Differential Diagnosis for Pain on Back of Scapula
Single Most Likely Diagnosis
- Musculoskeletal strain or sprain: This is the most common cause of pain in the back of the scapula, often resulting from overuse, poor posture, or direct trauma to the area. The pain can radiate down and be exacerbated by movement or certain positions, such as laying down.
Other Likely Diagnoses
- Rhomboid strain: The rhomboid muscles are located in the upper back and can cause pain in the scapular region when strained. This pain can feel like a burning sensation and may radiate down the back.
- Scapulothoracic bursitis: Inflammation of the bursae between the scapula and the thoracic wall can cause pain in the back of the scapula that may feel like fire and can be worse with movement or pressure.
- Thoracic outlet syndrome: Compression of the nerves and/or blood vessels that pass through the thoracic outlet (the space between the collarbone and first rib) can cause pain in the scapular region that radiates down the arm, along with other symptoms like numbness and tingling.
Do Not Miss Diagnoses
- Pulmonary embolism: Although less common, a pulmonary embolism can cause sudden, severe pain in the back that may radiate to the scapula, especially if the embolism is large and affects the upper lobes of the lungs. This condition is life-threatening and requires immediate medical attention.
- Pneumothorax: A collapsed lung can cause sharp, stabbing pain in the chest that may radiate to the back and scapula, worsened by deep breathing or coughing. This is a medical emergency.
- Myocardial infarction: In some cases, a heart attack can cause pain that radiates to the back, including the scapular area. This pain is often described as a pressure or squeezing sensation rather than a burning one but can vary.
Rare Diagnoses
- Tietze's syndrome: A rare condition characterized by inflammation of the cartilages and surrounding tissues of the ribs, which can cause severe pain in the chest and back that may radiate to the scapula.
- Sickle cell crisis: Individuals with sickle cell disease can experience episodes of severe pain due to vaso-occlusive crises, which can affect any part of the body, including the back and scapular region.
- Pancoast tumor: A type of lung cancer located at the top of the lung that can cause shoulder and scapular pain due to invasion of the brachial plexus and other structures. This is a rare condition but important to consider in the differential diagnosis due to its serious implications.