Common Causes of Right Scapula Pain
Right scapula pain is most commonly caused by rotator cuff dysfunction, scapulothoracic bursitis, and mechanical abnormalities of the scapulothoracic articulation. 1, 2
Musculoskeletal Causes
- Rotator cuff pathology: Tears, tendinopathy, or dysfunction of the rotator cuff muscles (particularly supraspinatus) can refer pain to the scapular region. Pain typically occurs during throwing motion release and deceleration phases 3
- Scapulothoracic bursitis: Inflammation of the bursa between the scapula and thoracic wall, often due to overuse or repetitive movements 1, 2
- Snapping scapula syndrome: Characterized by audible or palpable crepitus during scapular movement, caused by abnormal scapulothoracic motion 1, 4
- Scapular fractures: Can be easily missed on conventional radiography due to the complex osteology and overlying ribs. CT is the best imaging modality for identifying and characterizing scapula fracture patterns 3
- Levator scapulae syndrome: Particularly common in young females, presenting with pain over the upper medial angle of the scapula that may radiate to the neck and shoulder 5
- Scapular winging: Often misdiagnosed as other shoulder conditions, caused by dysfunction of the serratus anterior, trapezius, or rhomboid muscles 6
Neurological Causes
- Cervical radiculopathy: Nerve root compression in the cervical spine can refer pain to the scapular region 3
- Peripheral nerve disorders: Particularly long thoracic nerve palsy affecting the serratus anterior muscle 6
Traumatic Causes
- Direct trauma: Falls or impacts directly onto the shoulder can cause scapular injuries 7
- Acromioclavicular (AC) joint separation: Often from falls directly onto the point of the shoulder with the arm in an adducted position 7
- Scapula fractures: May require surgical fixation, especially when involving the glenoid neck 3
Age-Related Considerations
- Adults over 40: More likely to experience rotator cuff tears due to normal wear and tear 3
- Athletes and overhead workers: Particularly vulnerable to overuse injuries including rotator cuff tears and scapulothoracic bursitis 3, 1
- Young throwers: Predisposed to atraumatic microinstability of the glenohumeral joint and weak rotator cuff muscles 3
Diagnostic Approach
- Physical examination: Assess for focal weakness, decreased range of motion during abduction with external or internal rotation, and tenderness to palpation 3
- Imaging:
- Radiography is the initial imaging modality of choice for suspected scapular fractures 3
- CT provides better visualization of scapular fracture patterns and displacement 3
- MRI is preferred for evaluating soft tissue injuries, particularly rotator cuff pathology 3
- Ultrasound can effectively identify full-thickness rotator cuff tears in ideal conditions 3
Common Pitfalls in Diagnosis
- Scapular winging is frequently misdiagnosed as rotator cuff disorders (20%), glenohumeral instability (8%), or cervical spine disease (6%) 6
- Inadequate physical examination may miss scapular dyskinesis, which contributes to rotator cuff injury 3
- Failure to consider scapulothoracic disorders when evaluating shoulder pain can lead to unnecessary or unsuccessful surgical procedures 6, 2
Understanding these common causes of right scapula pain is essential for accurate diagnosis and appropriate management of patients presenting with this complaint.