Is It Really My Shoulder? Diagnosing Ambiguous Pain Around the Shoulder Blade

Got Pain Around the Shoulder Blade?

One of the most common complaints that people have when they come into our office for treatment is pain between the shoulder blades. If you suffer from pain in this area you know how annoying and persistent it can be - seemingly irritated by almost all of our normal day to day activities and very difficult to get rid of. You’ve probably gotten your fair share of massages and body work to have the “knots” in your neck and shoulders rubbed out, but by now you probably realize that you can’t massage your way out of this problem. 

Many times, when palpating people’s shoulders to search for the structures that are most likely the root cause of their pain, people will say things like “but that's not where it hurts! (*Points at painful spot*,) can you just rub it here and loosen it up?”

While it makes perfect sense that people assume that the location of their pain is also the location of the problem, many times what people experience as pain between the shoulder blades actually originates somewhere else in the body. The truth is that the shoulder is a complicated joint with many overlapping structures at play, and identifying the exact structure that is causing you pain and limited mobility takes an expert’s knowledge and skill set.

In the case of pain stemming from or around the shoulder blade, overloaded muscles near the neck and back result in tightness and pain, but the phenomenon causing these muscles to become overloaded in the first place is likely myofascial adhesion in the neck or shoulder. If you’ve never heard of myofascial adhesion, it’s the most common problem in the human musculoskeletal system and affects almost everybody in some way. So why have you never heard of it before? You have, but have probably heard it called “scar tissue”. Just as picking a scab on your skin can cause scars to harden and heal in a lumpy bumpy way that obstructs the smooth feel and function of surrounding skin tissue, adhesion in the muscles and joints comes from injury (either acute or slowly over time) and causes limited mobility and pain if untreated.

The good news here is that adhesion is one of the most reversible problems in the human body, even if you’ve already been diagnosed with degeneration in your joints or soft tissue. The bad news, as you may have guessed by now, is that no amount of massages will solve the problem- that takes an expert trained in finding and removing adhesion. Once the offending adhesions are identified and removed, the overload is diminished, and the pain is significantly reduced. More good news - Dr. Mike is just such an expert and has helped many clients over the years resolve their stubborn neck and shoulder pain for good.

Getting The Right Diagnosis

So how can you tell where the pain around your shoulder blades is really coming from? First you have to identify whether the pain you’re dealing with is actually located in the shoulder blade. Many people think their pain is located on the shoulder blade when in reality it is actually below, beside, beneath or around the blade itself. The image below maps out the area considered the shoulder blade:

A (1) (2).png

Pain in the “A” region (on either side) demarcates the boundaries of the shoulder blade. Pain in this area is often related to the structures of the rotator cuff (comprised of the infraspinatus, teres minor, subscapularis and supraspinatus muscles). This is true shoulder blade pain - often appearing near the back of the arm or armpit, in the armpit itself, or under the shoulder blade.

Conversely, pain that is primarily located in the “B” region between the shoulder blade and the spine most likely originates from the cervical spine and neck. Diagnosing pain in this region is a bit more complex that diagnosing rotator cuff issues, but common characteristics of this type of condition are that it gets worse with sitting, or when you tuck your chin to your chest.

Pain in both areas A and B are extremely common for our clients due to the amount of time most of us spend looking down at our phone or computer screens, sitting at a desk, writing and typing. Going through our lives with chronic poor posture and our heads hanging off of our necks staring down at our phones puts our bodies on the fast track to developing adhesions in the neck that cause so much of the pain between the shoulder blade and spine that clients come to us with.  
If you’re currently suffering from neck and/or shoulder pain, you can use the following self tests to give yourself a good sense of where your pain is most likely originating.

Self-Tests For Shoulders and Neck:

Here’s a simple test to quickly check shoulder function. If you fail this test, there’s a good chance that your pain is related to adhesion or degeneration in the shoulder.
You can perform this test on yourself or with a friend. Here’s how it goes:

  1. Stand up straight with your feet shoulder length and parallel and arms relaxed at your sides.

  2. Keeping your arms straight, raise them out to your sides, trying to touch your palms together above your head.

  3. You PASS the test if you can touch your biceps to your ears after bringing your palms to meet above your head WITHOUT pain, tension or much effort in the arm and shoulder.

  4. You FAIL if you cannot touch your biceps to your ears with equal ease and comfort on both sides, or if it takes effort or causes you pain to go through the test.

Now let’s test the neck! Failing this test means that your ambiguous shoulder-area pain likely originates in your neck or cervical spine. It goes like this:

  1. Stand up tall and straight with your back to a wall. Your heels, shoulders and the back of your head should easily be able touch the wall at the same time. If you can’t do that,  or you have to crane your neck to get the back of your head to touch the wall behind you, you have already failed the test and are likely suffering from a neck or cervical spine injury. 

  2. Keeping your shoulders against the wall, peel the back of your head off the wall while tucking your chin toward your sternum, trying to touch your chin to your chest.

  3. You PASS if you can get your chin to touch your sternum easily and without pain.

  4. You FAIL if you cannot easily assume the starting posture, if you feel tension or pulling across/between the shoulder blades or in the back when tucking the chin.

“Hold on!” you might be thinking to yourself. “I failed both tests! What gives?”. What gives is that you, like many many others, have a more complicated case compounded by adhesion in multiple area of the body. This is extremely common but makes it all the more urgent that you seek out high quality treatment and a proper diagnosis. An expert should be able to prioritize the issues you face and lay out a comprehensive treatment plan that addresses your goals and concerns.

Final Thoughts

We are consistently shocked by the amount of people we see who tell us that the doctors they’ve previously been treated by have given them diagnoses such as “bursitis” (inflammation of the padding of the shoulder joint), “scoliosis” (a curved spine) and the real kicker, “shoulder pain”! Here's a quick PSA for anyone who has been given these or similar explanations for their pain from medical professionals: THESE ARE NOT TRUE DIAGNOSES - they are symptoms. Unless your doctor can tell you exactly where and what is causing your pain, they have not properly diagnosed you.

If you've gotten unsatisfactory explanations about the source of your pain from three or more other doctors and have all but given up hope for a pain-free future, we can help you. The likely answer is that your diagnosis is adhesion, and we have the tools (and the hands) to address it once and for all. Give us a call at 347 841 6076 to schedule your evaluation and get on the road to a pain-free life today.