Chronic parascapular pain (shoulder blade)
Chronic parascapular pain—persistent discomfort around the shoulder blade—can be frustrating, especially when it lingers despite rest or general stretching. It’s a common complaint we see in our clinic, often affecting people with desk jobs, athletes, or anyone performing repetitive shoulder movements. The good news? With the right diagnosis and management plan, most cases can significantly improve.
What is Parascapular Pain?
“Parascapular” refers to the area around the scapula (shoulder blade). Pain in this region can feel dull, sharp, achy, or even radiate into the neck, shoulder, or down the arm. The cause isn’t always from the shoulder joint itself—it can stem from muscles, nerves, posture, or referred pain from the neck or thoracic spine.
Common Causes of Chronic Parascapular Pain
1. Myofascial Pain Syndrome
This is one of the most common causes of chronic shoulder blade pain. It’s characterised by muscle knots (trigger points) in muscles like the trapezius, rhomboids, or levator scapulae.
Presentation:
Dull, aching pain
Pain may refer into the neck or shoulder
Worse with stress or poor posture
What Helps:
Massage therapy or dry needling
Trigger point release techniques
Exercises: scapular rows, thoracic extensions, pec stretches
2. Scapular Dyskinesis
This refers to abnormal movement of the shoulder blade during arm motions. It often stems from muscle imbalances or poor control.
Presentation:
Shoulder instability
Winged scapula
Pain with overhead activities
What Helps:
Strengthen serratus anterior and lower trapezius
Improve scapular control
Exercises: wall slides, scapular clocks, prone Y/T/W
3. Postural Syndrome
Spending long hours hunched at a desk or looking down at a screen can lead to muscular fatigue and pain between or beside the shoulder blades.
Presentation:
Aching pain after sitting
Forward head posture
Relief with movement
What Helps:
Postural correction and ergonomic changes
Strengthening the posterior chain
Exercises: chin tucks, band pull-aparts, wall angels
4. Thoracic Outlet Syndrome (TOS)
TOS involves compression of nerves or blood vessels between the neck and shoulder.
Presentation:
Pain, numbness, or tingling down the arm
Symptoms worse with arm overhead
May involve coldness or weakness
What Helps:
Stretching tight muscles like scalenes and pec minor
Neural glides and rib mobilisations
Exercises: pec minor and scalene stretches, first rib mobilisation
5. Cervicogenic Referral
Neck issues can sometimes cause referred pain to the scapular region.
Presentation:
Pain starts in the neck
Reduced neck mobility
Pain can mimic shoulder conditions
What Helps:
Address the cervical spine (manual therapy, traction)
Exercises: chin tucks, deep neck flexor work, cervical ROM drills
6. Rotator Cuff or Shoulder Dysfunction
When the shoulder joint doesn’t move well, the scapula can become overloaded, leading to parascapular pain.
Presentation:
Pain with lifting or reaching
Weakness or shoulder instability
Clicking or catching
What Helps:
Rotator cuff strengthening
Scapular stabilisation
Exercises: resisted shoulder rotations, scaption, scapular retraction
7. Rib Dysfunction
A subtle rib misalignment or sprain can produce sharp pain near the scapula, often aggravated by breathing or rotation.
Presentation:
Pain with deep breaths or trunk movement
Sharp or stabbing pain
Local tenderness over the rib
What Helps:
Mobilisation and manual therapy
Breathing exercises
Exercises: thoracic rotations, cat-cow, diaphragmatic breathing
8. Long Thoracic Nerve Palsy
Injury to the nerve that powers the serratus anterior can cause scapular winging and weakness.
Presentation:
Medial scapula winging
Pain or weakness with arm elevation
History of trauma or repetitive strain
What Helps:
Neural flossing
Serratus-specific strengthening
Exercises: push-up plus, serratus punches, wall slides with foam roller
Final Thoughts
Chronic parascapular pain doesn’t have a one-size-fits-all solution—it depends on the root cause. The most effective approach includes a combination of hands-on therapy, tailored exercise, postural correction, and lifestyle adjustments.
If you’ve been dealing with shoulder blade pain that doesn’t seem to go away, let one of our chiropractors, massage therapists, or movement professionals assess and guide your recovery. At Epoch Health, we’ll help you move better, feel stronger, and live pain-free.