What Causes a Tender Knot Under the Shoulder Blade?

The shoulder is an intricate part of the human body. It consists of a ball-and-socket joint, where a rounded bone moves inside the depression of another bone. This structure helps to give the shoulder the best range of motion of any of the body’s joints.

Because of this design, our arms can reach down to tie our shoes, rise above our heads to reach something on a high shelf or move in a semi-circular motion to throw a ball.

But we pay a price for this mobility in that our shoulders are apt to be problematic, in part because of the complexity of the joint. Shoulder pain is one of the most common orthopedic problems, according to the National Institute of Health.

The rotator cuff, a combination of muscles and tendons that keeps your arm bone centered in your shoulder socket, is frequently a cause of shoulder pain. This is especially true for baseball pitchers and other athletes.

Bursitis, arthritis, tendinitis and tendon tears are other common causes.

But for others, the pain or “knot” they feel under the shoulder blade is linked to the neck, even in cases where there is no overriding pain in the neck.

Knot really

Cervical radiculopathy is the fancy medical term for pinched nerve. It occurs when a nerve in the neck is compressed or irritated where it branches away from the spinal cord. This can cause radiating pain in the shoulder and/or arm, along with muscle weakness and numbness.

Cervical radiculopathy is most common in adults middle aged or older, though anyone can get it. For older people, “wear and tear” is most often the reason. A degenerated disc or arthritis could be pinching the nerve.

In such cases, the problem evolves over several years.

With aging, we experience degenerative changes in the discs of the spine. These changes put pressure on nerve roots that can cause the discs to lose height, become stiffer and begin to bulge. As the vertebrae move closer together, pinching can occur.

In younger people, cervical radiculopathy can result from trauma.

This shoulder problem is fairly common. Cervical radiculopathy has an annual incidence rate of 107.3 per 100,000 for men and 63.5 per 100,000 for women, according to the NIH.

Untying the knot

Treating the problem as soon as possible is important. This will improve the likelihood of a quick recovery.

• Making an appointment with a health care professional who specializes in pain management is a good first step in addressing the knot under your shoulder.
• At your visit, the doctor will discuss your symptoms and perform a physical examination to better understand the cause of your pain. The physician may ask you to make certain movements of your shoulder or neck to get a better handle on the situation.
• Imaging tests such as X-rays or CT scans may be ordered and reviewed as part of the examination.
• Once a diagnosis is made, your doctor will discuss treatment options. They include physical/occupational therapy, injections and in some cases medications.
• If there is significant compression of the nerve, surgery may be necessary to relieve the pressure and pain. However, doctors typically exhaust all other options before considering surgery.