Pain Near the Shoulder Blade It might not be a trigger point!
Chronic pain near the shoulder blade, particularly near the inside of the shoulder blade, is a common reason for seeking care. It often starts out feeling like something that can be self-managed and there is often a long list of therapies that have been tried already – lacrosse balls, spikey balls, theracanes, massage guns, heat packs, etc.
Oftentimes, there will be some level of relief, however it’s mostly short-lived.
It’s a difficult area of the body to self-treat. Sometimes a significant other will intervene with an elbow or pair of thumbs to try and release the painful spot. When this doesn’t provide lasting relief either, the next stop is often a massage therapist.
Sometimes, this is where the pain ends. At least for the time being. But for many others, the pain either doesn’t go away at all or comes back quickly. Unfortunately for those people, no amount of massage, stretching, taping, Chiropractic adjustment or dry needling is likely to give anything more than temporary relief.
There are 2 common reasons for pain near the inside of the shoulder blade which can be misdiagnosed.
1. Referred Pain (cervical spine)
An inflamed disc or joint in the neck (cervical spine) can cause referred pain felt near the shoulder blade. This is typically described as being dull, achy or even throbbing at times. When it gets really bad it can be sharp and cause a lot of pain. The lower segments of the neck are the most commonly injured, due to chronic loading over time with poor posture, e.g. looking down at devices.
A disc injury in the neck may not be properly recognised and treated, because it closely mimics other, more popular diagnoses.
It’s important to dive deeply into the patient history and physical assessment, because disc injuries can be misdiagnosed as a trigger point, muscle “knot”, or muscle spasm.
Sometimes there will be a history of neck tightness, stiffness and pain. One of the most common events is to wake up “stuck” and being unable to move properly first thing in the morning. Most folks report feeling like they “just slept wrong”, however it’s actually an irritated disc in the neck which is causing the surrounding muscles to lock up and prevent movement. This typically improves throughout the day and will often self-resolve, however it is a telltale sign of deeper dysfunction in the cervical spine.
When a disc becomes inflamed it can refer pain in a well-defined pattern, known as a sclerotome. In our evaluation we pay special attention to exactly where you feel the pain so that we can understand which spinal level is likely to be causing the symptoms.
2. Nerve Entrapment
There are several nerves that can become entrapped near the shoulder blade and cause annoying symptoms. Two of the most common are the Dorsal Scapular Nerve and the Spinal Accessory Nerve.
A nerve becomes stuck due to a build-up of adhesion that tethers it to the surrounding tissues (trapezius muscle, levator scapulae muscle, rhomboid muscles). This causes the nerve to become entrapped and lose the normal ability to glide and slide. Symptoms include chronic tightness, tension, aching pain and/or a feeling like your shoulders are being lifted all the time.
The spinal accessory nerve innervates the upper trapezius muscle, the “bowling ball” muscle on the top of the shoulders. The dorsal scapular nerve also passes underneath the trapezius and is frequently entrapped leading to trigger points and pain. This becomes a target for therapists to release painful trigger points that cause neck and shoulder pain.
It’s common for patients to remark “I carry all of my tension there”, or, “that’s the knot that just doesn’t go away”.
In many cases the underlying reason for this is a nerve entrapment that is causing overactivity in the muscle, leading to only temporary relief despite all efforts with treatment.
👉 For more on Nerve Entrapment, see this THIS ARTICLE
What causes these problems?
The vast majority of people develop these problems over a long period of time through repetitive daily tasks and postures. Working at a desk for long hours, 5+ days per week is a big contributor, along with anything that involves looking down repeatedly, i.e. staring at a phone or other device for long periods of time. These postures lead to the development of fibrous adhesion, due to a lack of blood flow in the tissues, which then goes on to cause other problems such as entrapped nerves and disc injuries.
For more on adhesion and how it develops, check out this previous article; Soft Tissue – What is it? Why does it matter?
What about trigger points?
There’s no doubt that muscular trigger points cause pain. However we should consider that the trigger point may not be the underlying problem, but it’s actually just a symptom of the problem.
Trigger points, or “knots”, are commonly understood to be caused by activities of overuse. But when these knots don’t resolve, it’s worth considering other potential factors:
- Protective tension from an underlying disc injury
- Nerve entrapment causing muscle overactivation
- Local muscle adhesion
Just treating trigger point alone is a bit like taking Panadol for a headache; it may help reduce the symptoms but it doesn’t actually address the underlying cause.
If you, or anyone that you know is suffering with chronic pain that won’t go away despite everything you’ve tried so far, please consider scheduling an Initial Consultation (link below on this page).
Dr. Christopher Aysom, Principal Clinician
BChiroSc, MChiro (Chiropractor)
Apex Soft Tissue & Spine
Pymble, NSW, Australia
https://apexsofttissue.com.au
What is a Nerve Entrapment?