Nagging, sharp pain between the shoulder blades is something a lot of us have experienced. Why is it always on the same side? Do you feel it on both sides? What causes it? I’m going to dive deeper into these questions and hopefully explain why we think it happens and how we can fix it.
There are multiple biomechanical reasons for pain in this region, however I will only touch on the cases that involve radiating pain from a nerve. Because of this, I will include a disclaimer: THIS INFORMATION DOES NOT 100% RULE OUT OTHER MECHANISMS OF PAIN BETWEEN THE SHOULDER BLADES. I am only touching on one specific mechanism because we see it the most in our office.
THE NERVE ROOT
Before we dive a little deeper, I want my readers to understand a little bit about a nerve root.
Don’t worry if the image confuses you, I’ll explain it in easy terms (hopefully). Look at where the arrow is pointing. That is the “root” of the nerve that comes out of your spine that controls things like movement, feeling, strength and much much more. The nerve root contains a bunch of little nerves that branch out of it. If we piss this nerve root off, we will also make the little nerves inside of the root angry as well. Most of the time, when the nerves are angry, they cause sharp, shooting pain. However, the pain won’t usually be where the root is. You’ll most likely feel pain in the areas that the little nerves go. This is called radicular pain.
You might ask… How does the nerve root get pissed off? Well, there are a number of ways, but the most common that WE see is from disc compression. Also known as disc “herniations” or “bulges”.. it is a lot more common than you think. I’ll save the details about this for another time.
SUMMARY: DISC COMPRESSION IRRITATES THE NERVE ROOT WHICH CAUSES PAIN.
Now, to get a little more specific, look at the images above. If you piss off the C7 nerve root, you might get pain similar to the areas shown on the left image, and visa versa for C8. The key word in that last sentence is might. Sometimes you’ll only feel arm pain, and sometimes (most of the time) you’ll only feel it in between your shoulder blades.
Why is the pain only on one side? This is because discs tend to herniate to one side, thus only irritating one side of the nerve root. If you do feel pain on both sides, it could mean that there is an injury deeper in the spinal cord, which is a topic for another time.
How do we fix this? Decompress the discs and allow the nerves/disc fibers to heal. This is easier said than done. More on this later.
I hope this helps someone out there.
-Dr. B