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29.11.2014
Marker-based and markerless X-ray Reconstruction of Moving Morphology (XROMM) were used to create precise and accurate animations of 3D rib motion in green iguanas during deep breathing. The three body weights of the torso - head, chest, and pelvis - are connected via the spine and supported by the large muscle groups of the upper back, abdomen, and pelvis. The limbs - arms and legs - attach to the torso in joints with a large range of motion (shoulder and hip joint respectively). The spine is a flexible column made up of cylindrical bones called vertebrae that are stacked on top of each other.
In between the vertebra are intervertebral discs, soft, gel-like cushions that keep the bones from rubbing against each other, increase spinal flexibility and absorb shock from everyday movements.
When the prolapsed disc presses on a nerve coming from the spinal cord, you may feel pain along the course of the nerve in addition to back pain.
The 12 medium sized vertebrae of the thoracic spine each have a pair of ribs attached and curve outward. Joined to the sacrum by a flat, circular layer of fibrocartrilage (a strong type of tissue) is the coccyx. Deep back muscles are arranged in several layers, with the deepest ones consisting of small bundles passing from one vertebra to its neighbour.
On the front of the rib cage, running horizontally between the top part of the sternum (manubrium) and scapula, is the clavicle, or collarbone. The Trapezius is a diamond-shaped muscle that covers the large area from the neck down to the 12th thoracic vertebra and from the spine to the ridge of the shoulder blade and lateral end of the clavicle. The Latissimus dorsi is a large, triangular muscle covering the middle and lower parts of the back.
Where the ilium, pubis and ischium have fused laterally, they form a cup-shaped cavity (acetabulum), the socket into which the head of the femur attaches to form the hip joint. Psoas major arises from the bodies of the lumbar vertebrae, runs anterior to the pelvis and inserts on the top part of the femur.
Quadratus lumborum originates from the posterior iliac crest and inserts on rib 12 and the transverse processes of the lumbar vertebrae.
The Pelvic Floor muscles are a group of several small muscles that form a large sling (or hammock) of muscles stretching from side to side across the floor of the pelvis. Several sets of muscles support the back, improve and help maintain posture and aid the spinal muscles with movement of the torso. The Transverse Abdominis  (“girdle”, or “corset”) is your innermost abdominal muscle and runs horizontally across the abdominal wall and along the midsection.
The Internal Obliques overlie and run diagonally to the Transversus abdominis (“back pocket”). The External Obliques run in a diagonally opposite direction; basically from the lower ribs along the side of the torso and partly on the front to the rectus and the pubic bone (“front pocket”). The Rectus Abdominis is the most superficial abdominal muscle and runs vertically along the front of our torso from the pubic bone to the sternum (inserting in the cartilage of the fifth, sixth, and seventh ribs). To complete the "house" image:The Pelvic Floor muscles (images above) are a group of several small muscles that form a large sling (or hammock) of muscles stretching from side to side across the floor of the pelvis. The Diaphragm (see image to right) is the dome-shaped muscle that forms the “roof” of your power house. The stomach is an organ of the alimentary canal, a muscular tube that forms part of the digestive system. Some of the abdominal muscles support spinal movement (rectus abdominis, external and internal obliques) and can thus be strengthened with exercises that move the spine in flexion, extension, lateral extension, rotation, undulation. Aside from a cheesy sound effect in a martial arts film a loud, guttural yell has other purposes. On a spiritual and emotional level, vocalizing such as yelling, yipping, grunting, sighing, promotes release of stress, tension, anger, aggression, etc.
Pain in the shoulder blades can be caused by bad posture, psychological stress, shoulder overuse, injuries, pinched spinal nerves, lung diseases and disorders of other chest and abdominal organs. Tingling, numbness or burning speak for a nerve damage, either from neurological diseases (shingles, brachial neuritis, transverse myelitis, multiple sclerosis) or nerve compression (herniated discs or broken vertebra in the neck spine, T4 syndrome); tingling can also occur due to increased muscle tension or migraine.
Rounded shoulders can result from tight chest and weak upper back muscles, for example, due to prolonged desk job, and can cause pain in one or both shoulder blades or between them [109].
