Anatomy of Scapula,Muscles and Ligaments

scapula_final.jpg

Scapula is bone of shoulder girdle. It serves as connection between upper limb and clavicle. Its acromion process articulates with clavicle at lateral end of clavicle to form acromioclavicular joint. It also forms glenohumeral joint, popularly known as shoulder joint through its glenoid cavity with head of humerus. It has two surfaces, three borders, three angles and three processes.

The surfaces

  1. The costal surface ( that abuts thorax) is concave and is directed medially and forwards. It is marked by three longitudinal ridges. Another thick ridge adjoins the lateral border. This part of the bone is almost rod like: it acts as a lever for the action of the serratus anterior in overhead abduction of the arm.
  2. The dorsal ( that can be palpated from back) surface gives attachment to the spine of the scapula which divides the surface into a smaller supraspinous fossa and a larger infraspinous fossa. The two fossae are connected by the spinoglenoid notch, situated lateral to the root of the spine.

scapula3.pngThe borders

  1. The superior border is thin and short. Near the root of the coracoids process it presents the suprascapular notch.
  2. The lateral border is thick. At the upper end it presents the infraglenoid tubercle.
  3. The medial border is thin. It extends from the superior angle to the inferior angle.

The angles

  1. The superior angle is covered by the trapezius.
  2. The inferior angle is covered by the latissimus dorsi. It moves forward round the chest when the arm is abducted.
  3. The lateral (or glenoid) angle is broad and bears the glenoid cavity (or fossa) which is directed forwards, laterally and slightly upwards.

The processes

  1. The spine (or spinous process) is triangular plate of bone with three borders and 2 surfaces. It divides the dorsal surface of the scapula into the supraspinous and infraspinous fossae. Its posterior border is called the crest of the spine. The crest has upper and lower lips.
  2. The acromion has two borders, medial and lateral; two surfaces, superior and inferior, and a facet for the clavicle.
  3. The coracoids process is directed forwards and slightly laterally.

Determination of the side

  1. The lateral (glenoid) angle is large and bears the glenoid cavity.
  2. The dorsal surface is convex and is divided by the triangular spine into the supraspinous and infraspinous fossae. The costal surface is concave to fit on the convex chest wall.
  3. The lateral thickest border runs from teh glenoid cavity above to the inferior angle below.

Scapula is usually fractured in trauma around shoulder. Usually it responds very well to conservative mode of treatments.

 

Various muscles and ligaments attach on scapula that are used to stabilize and move the bone. Movement of scapula helps in movements of shoulder joint.

scapula_attach.jpg

Muscles

  1. The subscapularis arises from the medial two thirds of the subscapular fossa.
  2. The serratus anterior is inserted along the medial border of the costal surface-one digitations to the superior angle, two digitations to the medial border, and five digitations to the inferior angle.
  3. The supraspinatus arises from the medial two thirds of the supraspinous fossa (including the upper surface of the spine).
  4. The infraspinatus arises from the medial two thirds of the infraspinous fossa (including the lower surface of the spine).
  5. The deltoid arises from the lower border of the crest of the spine and from the lateral border of the acromion.
  6. The trapezius is inserted into the upper border of the crest of the spine and into the medial border of the acromion.
  7. The long head of the biceps arises from the supraglenoid tubercle; and the short head from the lateral part of the tip of the coracoid process.
  8. The coracobrachialis arises from the medial part of the tip of the coracoid process.
  9. The pectoralis minor is inserted into the medial border and superior surface of the coracoid process.
  10. The long head of the triceps arises from the infraglenoid tubercle.
  11. The teres minor arises from the upper two thirds of the rough strip on the dorsal surface along the lateral border.
  12. The teres major arises from the lower one third of the rough strip on the lateral aspect of the lateral border.
  13. The levator scapulae is inserted along the dorsal aspect of the media border, from the superior angle up to the root of the spine.
  14. The rhomboideus minor is inserted into the medial border (dorsal aspect) opposite the root of the spine.
  15. The rhomboideus major is inserted into the medial border (dorsal aspect) between the root of the spine and the inferior angle.
  16. The inferior belly of the omohyoid arises from the upper border near the suprascapular notch.

Ligaments

  1. The margin of the glenoid cavity gives attachment to the capsule of the shoulder joint and to the glenoid labrum.
  2. The margin of the facet on the medial aspect of the acromion gives attachment to the capsule of the acromioclavicular joint.
  3. The coracoacromial ligament is attached
    1. To the lateral border of the coracoid process, and
    2. To the medial side of the tip of the acromion process.
  4. The coracohumeral ligament is attached to the root of the coracoid process.
  5. The coracoclavicular ligament is attached to the coracoid process: the trapezoid part on the superior aspect, and the conoid part near the root.
  6. The suprascapular ligament bridges across the suprascapular notch and converts it into a foramen which transmits the suprascapular nerve. The suprascapular vessels lie above the ligament.
  7. The spinoglenoid ligament bridges the spino-glenoid notch. The suprascapular vessels and nerve pass deep to it.

Clinical Features

  1. Paralysis of the serratus anterior cause ‘winging’ of the scapula. The medial border of the bone becomes unduly prominent, and the arm cannot be abducted.
  2. In a developmental anomaly called scaphoid scapula, the medial border is concave.

Text adapted from: Human Anatomy by BD Chaurasia

Image Credit: Wikipedia

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Comments

  1. Brian says

    My girlfriend experiences back pain which is really pain in her shoulder blade. When I massage her back and loosen her up from a day of tension, I crack joins along the edge of her left (looking at her back) shoulder blade toward her spine. She says this feels incredibly good and makes pain and burning feeling go away for hours, sometimes days.

    I am not craking her back, which I do by stepping on her back in certain places.

    So, what is it that I am cracking that gives heer so much releif? keep in mind she is very large busted which I amsure is part of the reason for some of her pain, but she experiences no pain with her right shoulder blade at all, zip, zilch, zero, none.

