Musculoskeletal strain: This is often the most common cause of pain near the shoulder blade due to overuse, poor posture, or direct injury to the muscles between or around the shoulder blades.

Costochondritis: Inflammation of the cartilage that connects the ribs to the breastbone can cause pain that radiates to the back and is felt near the shoulder blade.
Gallbladder disease: Gallstones or inflammation of the gallbladder can cause pain that is typically felt in the right upper abdomen but can also radiate to the back and be felt near the right shoulder blade.
Pulmonary issues (e.g., pneumonia, pleurisy): Infections or inflammation of the lung tissue or the lining around the lungs can cause sharp pain that worsens with deep breathing or coughing, sometimes felt near the shoulder blade.
Referred pain from the neck: Herniated disks, osteoarthritis, or other neck problems can cause pain that radiates down to the area between the shoulder blades.

Myocardial infarction (heart attack): Although less common, pain from a heart attack can sometimes be felt in the back and between the shoulder blades, especially in women. It's crucial to consider this diagnosis, especially in patients with risk factors.
Pulmonary embolism: A blood clot in the lungs can cause sudden, severe pain that is worse with deep breathing, which might be felt near the shoulder blade.
Aortic dissection: A tear in the aorta's inner layer can cause severe, tearing pain that can radiate to the back and be felt between the shoulder blades.

Pancreatitis: Inflammation of the pancreas can cause severe abdominal pain that radiates to the back.
Tumors (e.g., lung, pancreatic, or spinal): Although rare, tumors in various locations can cause pain near the shoulder blade, depending on their location and size.
Shingles (herpes zoster): Reactivation of the varicella-zoster virus can cause a painful rash that might be felt near the shoulder blade if the affected nerve roots are in that area.