Differential Diagnosis for Pain Beneath Scapula
- Single Most Likely Diagnosis
- Musculoskeletal strain or sprain: This is often the most common cause of pain beneath the scapula due to overuse, poor posture, or direct trauma to the area. The pain is typically localized and may radiate to the shoulder or arm.
- Other Likely Diagnoses
- Thoracic outlet syndrome: Compression of the nerves and/or blood vessels between the clavicle and first rib can cause pain beneath the scapula, along with numbness, tingling, and weakness in the arm.
- Costochondritis or Tietze's syndrome: Inflammation of the cartilage that connects the ribs to the sternum can cause sharp pains in the chest and back, including beneath the scapula.
- Scoliosis or kyphosis: Abnormal curvature of the spine can lead to uneven muscle strain and pain beneath the scapula.
- Pulmonary embolism (less common but can present with referred pain): Although less common, a pulmonary embolism can cause sudden, severe pain beneath the scapula, especially if it is related to a blood clot in the lungs.
- Do Not Miss Diagnoses
- Myocardial infarction (heart attack): Pain from a heart attack can radiate to the back and be felt beneath the scapula, especially in women. It is crucial to consider this diagnosis, especially in patients with risk factors for cardiovascular disease.
- Pneumothorax: A collapsed lung can cause sudden, severe pain beneath the scapula, which worsens with deep breathing.
- Esophageal rupture or perforation: Severe, sudden pain beneath the scapula can be a symptom of an esophageal rupture, which is a medical emergency.
- Aortic dissection: A tear in the aorta can cause severe, tearing pain that radiates to the back and can be felt beneath the scapula.
- Rare Diagnoses
- Pancoast tumor: A type of lung cancer located at the top of the lung can cause pain beneath the scapula due to invasion of the nearby nerves and structures.
- Osteoid osteoma or other bone tumors: Rare bone tumors can cause localized pain beneath the scapula.
- Referred pain from abdominal organs: In rare cases, pain from abdominal organs like the pancreas, gallbladder, or spleen can be referred to the back and felt beneath the scapula.