  2. Dr Arun Pal Singh says

    Brian,

    Most of the back pains originate in spine and could be unilaeral ( On one side only) in regions around the spine.

    From your description also, it appears that the pain is originating from spine.

    The crackling sound that comes originates from structures around the joints. In some people cracking provides relaxation.

    A bad posture might be contributing to the pain and if that is the case posture correction would help her.

    You might want to consult a physician and a physiotherapist if it persists.

  3. Bee Cem says

    My mum has been experiencing SEVERE EXCRUDIATING PAIN in her right upper back on the boney part, she saids its the bone part running all the way down her arm on that side too. We went to the hospital and tests were taken all back ok including bllod tests, chest x ray, heart tests etc. Even though pain killers were given these are not really helping as the pain is still persistant.

    Please help

  4. Dr Arun Pal Singh says

    Bee Cem,

    You need to provide me with more information

    Age of your mother?

    Any numbness in the hands?

    Is pain in the neck or below neck?

    Is it in the midline of back or somewhere else?

    Please let me know these details so that I can make a picture.

    Thanks,

    Arun Pal singh

  5. D.J. says

    Back in May of 2008, I carried a large amount of weight (close to 50 lbs.) over a mile. Since then, I have had a persistent back pain right around my right shoulder. Some days are worse than others, but the pain persists. I am getting to where it is hard to sleep at night. I didn't feel anything tear, but even the simplest of movements does cause some pain. I am a large male (300+ and 6'3") that works outside a lot with no abnormal medical history. I hurt my lower back in 1994 lifting and dragging a 400 lb. tree and hurt my leg (psyatic [SP] nerve) around that time. Any suggestions as for treatment (other than quit lifting large amounts of weight)?

  6. Dr Arun Pal Singh says

    DJ,

    If one has persistent back problems he/she is always advised to avoid lifting of heavy weights as it stresses the spine further.

    I would advice you to see a physician so that your problem can be investigated and diagnosis could be reached at.

  7. ramesh m gal says

    my son who has recently started playing tenis has overstreched his

    back , & as per doctor he has slight crack in lingament at bottom.

    he has suggested bed rest for one week & has given injection of

    depapred with lingocaine . what is this chemical name of depa

    pred? kindly advise if above is ok.

  8. Dr Arun Pal Singh says

    METHYLPREDNISOLONE ACETATE is the name of the drug you mentioned. It is prescribed quite commonly for pains in muscles and ligaments and inflammation of soft tissues.

    The treatment seems fine. But rest is very important.

    Take care.

  9. Joyce says

    I have been having pain in the area of my left scapula toward the spine side. The massage and adjustment my chiropractor provided has helped a lot but he said "the attachment" could be sore for several days. What attachment is he talking about?

    Thanks.

  10. Dr Arun Pal Singh says

    I am not able to make out anything from your information. I think you can better clarify it with your chiropractor.

  11. Tom E. says

    I injured my upperback weightlifting over a month ago. The pain was on my right scapula area. I was unable to turn laterally without pain and discomfort. So I took a week and a half off of all exercise, resting my back, icing it, and taking NSAID's.

    After that week or so the pain became less specific and I began to experience bad back spasms further limiting my movement: muscle guarding. I lost the locality of the injury.

    So I then began stretching, getting massages, and anything else I thought to break the back spasm cycle. And now that I have somewhat resolved the spasms the specific point pain on the outside of my right scapula is more prevalent. I feel like it has to be some kind of ligament damage, and unfortunately I have a plate in my ankle so MRI's are out of the question. Any suggestions?

    Thanks.

  12. Dr Arun Pal Singh says

    Is there any tender spot or a point which is painful to touch.

    Did you consult a physician?

    Can you provide me more information on nature of pain.

  13. D flint says

    I landed on my right shoulder when was snow boarding. It was very painful. I had an x-ray at the local emergency room. I was informed that it was an AC separation. Which was pointed out to me on the film. They gave me a soft brace that pulls my shoulders back and an arm sling to stabilize my shoulder . It has been about 36 hours. I have not yet made an appointment with an orthopedic doctor and I was wonder if I still should. Everything I read tells me not much can be done. If I don't go to the Doctor. Then how long should I wear the harness and what is the recovery time that I should expect? I have planned a ski trip mid February will I be recovered enough and is there anything I can do to speed up the process?

  14. Dr Arun Pal Singh says

    D Flint,

    You should see an orthopedician. AC separation is very much treatable and treatment depends on the severity of injury.

    You can consult with your doctor and plan your treatment. He/she would be better able to guide you about the course and outcome.

    I hope that helps.

  15. Odelia Ramon says

    My back just started feeling a burning sensation mostly on my upper right hand side shoulder blade area…i have been testing myself to pin point why this happens. So, what i have observed of myself is that when i am sitting down at school, or my computer and have snug pants on, thats when my upper right hand side part of my back starts with this burning sensation which is awful. My left side is mild hardly there its the right side thats having the FUN… Any advise would be helpful. I am 37 year old Female…I am a mother of 5 children… ages 19, 17, 15, 9, & 4…..So, this just started early this month….Maybe my pants are puncturing my stomach or gallbladder or who knows i have heard soooo much i should go to the doctor but am worried. Much thanks for your time…

  16. Kiran says

    Hello Dr.Arun,

    For the past 2 months I have been observing a tingling or burning sensation in my back—on the left side of the spine below the shoulder bone.It's not there all the time but it comes and goes.Sometimes I can feel the burning sensation more and rest of the times it is not noticable.I am a 33yr old female.I can't find any reason for this to happen.It just happened all of a sudden.

    Can you please let me know the reason for this burning sensation.It has been bothering me a lot and have been very stressed and worried to see a doctor wondering what they would predict of it.So please let me know what could be the reason.

    Thanks.