In a standing or sitting position with arms parallel to the body, pull your shoulders back and down and hold for 2-3 seconds (repeat 3 x 12) [70]. Place your arms in a hug position and squeeze the shoulder blades for 8 seconds (repeat 6 x) [71]. Myofascial pain syndrome is a chronic condition with palpable knots and taut bands in the muscles and their sheaths (fascia) that act as trigger points. Snapping on the knots in the shoulder blade area triggers muscle twitches at the site of the snap and deep aches in the shoulder, back side of the arm, hand and little and ring finger (Picture 2) [18]. Trigger points can be also found on the back of the head, neck, in the lower back and hips [18]. Myofascial pain syndrome can result from prolonged sitting (office job, computer work) or standing, carrying heavy loads in a hand or over a shoulder, pregnancy, breastfeeding or playing an instrument, such as violin, guitar, flute, piano or drums.
Trapezius strain is characterized by discomfort, tightness and muscle knots between the shoulder blades, pain and tingling that can radiate to the shoulders, neck and head. Causes include poor posture, repetitive lifting, workout exercises, such as pull-ups, tilting the head sideways when using the phone, scoliosis and discrepancy in leg length [81].
Place the arm on the affected side behind the back, hold the wrist with the other hand, bend the neck sideways to the opposite side and hold for 30 seconds. Serratus anterior muscles on both sides of your chest, below the armpits, help raise your upper arms forward and upward, for example, during sprint, workout exercises (push-ups, bench presses) and expand your chest during breathing in.
Muscle strain refers to overstretched muscle and muscle tear refers to a rupture of a part and rarely of an entire muscle. Strain or tear of the rhomboid muscle, which connects the shoulder blade with the spine, can occur during carrying a heavy backpack, reaching for something heavy on a high shelf, push-ups, pull-ups, weightlifting exercises (deadlift, bench press, squat), or in sports, like basketball, bowling, boxing, cycling, gymnastics, golf, handball, martial arts, rowing, running, shooting, skiing and tennis. Place the arm of the unaffected side horizontally over the chest, grab the wrist with the hand of the affected side and pull the arm sideways and backwards. Muscle contusion is a muscle hematoma (a blood collection in the muscle) caused by a direct blow [4]. Treatment can include shoulder rest and applying ice wrapped in a cloth for 20 minutes immediately after the injury. Snapping scapula syndrome refers to snapping, grinding or popping sound during shrugging or lifting an arm sideways, when the shoulder blade rubs against the rib cage and, sometimes, tenderness and palpable crepitus over the medial side of the scapula, and pain between the shoulder blades when lifting the arm above the shoulder level [84]. The syndrome can develop in overhead throwing athletes, such as baseball, tennis, volleyball and waterpolo players, javelin throwers, shot putters and swimmers. According to some reports, migraine headache can start as pain or tingling in the shoulder blade area that progresses to one side of the head.
Polymyalgia rheumatica is an inflammatory muscle condition of an unknown cause in individuals over 50. Bilateral aches and stiffness in the shoulder and hip muscles that are worse in the morning and improve through the day may develop overnight or in few days [16]. A related condition called giant cell arteritis can also cause pain in the temples, disturbed vision and fever [16].
Whiplash is a strain or tear of the neck muscles, tendons or ligaments or even a damage of the spinal discs and nerves caused by a sudden neck movement backwards and forwards, most commonly in rear-end car accidents and motorbike falls. Fibromyalgia is a chronic condition with widespread dull musculoskeletal aches, fatigue, sleep, memory and mood issues. Typically, more than 10 symmetrical tender points can be found on the bottom of the back of the head, above and between the shoulder blades, on the upper parts of the buttocks, bottom of the front side of the neck, on each side of the upper part of the breastbone, on the hips, on the outer sides of the elbows and on the lower medial sides of the knees (Picture 4) [13]. Fibromyalgia mostly affects women; it can develop after an accident, disease or stressful event or without an apparent reason. Treatment includes analgesics, stretching exercises and adopting a healthy life style [78]. Shoulder blade fracture can occur during a fall on an extended arm or due to direct hit to the shoulder blade in motorbike falls or collisions, for example, in rugby or hockey.
The pain can radiate into the neck or upper arm and can can be aggravated by moving an arm, pressing down on a shoulder or firmly pressing on a shoulder blade at the site of the fracture, by sleeping on the back, deep breathing or coughing [8]. Fracture of one or more ribs can cause sudden, severe, sharp pain near the shoulder blade; the pain is usually aggravated by breathing, coughing, moving, bending or pressing upon the broken rib.


Vertebral fractures are most common in older people with osteoporosis or spinal cancer (metastases, multiple myeloma) in whom they can be caused by minor accidents, like falls, or even by coughing hard [11].
Asymmetric pain in the pelvis or other bones, possibly including one or both shoulder blades [39].
The pain can be triggered by bending the neck backwards, turning the head sideways, or lying down. Symptoms are aggravated by raising an arm above the shoulder, for example, during combing the hair [20].
