Can shoulder blade pain radiate to the chest and down the left arm, causing pain and tingling?

Can Shoulder Blade Pain Radiate to Chest and Left Arm?

Yes, shoulder blade pain can absolutely radiate to the chest and down the left arm with pain and tingling, but this pattern demands immediate cardiac evaluation to exclude life-threatening conditions before attributing symptoms to musculoskeletal causes.

Critical First Step: Rule Out Cardiac Causes

Women who present with chest pain are at risk for underdiagnosis, and potential cardiac causes must always be considered 1. The pattern you describe—pain between the shoulder blades radiating to the chest and left arm—overlaps significantly with cardiac presentations:

• Pain or discomfort in the jaw, neck, arms, or between the shoulder blades occurs in 61.9% of women with acute coronary syndrome 1
• Women commonly present with chest pain similar to men but have greater prevalence of accompanying symptoms including back pain 1
• Pain radiating to the left arm is a classic feature of myocardial ischemia, though it does not exclude musculoskeletal origin 1

Red Flags Requiring Emergency Evaluation

Seek immediate medical attention if you experience 1:

• Associated symptoms: Shortness of breath, diaphoresis (sweating), nausea, lightheadedness, or sense of impending doom
• Sudden onset of severe pain, especially if described as "ripping" or "worst pain of my life"
• Pain that occurs at rest or with minimal exertion
• Pain that gradually builds in intensity over several minutes

Musculoskeletal Causes After Cardiac Exclusion

Once cardiac causes are excluded through appropriate evaluation (ECG, cardiac biomarkers, clinical assessment), several musculoskeletal conditions can produce this exact pattern:

Cervical Spine and Nerve Root Pathology

Radiating pain accompanied by motor or sensory changes, particularly below the elbow, strongly suggests a neurologic etiology of shoulder pain 2:

• Cervical spine disorders are common extrinsic causes of shoulder pain that can radiate to the chest and arm 3
• Nerve root compression from cervical disc herniation or foraminal stenosis can cause pain between shoulder blades with radiation down the arm and tingling 2
• The pain may originate as far medially as the spinal cord or as far distally as the axillary border of the scapula 2

Myofascial Pain Syndrome

Active myofascial trigger points in shoulder and upper back muscles are significantly more common on the painful side and can produce referred pain patterns 4:

• Trigger points in the rhomboids, trapezius, or infraspinatus can refer pain to the chest wall and down the arm 4
• These are reliably diagnosed by palpation for taut bands, spot tenderness, and pain recognition 4
• Treatment with dry needling, myofascial manipulation, or ischemic compression is effective 4

Rotator Cuff and Subacromial Pathology

Pain during abduction beyond 90° indicates subacromial space narrowing, characteristic of subacromial impingement syndrome 5:

• Radiation to the lower arm during abduction is consistent with subacromial pathology 5
• Pain with external rotation suggests rotator cuff involvement 5
• However, pain only with movement (not at rest) suggests mechanical impingement rather than inflammatory or cardiac causes 5

Diagnostic Approach

After cardiac evaluation, the following characteristics help differentiate causes 1, 3, 2:

Favor musculoskeletal origin if:

• Pain is positional (changes with body position or arm movement) 1
• Pain is sharp and increases with inspiration (suggests musculoskeletal or pericarditis, not ischemia) 1
• Pain can be localized to a very limited area 1
• Fleeting pain of few seconds' duration (unlikely cardiac) 1

Favor neurologic origin if:

• Tingling extends below the elbow with motor or sensory changes 2
• Pain worsens with neck movements or specific arm positions 3
• Weakness or numbness in specific nerve distribution 2

Management Pathway

1. Immediate cardiac evaluation if any concerning features present 1
2. Plain radiographs of cervical spine and shoulder if musculoskeletal suspected 1
3. MRI without contrast if symptoms persist after 8-12 weeks of conservative management or if neurologic deficits present 6
4. Conservative management includes NSAIDs, structured exercise therapy, and physical therapy focusing on posture and scapular stabilization 6

Critical Pitfall to Avoid

Do not assume shoulder blade pain is benign without cardiac evaluation, especially in women, elderly patients, or those with cardiovascular risk factors 1. The overlap between cardiac and musculoskeletal presentations is substantial, and underdiagnosis of cardiac causes in women is well-documented 1.