  17. Dr Arun Pal Singh says

    Kiran,

    Most likely, it is a symptom originating from spinal nerve root. There could be many reasons for it including wrong posture as most common cause.

    If you have continued problem, you should see a physician so that you could be investigated and cause may be found.

    I hope that helps.

  18. Shane says

    I began to have neck stiffness with flexion without any infectious symptoms (fever, Headaches). Over the past two week my pain localizes medial of my left scapula, worsened withneck flexion/lateral rotation. Xrays of my thoracic spine were completely normal. However, I continue to have pain in that region on NSAIDs. I have had no trauma or any events that started the pain. No numbness or tingling down my arms. No deformity noted on exam or pain with touch/deep pressure.

    Interestingly my pain worsens at night ?due to positioning or NSAIDs wearing off.

    Thanks

    Shane

  19. Dr Arun Pal Singh says

    Have you got your neck examined for cervical spine especially lower vertebrae of C spine. There are symptoms in the neck also and I think both scapular pain and neck symptoms could be related.

    You can add NSAIDs in the night also for the night relief.

    You seem to understand medical terminology {As it appears from your query writing}.

    What do you do?

  20. ati says

    hi dr arun i study medcine in colege im iranian and want to help me plz can u say to me that how can remember condition of muscel and artery nd nerv for always?when i read them after somtimes i forget som them can u send me som pictures for exampl the picture of upper limb with muscele and artery and varies and nerv together in one picture

    • Dr Arun Pal Singh says

      Ati,

      Do not get discouraged. That is the usual thing that happens. Everybody forgets. As you read, remember and apply your knowledge, you would start storing the data.

      Try to make associations and develop our own methods to remember the things.
      All the best

  21. margaret says

    I was scooping out very hardened ice cream with left hand (am left-handed) and felt a discint snap behind my left scapular. Since then whenever I use my hand alot( i.e. scrubbing the counter, even writing alot ) I get pain under my left scapular area that goes up the neck muscle into my back of left head, temple and even face. I get horrible headaches. What do you think happened when I was scooping out the hard ice cream?

  22. Dr Arun Pal Singh says

    Maragret,

    Have you got yourself checked for cervical spondylosis. Your symptoms have some of feaures that suggest this. A simple xray of neck would help in diagnosis.

    The only point against is that the pain comes on use of limb and goes to face etc.

    It does not seem to be a result of what happened when you scooped your ice cream. At the most you might have had a sprain but that would not cause such symptoms over widespread area.

    I would advise you to get yourself examined.

  23. stephanie says

    I am a 23 year old mother of one. I have had severe pain under my left scapula for about 6 years. I have seen a few different doctors and they all say its just muscle spasms. I havent been able to get x-rays or anything as I do not have health insurance. It seems to be the worst when the weather changes or when it rains. But the pain can be unbearable. I have tried exercising it and stretching it, it doesnt get any better. My mother had degenerative disc disease and had a few back surgeries. She has had slipped and herniated discs. This is the same for two of my aunts also. I was wondering if this could be hereditary and if my shoulder pain could be deferred pain from my spine. I have tried muscle relaxers and pain killers. Nothing seems to work. Am I destined to have back surgery along with the rest of the women in my family?

  24. Dr Arun Pal Singh says

    Stephanie,

    Heredity factor in disc diseases is not proven yet. I cannot comment upon destinies but i would suggest you to seek an opinion from a physician. Pain in scapular area generally originates from spine. Pain killers, muscle relaxants and physiotherapy are general modes of treatment.

    Xrays and MRI are needed to rule out any major pathology. These are the basic investigations which needed to be done in these cases.

    I am not sure how does health system work in your country but I sincerely suggest you to see a physician.

  25. amanda says

    The muscle that runs along the left side of my spne is swollen and hurts very bad. the pain never goes away, just gets worse and better. it has been like this for a year and a half but no docters have told me what it is? im 16 and i dont feel i should go through back troube at this age. oh, its about in the middle area of my torso right along the left side of my spine, and there is not a problem with my bones, i've had many x rays, and physical therapy does nothing. plaesa help me out … :] thank you

    • Dr Arun Pal Singh says

      Amanda,
      I am not able to make anything out of info provided by you. Would you please elaborate and mail the xrays.

      You can get the email from contact us page.

  26. Maria says

    I have had pain in my right shoulder blade for about 2 years. I have gone to a chiropractor and had physical therapy. All they say is that I have tight ribs. It helped slightly but now that I haven't done it in a little while it hurts even worse. The pain goes from right underneath the shoulder blade and up and over my right shoulder all the way down my arm and it has been constant. I stapled something at work yesterday and had a sharp shooting pain in my pinky all the way up my arm. I think I need a can of some sort, but am not sure where to go next. Do you recommend a specific type of doctor/test. Thanks

    • Dr Arun Pal Singh says

      @Maria,

      Your pain seems to be originating from your cervical spine. It might either be due to cervical spine itself or cervical rib.

      Consult a physician who deals in orthopedic disorders or spine disorders.

      Shooting pain that traverses whole of upper limb would almost always come from cervical spine.

      I hope that helps.

  27. R. Smith says

    I have has pain in the left scapular region since April of this year (2009). I started working out doors driving cars and developed this pain. It gets worse when pressure is applied, i.e. putting on a seat belt, and at night. To alleviate the pain I take multiple showers at night and have learned how to sleep sitting on the floor with my head in a dinning chair. If I lay in bed then invariably I will be up multiple times and taking a shower.

    The pain is not constant and comes and goes, however when I do have this pain it is like a band that goes around my left shoulder (including upper arm) and it is hard to breathe. I do not have insurance so even seeing a doctor is hard and has to be saved for.

    Can you help me?

    • Dr Arun Pal Singh says

      @R. Smith,

      From your description it seems that you have might have a fibromyalgia in the involved area.

