Interscapular Pain

Lennard Funk

Interscapular pain is pain felt between the shoulder blades. The causes may be secondary (most common) or primary (rare).

Many neck, thoracic spine and shoulder problems can give rise to secondary pain in the interscapular area. In these cases the primary problem is often felt in the affected area, with radiation to the interscapular region.

1. Neck
Pain from a cervical disc disease can radiate to the interscapular area, as well as down the arm. An MRI scan of the neck should confirm the diagnosis.

2. Shoulder:
Longstanding shoulder problems lead to scapula dysfunction and periscapular pain. A thorough shoulder examination and imaging of the shoulder is essential. The common causes are shoulder instability, rotator cuff tears and AC joint dislocations.

3. Thoracic spine:
Disorders affecting the thoracic spine cause pain radiation to the interscapular area. Stiffness of thoracic rotation is indicative, along with MRI scans.

Once all the common secondary causes have been excluded, primary problems in the interscapular area should be considered.

1. Snapping scapula:
This causes both pain and very loud popping noises when moving the scapula. This may be due to a bony lump and/or bursitis. Read more here.

2. Levator Scapulae syndrome:
Pain felt from the top of the scapula to the neck in the line of the levator scapula muscle {1}. Often associated with scapulothoracic bursitis. Treatment involves physiotherapy aimed at the lavatory scapula muscle.

3. Cervico-thoraco-scapula Syndrome / T4 Syndrome {2}/ Scapulocostal Syndrome {3}{4}:
This is a diagnosis of exclusion, for which the cause is not known. It is not a diagnosis recognised by the traditional medical and surgical community, as there is no clear and easy way to diagnose it. However, it is a broad range of symptoms affecting the interscapular area. The three syndrome may be separate entities, but the symptoms overlap and the management is similar. They are mainly found in adults in the 20-40 year old age group. Pain can be constant and severe. It often is mainly localised in the interscapular area, but can radiate to the neck, down the arms and lower back. It is often bilateral. Numbness and pins and needles are sometimes a feature. It is important to exclude a neck or thoracic cause for the pain. Treatment involves physiotherapy aimed at the thoracic spine and scapulae. Trigger point treatment is often useful and injections sometimes useful if the painful area is well-localised. Surgical release of the serratus posterior superior has been described by Fourie {5}, but this is not established practice.


1. Menachem A, Kaplan O, Dekel S. Levator scapulae syndrome: an anatomic-clinical study. Bull Hosp Jt Dis. 1993;53(1):21–24. 
2. Menck JY, Requejo SM, Kulig K. Thoracic spine dysfunction in upper extremity complex regional pain syndrome type I. J Orthop Sports Phys Ther. 2000 Jul.;30(7):401–409. 
3. Cohen CA. Scapulocostal syndrome: diagnosis and treatment. South. Med. J. 1980 Apr.;73(4):433–4, 437. 
4. MCGOVNEY RB. Scapulocostal syndrome. Clin Orthop. 1956;8:191–196. 
5. Fourie LJ. The scapulocostal syndrome. S. Afr. Med. J. 1991 Jun. 15;79(12):721–724. 

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