Chest tightness and abnormal sensations (a sense of swelling, extreme perception of cold and heat, numbness and tingling) in a hand, all 5 fingers and forearm (Picture 5); symptoms are not aggravated by active movements of the spine [79,87].
Causes include repetitive forward, backward and sideways bending or twisting of the trunk (dentists, surgeons, electricians, assembly-line workers) and carrying heavy backpacks [87]. A reactivation of a previous infection with the Herpes-zoster virus in one of the spinal nerves that arise from the lower neck or upper chest part of the spinal cord can cause burning pain, sometimes (after several days or few weeks) followed by red, itchy and tender blisters in the form of a stripe that runs horizontally from the spinal line over the shoulder blade toward the front of the chest, usually only on one side [23]. Brachial neuritis, also called idiopathic brachial plexopathy, neuralgic amyotrophy or Parsonage-Turner syndrome (PTS), is a rare neurological condition of an uncertain cause, which may include infection, vaccination (flu, tetanus, hepatitis B), surgery or trauma [60,75].
Transverse myelitis is an inflammation of the spinal cord, which may be caused by a viral infection, Lyme disease, multiple sclerosis or systemic lupus erythematosus. The long thoracic nerve travels from the armpit vertically down the side of the chest on each side and supplies the serratus anterior muscle. Pleurisy is an inflammation of the lung membrane (pleura) caused by a viral infection, such as flu, or bacterial infection, such as pneumonia or tuberculosis [43]. Sudden knife-like pain on one side of the chest, followed by vague pains around the chest and shoulder blades, worsened by breathing, coughing and moving the arms and torso [44]. Constant pain on one side of the chest or back, coughing up blood, loss of appetite, nausea and weight loss [41]. Pulmonary embolism is a clot in the pulmonary artery; it usually occurs in individuals with deep vein thrombosis. The pain can radiate to the neck, jaw, into the left, both or between the shoulder blades or down the upper left arm to the fingers [32]. Sharp, central or left chest pain, which can radiate to the throat, jaw and left or both shoulder blades or arms; the pain can be aggravated by deep breathing, eating, coughing and lying down, and relieved by sitting and leaning forward [36]. Causes include viral infections, tuberculosis, heart attack, trauma, systemic lupus erythematosus, rheumatoid arthritis, kidney failure or cancer. Esophageal cancer can cause pain behind the breastbone or between the shoulder blades, especially during swallowing [45]. Aortic dissection (tear) can cause sudden, severe, tearing pain in the middle of the chest and between the shoulder blades [37].
Moderate pain on the left side of the upper abdomen, chest, shoulder, inner part of the arm and little and ring finger (splenic flexure syndrome); the pain can last for few hours [30,80]. Burning pain in the upper middle abdomen and, according to anecdotal online reports, between shoulder blades. Stones in the common bile duct can present with additional symptoms: jaundice, pale and smelly stools and dark urine [50].
Dull flank pain below the right or left shoulder blade, which can be triggered by tapping over the kidney but less likely by the body movements. Sudden, sharp pain in the right or left flank that can persist for several hours and can radiate to the right or left abdomen or groin. A lump and dull, persistent pain in the upper left abdomen, which can be worse with deep breathing and may radiate to the top of the shoulder blade (Kehr’s sign) [76]. Other splenic disorders with possible left shoulder pain include ruptured spleen, splenic infarct and abscess [30,65]. After liver biopsy, some individuals can feel pain in the right shoulder blade area for few days [59]. Calcific tendinitis, a chronic inflammation of rotator cuff tendons of an unknown cause, can cause mild or severe and sharp pain in the shoulder and upper arm that comes and goes; other symptoms can include stiffness, catching or snapping in the shoulder [96,100]. Adhesive capsulitis is an inflammation and thickening of the shoulder capsule, which wraps the shoulder joint. Shoulder sprain means overstretching or rupture of the shoulder joint capsule, which can be caused by falling on an outstretched arm, direct blow to the shoulder or overuse of the shoulder in sports, such as swimming, waterpolo, baseball, rugby, skiing, or heavy lifting [103]. Symptoms may include dull or sharp pain in the shoulder and upper arm, tenderness, shoulder joint instability, swelling, redness, warmth or bruising around the shoulder [103]. Shoulder joint subluxation means partial dislocation of the head of the upper arm bone from the shoulder joint caused by an injury of the shoulder joint capsule or cartilage (labrum) [104,105]. A tear of shoulder joint cartilage can result in painful clicking, popping or locking when moving the shoulder [96,97]. Avascular necrosis of the head of the upper arm bone (humerus) means bone death due to impaired blood supply. In an early, painful phase of a shoulder or shoulder blade injury, shoulder rest prevents further damage. To reduce pain, swelling or bruising, put ice in a plastic bag, wrap it into a cloth and hold over the painful area for up to 20 minutes, several times a day.