      However, it is necessary to visit a doctor to get diagnosed and treated. This unfortunately cannot be done here.

      With the kind of discomfort you have, I think you should find a way to see a doctor.

      All the best.

  28. Karen says

    I had shoulder surgery for impingement since then my left dominate arm doesn't work well.

    Prior to that I had herniated disc in neck and back from a car accident. When the Dr. did my shoulder surgery he said that he lifted up my scapula and shaved a BIG spur under it in which it dug into my trap muscle. The Dr. said that he didn't think it was torn that it was just inflamed. This was on 05 and all I did yesterday was get my hair done and lifted my arm just to dry my hair. I have only had two hrs of sleep, I can't move my neck use my arm and the whole shoulder girdle HURTS! I also just had an Xray of my ankle because it wants to go out on me it is also on my left side but it came back normal. So what is going on I can't take this PAIN!!!

    Can you please help? I want to call 911 but I know that I will lay in ER for ten hrs. before I get seen….

    Help!

    • Dr Arun Pal Singh says

      @Karen,

      Even with all my best wishes,sincerity and earnest will to help, I cannot be a substitute to a physician who can see and examine you.

      If you are in that much pain, you must visit your nearest doctor.

      This website or I cannot prescribe a treatment because patient is not talked to and examined and that is a necessary part of patient evaluation.

      I understand one does not like waiting but certain things are not in our hand.

      Take care.

  29. udit says

    dr. i just wanted to know the developmental relationship between serratus anterior and scapula?
    is there any connection due to which serratus anterior being attached to the axillary border makes the lateral border much thicker than the axillary border..????

    • Dr Arun Pal Singh says

      @udit,

      What do yu want to know exactly and why? Is it in relation to some p[roblem or it is an academic question?

  30. Sarah says

    I have a constant burning sensation in the middle of my back between my shoulder blades, mainly on my right hand side, i have been to see a specialist who used to crack my spine as it was curved to the left between my shoulder blades and the muscle on the right handside was being constantly pulled, the problem has recently come back but am not sure what else to do, my treatment was discontinued due to them not being able to do anything more, i use a pc for at least 7 hrs per day and i am right handed so mainly use my mouse with the my righthand. Is there anything u can suggest?

    • Dr Arun Pal Singh says

      @Sarah,

      Have you consulted a doctor who specializes in spine. if not please do.

      Take frequent breaks when you work on computer.

      But get your diagnosis made first. See a specialist around you.

  31. Karen says

    I posted a comment on here a about 15 days ago and, I did go to the DR. I was the one in PAIN when all I did was blow dry my hair that day…When I saw the Dr. he did examine me and he told me that I had sprained my neck, shoulder and upper back…so can pain in your shoulder girdle be a result like that?

    Like I had said before alone with the shoulder surgery that went bad I do have herniated disc in the neck and low back…So how can a dr tell if some thing is sprained??

    • Dr Arun Pal Singh says

      @Karen,
      A pain radiating girdle is more of neuralgic in nature and less likely to be due to sprain.

      Did you consult a specialist?

  32. Liane says

    Hello… I am a massage therapist and i woke up this morning with pain and numbness in the index finger and middle finger (digits only). Throughout the day, i noticed that the numbness would come and go. Then, i found a trigger point on my forearm that radiates pain to my whole hand.. particularly my pinky and my ring finger on the left side. I had my co-worker run a hot stone on my arm to penetrate into that muscle. It seems like it is getting worse… the numbness is persistent. Also, my scapula, from my trapezius down to the mid-scapula towards the spine is very stiff…. you have to dig under the scapula to give it any relief. Is there any home remedies i can do for this? Also, i am worried it is the beginning stages of Carpal Tunnel… what do you think?

    • Dr Arun Pal Singh says

      @Liane,
      If there is a trigger point in forearm it is less likely to be a carpal tunnel syndrome.
      Cervical rib, thoraccic outlet syndrome, cervical spondylosis are the conditions that I would like to rule out.
      Please consult a physician.

  33. Kiran says

    Hello Dr.

    I have been suffering with pain and swelling in my left hand for th epast few months.The pain was on and off.Now for the past 1month there is pain almost everyday in the left hand near the wrist near the thumb,there seems to be a swelling in the nerve near the wrist it hurts badly sometimes and the pain passes from there to the bicep and to the shoulder and to the left side of the neck.When the pain is more the left shoulder ,neck and the wrist area hurt and also there is swelling in the bicep area.This has been going on for the past 1 month continuously.Swelling doesn't seem to go.

    PS: I use left hand more in daily household work.Recently I had an X-Ray for the spine and the doctor said the cervical spine is all fine but I do have curvature in thoracic and lumbar spine.

    Please let me know what the problem is.

    Thanks

    Kiran

    • Dr Arun Pal Singh says

      @Kiran,

      Can you please send me a picture of the swelling that also includes wrist and hand.

      Did you get xray of the wrist and hand?

      Can you send me that too.

      Use contact [at] boneandspine.com to mail these.

      Thanks

  34. Kiran says

    Hello Dr.

    This is continuation to the previous comment I wrote today.I forgot to mention that whenever I hold my kids or grocery bags with the left hand the hand hurts more and there is swelling in the arm muscles and swelling between the shoulder and neck too.Today my whole left hand from wrist to neck has been hurting ever since morning( except the palm and fingers).

    Please let me know what could be the problem.

    Thanks

    Kiran

  35. Kiran says

    Hello Dr.Arun

    I have a question regarding pain in my left hand.The pain starts from left wrist (pain originates from a nerve near the left thumb near the wrist) and passes to the flexor carpi radialis region and there is swelling in this part of the arm and moves to the shoulder joint and the shoulder .Please let me know what could be the reason for this.Whom should I consult regarding this.Most of the time the pain is near the wrist and the thumb.I feel that this pain originated first when I played a video game using a gaming remote.From then my left hand has never been the same since last 5 months.I played only a few times and now I don't play that anymore.

