Differential Diagnosis for Scapula Pain

• Single most likely diagnosis
  • Musculoskeletal strain or overuse: This is the most common cause of scapula pain, often resulting from activities that involve repetitive movements of the shoulder or arm, such as lifting, throwing, or rowing. The strain can affect the muscles, tendons, or ligaments around the scapula.
• Other Likely diagnoses
  • Scapulothoracic bursitis: Inflammation of the bursae between the scapula and the thoracic wall can cause pain in the scapular region. This condition is often associated with repetitive movements or direct trauma to the area.
  • Subscapular bursitis: Similar to scapulothoracic bursitis, inflammation of the bursae under the scapula can lead to pain, especially with movements that involve the scapula.
  • Rotator cuff tendinitis or tear: While the rotator cuff is located around the shoulder joint, its tendons attach to the scapula. Inflammation or tears in these tendons can cause pain that radiates to the scapular area.
  • Thoracic outlet syndrome: Compression of the nerves and/or blood vessels that pass between the neck and shoulder can cause pain in the scapular region, among other symptoms.
• Do Not Miss diagnoses
  • Pulmonary embolism: Although less common, pulmonary embolism can cause referred pain to the scapula, especially if the embolism affects the upper parts of the lung. This condition is life-threatening and requires immediate medical attention.
  • Pneumonia or pleuritis: Infections or inflammation of the lung or pleura can cause pain that is felt in the scapular area, especially if the condition affects the lower parts of the lung.
  • Osteoporotic fracture: In individuals with osteoporosis, even minor trauma can cause fractures, including those of the scapula. These fractures can be painful and may not always be immediately apparent.
  • Pancoast tumor: A type of lung cancer located at the top of the lung, which can cause shoulder and scapular pain due to local invasion of the tumor into the surrounding structures.
• Rare diagnoses
  • Scapular stress fracture: Although rare, stress fractures can occur in the scapula, typically in athletes involved in sports that include repetitive throwing or overhead activities.
  • Osteoid osteoma or other bone tumors: Benign or malignant tumors of the bone can cause pain in the scapular region, depending on their location.
  • Referred pain from visceral sources: Rarely, pain from abdominal organs (like the gallbladder or pancreas) can be referred to the scapular area due to shared nerve roots.