From the Guidelines
Scapular spine pain and tenderness are commonly caused by muscle strain, inflammation, or injury to the surrounding structures, with the most frequent causes including trapezius muscle strain, rotator cuff tendinopathy, scapular dyskinesis, and myofascial pain syndrome. The causes of scapular spine pain and tenderness can be diverse, including:
- Muscle strain from poor posture or overuse
- Rotator cuff tendinopathy
- Scapular dyskinesis (abnormal movement patterns)
- Myofascial pain syndrome with trigger points
- Direct trauma
- Osteoarthritis of the acromioclavicular joint
- Referred pain from cervical spine issues
- Less commonly, bone pathologies like fractures or tumors
Treatment typically involves rest, ice for acute pain, followed by heat therapy for chronic pain, and over-the-counter anti-inflammatories like ibuprofen or naproxen for 7-10 days. Physical therapy focusing on scapular stabilization exercises and proper posture correction is often beneficial. Persistent pain lasting more than 2-3 weeks despite these measures warrants medical evaluation, as it may indicate a more serious underlying condition requiring specialized treatment, as noted in studies such as 1.
From the Research
Causes of Scapular Spine Pain and Tenderness
The causes of scapular spine pain and tenderness can be attributed to various factors, including:
- Direct or indirect trauma 2
- Overuse syndromes 2
- Glenohumeral joint dysfunction 2
- Osseous abnormalities 2
- Muscle atrophy or fibrosis 2
- Idiopathic causes 2
- Scapulothoracic bursitis and crepitus, which can be caused by inflammation of the bursae secondary to trauma or overuse 2
- Snapping scapula syndrome, a condition characterized by disruption of normal scapulothoracic articulation and inflammation of numerous soft tissue and bursal structures 3, 4, 5
- Metastatic disease, such as colon adenocarcinoma, which can cause scapular pain and tenderness due to osseous metastases 6
Specific Conditions Associated with Scapular Spine Pain and Tenderness
Some specific conditions that can cause scapular spine pain and tenderness include:
- Scapulothoracic bursitis, which refers to inflammation of the bursae secondary to trauma or overuse 2
- Scapulothoracic crepitus, which is defined by a grinding, popping, or thumping sound or sensation secondary to abnormal scapulothoracic motion 2
- Snapping scapula syndrome, which can produce significant shoulder dysfunction in many patients 4, 5
- Spinal stenosis, which can cause scapular pain and tenderness due to compression of the spinal cord or nerve roots 6
Diagnosis and Treatment
Diagnosis of scapular spine pain and tenderness typically involves a focused history and physical examination, with supplemental imaging used to assess for structural etiologies when nonoperative management fails 5. Treatment options include nonoperative management, such as scapular strengthening, postural reeducation, and core strength endurance, as well as surgical intervention, such as bursectomy, superomedial angle resection, or partial scapulectomy 2, 3, 4, 5.