    I work with both the hands but use left hand a little more for the chores around the house. When I lift my kids or hold grocery bags the hand hurts more and sometimes there is swelling in the shoulder and bicep.

    PS:I posted this question 3 days back but it seems to be deleted .I am posting it again .Please let me know the reason for the pain.Recently I had an X-Ray for the spine and the doctor says the cervical spine is all fine but there is slight curvature in my thoracic spine and lumbar spine.

    Thanks

    Kiran

    • Dr Arun Pal Singh says

      @Kiran,

      I did reply to your previous query. From your description of hand symptoms, it seems that you have problem in the hand/ wrist region but that should not cause pain in the neck/shoulder region.

      That is one aspect I am not able to fit into the picture.

      Pain in shoulder /neck region can originate in the spine or shoulder.

      You would be best served by a doctor who can examine you and then investigate you accordingly.

      There are plenty of conditions that can cause these kind of symptoms and I do not want to cause you undue anxiety by providing a list.

      Please visit an orthopedician and get yourself examined.

      If you want some information on anything, please let me know.

      I hope that helps.

  36. Tami says

    I am a college-level thrower (discus/hammer/shotput). I have pain along the vertebral border of my right scapula. It is alleviated to a degree with massaging of the area, yet during this massaging pain radiates down my right arm/hand and up my neck into the right temple. I was told at one point by my trainer that this might be a problem with the labrum. I did some execises with elastic bands, but really got no relief. Any suggestions?

    • Dr Arun Pal Singh says

      @Tami,
      Radiating pain is less likely from labrum and more from spine.

      Please get yourself examined by a physician.

  37. G Chancey says

    Dr Arun Pal Singh

    First I want to say how wonderful it is for you to take time out of your busy schedule to answer peoples questions. And I can also see how some folks may come across short with you and not apreciative of what you're doing. Speaking from my own experience, our back pain issues make us get to becaome short at times. Please know that I do appreciate your involement in this blog and please be assured that you are building your treasures in heaven!!

    With that said, I can relate to your August 13th inquiry from a Smith. I took the liberty to paste his question in as follows:

    "I have has pain in the left scapular region since April of this year (2009). I started working out doors driving cars and developed this pain. It gets worse when pressure is applied, i.e. putting on a seat belt, and at night. To alleviate the pain I take multiple showers at night and have learned how to sleep sitting on the floor with my head in a dinning chair. If I lay in bed then invariably I will be up multiple times and taking a shower.

    The pain is not constant and comes and goes, however when I do have this pain it is like a band that goes around my left shoulder (including upper arm) and it is hard to breathe. I do not have insurance so even seeing a doctor is hard and has to be saved for.

    Can you help me?"

    You replied that it could be fibromyalgia.

    In my case, my PCP has had me go thru all the MRI's and Cat Scans and specialist and is now of the opinion that Cymbalta may take care of it. I tried it for about a week and felt like crap! He told me that I had to give it 4 to 6 weeks. That was about a month ago and I am trying a vitamin and supplement approach of magnesium and others but it hasn't helped yet. My niece is suggesting yoga now. I have always felt that it's something from my football days that is only now creating problems. Should I give the Cymbalta one more chance before I try something way out there in left field? I guess that if Cymbalta were to work (which I read that they really don't know why it works for fibromyalgia), will I have to take it for the rest of my life – I'm a relatively healthy 57 year old male. And fibromyalgia seems to affect females more??

    • Dr Arun Pal Singh says

      @G Chancey,

      Would you please describe your symptoms. Relating your condition to others would introduce bias in my observation.

      Please let me know.

      And thanks for the appreciation.

  38. G Chancey says

    Dr Arun Pal Singh,

    It's me again. I'm trying to visuals the diagram of the Left Scapula on your web site and am I not mistaken to believe that the diagram is actually showing the Right Scapula's dorsal and costal views?

  39. G Chancey says

    Dr Arun Pal Singh,

    My apologies – I just got back from my doctor's office and he explained how it is the Left Scapula view. He also explained he wasn't treating me for fibromyalgia but for some muscle thing with the cymbalta. He's ruled out that it's a vertabre nerve issue and wants me to try physical therapy. My wife is upset that I didn't ask him to give me a referal to a neurologist. (her doctor recommended one). I tried to explain that all the mri's and cat scans have ruled out a nerve related diaognysis (sp) but she thinks he's wronged and that it still should be looked at by a neurologist. Can you possibly help in this argument?

    Gordon

  40. Jay says

    I have had pain in the back of my left shoulder for over a year-and-half now. The pain is generally in the scapula area, and looking at the diagram of the scapula bone, I can tell that it is along the medial border of the bone, more towards the top, pointed area. I have had an MRI of the upper spine taken, physcial theray (twice in the past year-and-half), and two different EMG tests, all negative.

    When I press the area of the back where the top pointed part of the scapula would be, it feels painful and sore somedays. I also feel cramping or tingling feeling in that area somedays. The pain is usually constant throughout the day.

    Not sure whom to go to now, since I seem to have run out of options.

  41. S.D. Owens says

    Hello, I am a 35 years old female, weigh approx. 113 lbs and work as a RN in a small but busy hospital. I am very right handed. For the last year I have had this burning sensation in my left scapula area. At one point about 18 months ago I went to the orthoMD and was diagnosed with carpal tunnel in my left hand (my thumb, pointer and middle finger on that hand went numb). I wear a brace at night now but only when I feel my hand is getting worse. It hasn't given me any problems in a long while, around 8 months. My shoulder on the other hand, kills me at times. I know that when I get stressed out at work or when I am tired, it hurts a lot more . It isn't really a "pain" feeling, it actually BURNS like someone is sticking me with a hot, sharp instrument. The burning sensation starts in one spot and spreads over my whole scapula. The muscle over my left scapula gets very tight and a knot comes up over the area where it burns. I feel that if someone would just hit me in the middle of the back with their fist that it would make the burning go away for a while. I don't know if this matters or not but my elbows, both of them have also started to bother me, but I pick up things a lot heavier than I am and I think that is what it wrong with my elbows. Any suggestions for this scapula issue would be great.

