What causes sharp pain near the posterior aspect of the scapula (shoulder blade)?

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Last updated: May 21, 2025View editorial policy

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Differential Diagnosis for Sharp Pain near Back of Shoulder Blade

  • Single most likely diagnosis
    • Musculoskeletal strain: This is the most likely diagnosis due to the common occurrence of muscle strains in the upper back, which can cause sharp pain near the shoulder blade. Activities such as heavy lifting, bending, or sudden movements can lead to this condition.
  • Other Likely diagnoses
    • Costochondritis: Inflammation of the cartilage that connects the ribs to the sternum can cause sharp pain that radiates to the back, including the area near the shoulder blade.
    • Thoracic outlet syndrome: Compression of the nerves or blood vessels between the collarbone and first rib can cause sharp pain in the shoulder and upper back.
    • Rib fracture: A fracture of one of the ribs can cause sharp pain near the back of the shoulder blade, especially if the fracture is in the upper ribs.
  • Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
    • Pulmonary embolism: Although less common, a pulmonary embolism can cause sudden, sharp chest pain that radiates to the back, including the area near the shoulder blade. This is a life-threatening condition that requires immediate medical attention.
    • Aortic dissection: A tear in the aorta can cause severe, sharp pain in the chest and back, which can radiate to the area near the shoulder blade. This is a medical emergency that requires prompt treatment.
    • Pneumothorax: A collapsed lung can cause sudden, sharp chest pain that radiates to the back, including the area near the shoulder blade. This is a life-threatening condition that requires immediate medical attention.
  • Rare diagnoses
    • Pancoast tumor: A rare type of lung cancer that occurs in the upper part of the lung can cause sharp pain near the back of the shoulder blade, as well as other symptoms such as arm weakness and numbness.
    • Osteoid osteoma: A rare, benign bone tumor that can occur in the ribs or spine can cause sharp pain near the back of the shoulder blade, especially at night.
    • Sickle cell disease: A genetic disorder that affects the blood can cause episodes of sharp pain, including pain near the back of the shoulder blade, due to sickling of red blood cells.

Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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