Description
Interscapular pain is a common symptom experienced between the shoulder blades. Which may be caused by a variety of structures which will be discussed below.
What is the relavent anatomy and causes of interscapular pain?
Facet joint syndrome is primarily a degenerative condition affecting the spine’s joints, where movement occurs. It can stem from wear and tear, trauma, or inflammation due to injury. This syndrome might coexist with other spinal and rheumatic conditions, and in severe cases, it can lead to nerve impingement, with symptoms radiating to the lower limbs.
What is the relavent anatomy and causes of interscapular pain?
1 Cervical spine/neck:
Your cervical spine consists of 7 vertebrae. Between each vertebra is an intervertebral disc. Movement occurs at the facet joint when we nod and look to the ceiling. Adjacent to these structures, we have nerves which branch off of the spinal cord. These nerves may be impinged by the disc and/or facet joint. This pain may be referred to the inter-scapular region. Localized pain at the disc and/or facet may also cause interscapular pain.
2 Thoracic spine/midback
Your thoracic spine consists of 12 vertebrae. Movement occurs at the facet joints. Pathology at the upper thoracic vertebrae may cause pain between the shoulder blades. Thoracic spine also forms joints with the ribs i.e. costotransverse and costovertebral joints. When these joints are inflamed or stiff, pain may occur between the shoulder blades. Repeated movements of the thoracic spine, shoulder blade may cause pathology at the costotransverse joint. Costovertebral joints are sometimes accompanied by conditions such as rheumatoid arthritis, ankylosing spondylitis.Who commonly presents with interscapular pain?
Females.
Between ages of 40-50.
Prolonged positions of looking up/down
Trauma
Rheumatoid arthritis
Osteoarthritis.
Ankylosing spondylitis
What are the symptoms associated with cervical and thoracic pathology?
You may experience localized neck pain and stiffness. Pain may refer to the scapula region. You may experience a burning/sharp pain sensation at the scapula region. In the thoracic spine, you may also have localized pain and stiffness, pain with breathing and coughing and in rare cases, breathing.
Physiotherapy management
Physiotherapy management will initially focus on providing symptomatic relief. Treatment will include stretches, active mobility exercises, strengthening of neck, upper back and shoulder muscles. Treatment will also include continuous education including the importance of ergonomics and posture during exercises. Conservative management is advised for the 3-6 months. If this fails to provide complete relief, corticosteroid injections may be worth considering. Your attending physiotherapist will refer you to a specialist for this, if indicated. If you are battling with interscapular pain, do not hesitate to book an appointment with one of our experienced physiotherapists on 011 027 211.
For persistent back or neck pain, contact us at 011 027 2111 to schedule a consultation with our skilled physiotherapists.
References
1.Arroyo, J.F., Jolliet, P. and Junod, A.F. (1992) ‘Costovertebral joint dysfunction: Another misdiagnosed cause of atypical chest pain’, Postgraduate Medical Journal, 68(802), pp. 655–659. doi:10.1136/pgmj.68.802.655.
2.Del Chiaro, A. et al. (2021) ‘Inflammatory disease of the costotransverse joints: US evaluation in 15 symptomatic patients’, Journal of Ultrasound, 25(2), pp. 167–175. doi:10.1007/s40477-021-00589-5.
3.Dreyfuss, P., Tibiletti, C. and Dreyer, S.J. (1994) ‘Thoracic Zygapophyseal Joint Pain Patterns’, Spine, 19(7), pp. 807–811. doi:10.1097/00007632-199404000-00014.
4.Slipman, C.W. et al. (2005) ‘Provocative cervical discography symptom mapping’, The Spine Journal, 5(4), pp. 381–388. doi:10.1016/j.spinee.2004.11.012.
5.Yoon, K.B. et al. (2016) ‘Clinical effectiveness of ultrasound-guided costotransverse joint injection in thoracic back pain patients’, The Korean Journal of Pain, 29(3), pp. 197–201. doi:10.3344/kjp.2016.29.3.197.