    Thank You,

    S.D. Owens

    • Dr Arun Pal Singh says

      @S.D. Owens,
      What you describe seems like a trigger point. It is a kind of hyperirritable spot in skeletal muscle that are associated with palpable nodules in taut bands of muscle fibers.

      Massage, Local heat, Ultrasonics and steroid injections are commonly used treatments for these and they usually respond well.

      You can talk to your doctor for diagnosis confirmation and treatment.

      If your Carpal tunnel syndrome is not getting better with conservative treatment, surgery may be considered.

      I hope that helps.

  42. neybi says

    i am a medical student n my boyfriend is having pain in medial side of scapular region only in sitting position.he feels this pain while sitting and studying and using laptops.he is now 21 yrs old..and he had experienced this same problem when he 17 yrs.please help..his exam is knocking at the door..but he cant study because of this problem.i would be really thankful sir if u reply my mail.

    • Dr Arun Pal Singh says

      @neybi,

      I would advise you take him to a physicians. I can provide the info but I do not make diagnoses because that involves examining of the patient.

  43. Jess says

    Hi,

    I am a 32 yo female w/ overall excellent health and habits. Over a year ago, my right scapula area started bothering me after a night of weight training. Over time, this has changed from a subtle constant spasm sensation to a very uncomfortable, nearly constant pain, which gets worse while sitting. My PT diagnosed me with a C7/C8 herniated disc, and noted that my right scapula did look rotated forward a little (causing it to stick out some in the back). So far, the PT exercises have made it much worse, including cervical traction. Currently, I have a almost grinding pain in my rt scapula, and when ever I pull my shoulder blades back, the right side of my back cracks. Sometimes, it feels like a slight clicking when I breathe as well. My neck has gotten stiffer as well, but this is a more recent symptom. Overall, my condition is only mildly responsive to NSAIDs. I am pushing my doctor for an MRI and just started taking Vicodin for pain because I can't sleep without it or a sleep aid (due to pain). Is there a chance this isn't a cervical herniation? Does it sound like anything else to you? Any feedback would be highly appreciated. I understand you cannot offer a diagnosis. I am just curious if you have any other ideas.

    • Dr Arun Pal Singh says

      @Jess,

      This appears to be a neuralgic pain of whatsoever cause and herniation of disc is one of them.

      I see that you are still to undergo MRI.

      How were you then diagnosed as case of disc herniation?

      The best way to approach this problem is to get examined and investigated.

  44. Rosemarie says

    Hello Doc! I am a 40 yr old female with pain in L)scapula region to my spine. This pain has been constant since an injury accident december 27 2005 while i was responding to an injury accident on the expressway. my apparatus was at a complete stop with a SUV stopped behind me. Impact came from small pickup truck going about 75mph with no application of brakes on his part at all as he was entranced by the first accident and never saw us.

    I saw the first impact w/ the SUV and stretched across the cabin to push my unrestrained fwd-sitting partner talking on the radio backwards into her seat when we were struck and pushed 130 ft along with the suv. Both arms were reaching across-starting with my R)arm in anatomical postition but then i had my upper torso twisted facing to the right and my left arm extended w/ palm facing towards her as i attempted to push her backwards in her seat. My cervical neck twisted to the left as looking out at the driver side mirror. not a great positioning for impact.

    I faired well tho and with adrenaline was able to get out from the rig and provide medical assistance to the patients in the suv until my pain started catching up with me.

    Because of workman's comp, my dx and treatment has been slow coming. Initially I was treated for sprains of affected areas…then it was found that i ruptured L5-s1.

    Because I was having consistent chest, L) arm, back pain a year later i followed up with a cardiac specialist…after a complete cardiac workup including a cardiac cath that my cardiologist said was negative of anyting lol…he referred me back to my orthopedic doctor for thoracic followup. a MRI was done and showed bulging discs at c6-c7 and i do not have my mri w/ me as i write this but i believe T2-3 ; T5-6; and T7-8. This was found in the past year –along with degenerative disc disease. And I jsut realized writing this, it won't be much help with out the mri to tell you about anything significant with these discs…other than telling you there wasn't any major significant pressure, tears, or impedements. lol sorry.

    but the reason i'm writing today is for a new symptom in this region. in the past 3 weeks, i have now a burning pain along with the deep sharp pain. Though I have good ROM, when i move or spread my scapulae…the feeling is like a stretch and ripping sensation….as if the bone is shredding the tissues. Very much like "synthetic spiderwebs for halloween being pulled apart and splitting open" as you stretch them across large openings. that's the best analogy for this sensation other than picturing nylons on a very obese object splitting open in runs and tears of the fabric.

    I have two more weeks until i can get in to my orthopedic doctor and would jsut like some ideas of what this could be. Apparently thoracic injuries are rare and the BWC is very obstinate of seeking diagnosis or treatment of such. But I feel that my mechanism of injury supports possible further thoracic damage…and an aging injury. Especially with constant thoracic pain lasting in this region for 3 years now. thoracic sprains do not last this long….even the bulging discs do not seem as if they could be causing these NEW symptoms. what am I missing or looking for…any plausible ideas please. I finally grew weary of the BWC and have been treating with a orthopedic specialist under my private insurance. I need to get to the bottom so that i may treat and heal. Oh, since this accident I have gained 72 lbs which i know is not helping my injuries at all but going from a high energy job as a firefighter/emt to pretty much a life of inertia comparatively…doesnt help.

    • Dr Arun Pal Singh says

      @Rosemarie,

      The pain is definitely neurological and because it is more when you move your scapulae, it goes more in favor of trigger points.

