots can cause shoulder pain as well. A spinal nerve exits from the gap between every vertebrae.
  • The lifting of your arm can close down or jam the joints in your neck. Thus, compressing a spinal nerve which radiates pain along its path (down the arm).
  • Thus, an onset of symptoms upon lifting your arm doesn’t confirm that the problem is caused in your shoulder!
  • Check your neck! This will see if movements of your head provoke your symptoms.
  • Neural tension of the peripheral nerves can also contribute to sharp, shooting nerve pain down the arms or into the armpit.

Pain Along the Top of the Shoulder

  • A main cause is muscular tightness of upper traps/levator scapulae
  • Stiffness in the upper Cx joints (C0/1/2) or mid/lower Cx stiffness (C3-7). This can refer to sections not only along the top of your shoulder but also to other areas!
  • Other causes involve cervical nerve root irritations or herniated Cx disc (if extremely severe)

Summary

  • PLEASE NOTE: This list is not conclusive – it is merely looking at structures outside the shoulder which are potential causes of symptoms.
  • The shoulder can 100% be the source of pain, but a holistic view must be taken to ensure the actual CAUSE is not overlooked.
  • There are so MANY structures associated with shoulder pain – don’t have tunnel vision!