Pain below the right shoulder blade has many potential causes, some of which are more serious than others. They range from muscle strain to infections, fractures and tumors. See your doctor to determine the cause, especially if the pain persists, gets worse or occurs repeatedly. Treatment depends on the underlying reason for the pain.
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Muscle and Bone Pain
The most common sources of pain near the shoulder blade are the muscles and bones that lie under and around it. Muscle pain is often caused by straining during exercise or sports, although any sudden movement -- such as a cough -- may bring on the pain. This type of pain is usually worse when repeating the action that caused it. Fibromyalgia is another reason for muscle pain below the shoulder blade. This chronic condition of unknown cause typically produces pain in multiple parts of the body, as well as fatigue.
Fractures of the spine or ribs may produce pain below the shoulder blade. They are usually caused by significant trauma to the area resulting from a fall or direct blow. Rarely, muscle or bone tumors begin in the area below the shoulder blade. Tumors may also spread to muscles and bones in this area from other organs, such as the skin, breasts and lungs.
Pneumonia and blood clots in the right lung may cause pain below the shoulder blade, which usually worsens when taking deep breaths. Coughing and shortness of breath may accompany the pain in both conditions and a fever is often present with pneumonia. Lung cancer may also produce pain below the shoulder blade. This pain is generally not affected by movement and may actually be worse while resting. Unexplained weight loss and a cough are other warning signs of lung cancer. Inflammation of the membrane surrounding the lung -- called pleuritis or pleurisy -- may also cause pain below the right shoulder blade that worsens with breathing. Pleuritis is often caused by an infection.
The top of the right kidney lies near the lower tip of the right shoulder blade, so kidney pain can produce pain in this area. Kidney pain may be due to a stone, infection or tumor. Kidney stone pain is typically severe and occurs as intermittent spasms. Movement does not affect kidney stone pain. Pain from a kidney infection -- known as pyelonephritis -- is generally constant. Nausea, vomiting and a fever often accompany the pain, and urine changes, such as dark or bloody urine, may be seen as well. Kidney tumor pain is usually constant but may become more severe over time.
Pain From Abdominal Sources
The brain may interpret pain from organs in the right upper abdomen -- such as the gallbladder or liver -- as coming from the right shoulder blade area because nerves for sensation in these organs enter the spinal cord at the same level. In addition to pain, gallbladder disease often produces nausea, vomiting and intolerance of fatty foods. Tumors, cysts and infections in the liver are all possible causes of pain below the right shoulder blade. A subphrenic abscess -- localized collection of pus above the liver but below the diaphragm -- can also produce pain below the right shoulder blade. Another possible reason for pain at this location is inflammation of the head of the pancreas, the part of the pancreas located on the right side of the upper abdomen.
If you've had the chickenpox, you are at risk for developing shingles. The virus that causes chickenpox lives in your nerves and can be reactivated, causing moderate to severe pain that usually appears before the development of a typical shingles rash. Shingles can occur virtually anywhere in the body, including below and around the shoulder blade. The vaccine called Zostavax reduces your chances of getting shingles.
Reviewed by Mary D. Daley, MD.