      Examine yourself or ask someone to have a look. Are the muscles in that area taut. Does palpation lead to pain and tenderness.

      If it is so you might discuss this with your doctor. Your local region and spine in any case should be evaluated to rule out any other pathology.

      I understand what you are going through and Sorry to hear all that happened.

      All the best and if you wish you can let me know what came out when you visit your doctor.

  45. Jess says

    Hi all,

    So, they finally did an MRI on my neck and up to T5 in order to diagnose the cause of ongoing scapula pain. The result of the MRI showed NO abnormalities in my neck. So, the pain is likely NOT caused by a disc herniation. Anyhow, I am writing because my physical therapist insisted that it was referred pain from my neck and was treating this through exercises and traction. I felt that the physical therapy was making it worse (especially the traction, which I guess is an odd response), which now I realize might have been the case because it wasn't a problem with my neck. Now, I am being referred to a physical med doctor. By the way, I am not sure why, but they did not image my scapula. Anyhow, the morale of my story is that you should trust yourself and advocate for yourself with your doctors. They were so convinced the pain was related to my neck, while I was not, and now I'm pretty sure that's why PT was making it worse.

    I do have some quick questions- I have some mild kyphosis. Is it possible that traction caused some strain on the muscles? I can't find any research articles to suggest that traction can be harmful, but I swear it caused me more pain and stiffness. Is traction ever contraindicated? And, could this pain be related to muscular strain related to the kyphosis? I have been working SO hard on my posture in the past year and wonder if there is some muscular imbalance.

    Thanks so much for this forum. I am finding that being an educated patient has helped me tremendously.

    • Dr Arun Pal Singh says

      @Jess,

      If traction is making your symptoms worse, it is better to discontinue it.

      No it will not cause any strain on the muscles to cause the symptoms.

      If you have kyphosis it leads to altered bimechanics and a long standing kyphosis my also be cause of pain.

  46. Helen says

    Hi Doc.

    I'm a 16-year-old girl. I was playing in a ringette (similar to ice hokey) game, and hurt what I thought was my left shoulder. It either happened when I was hit into the boards, or when another player's shoulder hit mine. I have pain around and under my left scapula, pain along my clavicle, some pain going up into my neck, and occasionaly some pain around the shoulder itself. The pain comes when there's pressure on the scapula (wearing a backpack, leaning back against a chair, etc.) and when I raise my hand above about shoulder level or lift anything with substantial weight, as well as sometimes when I'm just doing nothing!

    I went to see my doctor, who said it wasn't an AC injury. He prescribed Apo-Naproxen, 3 times a day, and sent me for x-rays. We won't get the results of the x-rays for another week. The naproxen hasn't done anything for the pain, so my pharmacist suggested Tylenol Extra-Strength between Naproxen doses, and Tylenol 1 at night. So far none of this has helped. I was hoping you could suggest something that might help with the pain, or even a CAUSE of the pain. Thank you!!

    • Dr Arun Pal Singh says

      @Helen,

      How old is the trauma? When did pain start after the trauma?

      If you touch that area, does it lead to pain?

      Does anything relieve your pain?

  47. Kyle says

    Hi Dr. Arun,

    I stumbled across this site when searching for "numb index finger and scapular pain", which is what I've got. I think I can trace it to weightlifting, probably scapular elevation exercises, and the pain is on the right side and is mostly under the top part of my scapula, extending a little into the lower neck. It especially hurts when I let my head lean backwards and I notice some relief when my head leans forward. I've had several muscle spasms in my right triceps and I've noticed numbing/tingling in my right index finger, especially at the tip.

    I'll be seeing a doctor as soon as I can get an appointment, but any help in the meantime is appreciated.

    • Dr Arun Pal Singh says

      @Kyle,

      Looks like your symptoms are originating from cervical spine.

      Stop heavy weights if you are still doing them and take frequent breaks from your work if it causes a strain on your neck.

      And do see a physician to get yourself examined.

  48. Imtiyaz says

    Doctor,

    I have a pain and numbness in my both (left and right)scapular region. Pain radiates through chest and it gives me tingling sensation in my left ring and last finger and shortness of breadth and one side nasal congestion. this really frighten me. Firstly i thought it would be angina so I went down for ekg, stress and lipid profile test, but it came normal. This is going from last 2 years. It started after I had an accident, but at that moment there was no pain in that region only my ligaments were teared off. I am 34 male, Married. weight 84 kg and 5.5 inch tall.

    Imtiyaz

    • Dr Arun Pal Singh says

      @Imtiyaz,

      Have you get yourself checked up for this.

      The symptoms may come from lower cervical spine and I think you should get yourself examined for that.

  49. Janq says

    Dr. Arun,

    I've been having shoulder pain that originates in the front of the arm near the armpit. When I move my arm above my head or forward as when placing my hands on the automobile steering wheel or reaching forward on the computer keyboard and then move it back to its normal place I hear a "snapping" sound almost the sound of an elastic band being snapped. The pain is very strong and once the "snap" is made the pain subsides. I'm not sure but I'm thinking it might be a ligament or tendon, but don't know how to explain the pain and sound to my physician.

    Thank you for your input.

  50. Janq says

    I thought of that. However, this sound is "loud" to me, but I'm not sure that it is loud enough to be heard by the doctor. Besides that I'm not sure it could be reproduced as it doesn't happen each time I move my arm. Could this be arthritis, or might it be something else?

    Thank you.

    • Dr Arun Pal Singh says

      @Janq,

      If it is so infrequent, stays like this and does not worsen over the time, I think it should not be cause for concern.

  51. eric says

    Hi Dr Singh,

    I tore all three ligaments off my left collar bone about 2 yrs ago. I go rock climbing regularly now and my chest is building non symetrically. On the left side where I did the damage my chest is larger than on the right. Can u recommend what exercises I need to do to even out. Thanks

    • Dr Arun Pal Singh says

      @eric,

      Did you see a doctor and got checked for ligamentous insufficiency?

      Get examined to know if surgery would help you or exercises would surfice!

  52. Mike says

    my thoracic spine was locked up for several years causing me severe chronic pain in the mid right back. A therapist finally suggested using a thoracic wedge to loosen in up. This did start to give me some relief but it never stayed mobilized for more than a couple of days. He finally determined and upon evaluation found my entire right shoulder to be out of wack. After attempting PT my entire shoulder MOSTLY the shoulder blade responded in severe pain especially the top and inside alongside spine.Any Idea what could be wrong with my shoulder blade that would cause so much pain?

    • Dr Arun Pal Singh says

      @Mike,

      Did you visit a qualified doctor. What you tell me does not translate into any meaningful conclusion.

      You must get a check up for thoraccic spine and associated region.

  53. Josh says

    Hi Doc,

    I have damaged my Right AC joint whilst skiing in January and am still having pain and 'crunching' sensations with movement. What process would be most effective for relieving the pain and stop the crunching?

    Also, what is the muscle that is located under the Scapula as both my shoulder blades are winging. I am currently doing exercises for my Serratus Anterior, but are there any more for this unknown muscle?

    Many thanks.

    • Dr Arun Pal Singh says

      @Josh,

      What was the damage?

      Dislocation? Subluxation?
      Also why do your shoulders wing? They should not unless you have weakness of your serratus anterior muscle.

      if you do have SA weakness, what is the reason for that?

  54. S. says

    Hello! doctor

    I am generally a healthy person but i feel weak in all my joints. i do not exercise. Would walking help? or what kind of exercise would you suggest to strengthen my joints?

  55. Dilawar says

    my mom often face unbearable pain in her muscles of chest (from back side of sholders) due to which she is finding it difficult to talk & breath. exrays of her chest doesn't show any problem.

    also at times she faces a problem of digestion. her stomach doesn't pass stool for days sometimes even more than week. and yet she seems normal when her stomach is not passing stool.

    now shes in pain in her chest from back side of sholders and in between sholders)..what should i do???

  56. Jackie says

    Dr Arun,

    About 6 months ago I had this pain in my back "just" beneath the wing bone or scapula as I believe it is called. It is a small spot, but radiates out to about 4-5 inches. It will start real slow and then build up sudden intensify in just a few seconds. This will last a few seconds. Then after a few seconds starts again. Sometimes this will go on for a few minutes, to several minutes. If I put pressure between the rib it alleviates it for awhile or if I sit with a heating pad it helps.

    It came back again a few weeks ago and when I have it it will last a couple of weeks. It went away again after a couple of weeks and now is back again.

    I am not sure if I need an internist or should I see another specialist for this? I would appreciate any suggestion you have. I don't know if I lifted anything very heavy. I am 64 yrs old and a very active person.

    If I take an Alieve it doesn't work, but the heating pad will help some while I am sitting with it on.

    Thank you

    @Jackie

    • Dr Arun Pal Singh says

      @Jackie,

      What you describe seems like a Trigger spot or Fibromyalgia.

      Please see your doctor. I am not sure how does your health care system work but you can begin by consulting primary health care physician.

      Take care.

  57. Ginalee says

    I have been having pain in my head face around shoulder blade and down arm all on my left side for a year now. I have had mri and ct of head mri of neck and thoracic spin…only showed minor things that the neurologist thought nothing of..my chiropractor and massage therapist both said that my left shoulder blade is out of place. It is closer to the left side of my body than it should be..(further from my spine) i can not tell a difference except for the pain that is around it and down my arm. I am wondering can it all be related..the head pain is always in same spot the face pain seems to be around the maxillary nerve in my face and the left side of my neck just has an uncomfortable feeling in it at all times and then it goes into my shoulder blade and down the arm..can the out of place shoulder blade be causing this all? I've been searching for help for a year and have gotten no relief! this all started after i had my son 11 months ago. During delivery my nurse kept trying to get me to make my chin touch my chest and push..i had problems doing this but they insisted that i do it! and every since i came off the pain meds from having my child i have had this pain! the head pain was so bad at first i went to the er twice! Which they did mri and ct and found nothing wrong with my head….The chiro has help some but not alot..i am wondering should i try physical therapy to get the muscle to pull the shoulder blade back into place or see another neuro and get a second opinion. the first one just kept trying meds and the last one made me sick and he insisted that i keep taking it so i just stopped going to him after the scans he just stopped trying to figure out what was wrong and just kept switching medications which were mainly antidepressants which i know are used for pain but were doing nothing for me. please give my any advice you have. Thanks, Ginalee

    • Dr Arun Pal Singh says

      @Ginalee,

      From your description it seems that the pain is coming from cervical area. Please see a spine specialist to get another opinion.

      Another thing that needs to be ruled out is neuralgia which I think already must have been considered by your doctor.

      Take care.

  58. Rich says

    I broke my scapula into five pieces, due to an indirect 2 storey fall in 2000. I live with cronic pain in my T4 area as a result of this injury. Upon examination, a radiologist reported scoliosis, probably congenital; stated with ignorance of my fall.

    Given the imbalance of muscles, my left, damaged, looks like I bodybuild, my right, dominant, looks like I don't exercise at all, I believe that it is more likely that the scoliosis is caused by muscular damage. Of 28 muscles on the scapula, 18 attach to my spine, if I am correct.

    Dr Arun Pal Singh, can you elaborate on this? Can one prove scoliosis caused by trauma? Can one disprove congenital scoliosis? Is my T4-T5 connected through soft tissue to my scapula?

    Thanks in advance

    • Dr Arun Pal Singh says

      For trauma to cause any change in spine curvature, it has to cause a spinal injury. Is there any vertebral trauma associated!

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