Heat pads can help relieve pain in myofascial pain syndrome due to increased tension of the upper back muscles.
Vapocoolant spray can reduce the pain in muscle strain or bruise and before myofascial pain release in myofascial pain.
A sling prevents the motion of the shoulder blade and shoulder and encourages their healing after a fracture, dislocation, rotator cuff injury or surgery. Shoulder blade exercises are intended to relieve pain due to tension of the upper back muscles or to prevent stiffness of the shoulder joint after injury. Do not exercise immediately after an injury or until you experience severe pain. Non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, can be used to relieve mild to moderate pain. Steroids can be used to treat inflammation in disorders, such as rheumatoid arthritis, polymyalgia rheumatica [16], polymyositis [31] and brachial neuritis [60]. Surgical treatment may be needed in pinched nerves, broken shoulder blade, calcific tendonitis, adhesive capsulitis and snapping scapula syndrome.
Antilla P et al, 2002, Muscle tenderness in pericranial and neck-shoulder region in children with headache. Hello I don’t know if you can help me or not, but I am 19 and I have very painful back pain like along my right shoulder blade. Have you fallen on the back, has someone hit you, were you running, cycling or lifting anything with that arm? It sounds to me it may be a problem with one or more nerves and I suggest you to visit a neurologist who can perform appropriate tests.
Yes I fell off a roof and landed on my right shoulder when I was 5 and come to think about it I’ve been dealing with this pain ever since then.
Hey Evan – I was reading your description of your shoulder pain and I have suffered the exact same pain for many years. Jen, Evan will probably not read this, but I suggest you to arrange an appointment with an orthopedist who can give you exact diagnosis.
Bev, all the nerves mentioned in the MRI report are in the lower back , so even if they were causing nerve impingement, you would feel pain in the lower back or legs and not in the shoulder blade. They also put me on some vitiams t control my neurotransmitter and Adreanal, I’ve just recently started on the vitiam but my shoulder is very concerning.
They are connected to the upper arm bones (humerus) and collar bones (clavicle) and to the muscles of the upper back, neck and arm. Lye on the ground (face-down) and raise your body to rest only on your toes and forearms, with elbows directly under the shoulders and hands made into fists. Put an elastic band around the solid object, sit down, hold the ends with both hands and pull 10 times [69]. The syndrome can be associated with headache, migraine, temporomandibular joint dysfunction or fibromyalgia [18]. Risk factors include weak upper back muscles, bone scars after a rib or scapula fracture or scapular dyskinesia [84].
The mechanism is not known; it may be caused by the change in the way how the brain processes pain signals. NOTE: Tender points in fibromyalgia are not the same as trigger points in myofascial pain and do not cause pain in distant body parts after pressing on them.


The pain can spread to the back of the neck and head or down the arm all the way to the fingers [21].
It can be damaged by a direct blow to the side of the ribs, sustained bearing of heavy loads over the shoulder, repetitive forward arm movements (sprint, boxing), deep massage or during removal of a breast and lymph nodes in the armpit (radical mastectomy).
Other causes of rotator cuff tendonitis or bursitis: systemic lupus erythematosus (SLE) [101], rheumatoid arthritis, gout and diabetes [99].
Causes can include shoulder immobilization, diabetes, hypothyroidism and hyperthyroidism. It can gradually develop in adults over 40 and cause deep ache in the front or the back of one shoulder and upper arm and severe stiffness with greatly limited range of motion of the shoulder [107].
Symptoms can include severe pain in the shoulder and entire arm and, sometimes, swelling, warmth and redness of the shoulder and a popping sound when moving the shoulder; pain can become worse by weather change [96,97]. The cause is not always known but can include shoulder trauma, using corticosteroids, alcoholism, sickle cell anemia or AIDS. A doctor can prescribe a shoulder brace in shoulder joint instability and impingement syndrome [108]. I have shoulder blade pain with burning pain and tingling and numbness that goes down to my fingers. 3 weeks ago I had a bout with pleurisy and i felt pain in both scapulas and pain along the spine in between scapulas, pain under breasts and chest pain. Ventilatory action of the hypaxial muscles of the lizard Iguana iguana: a function of slow muscle.
Treatment includes physical therapy; rarely, surgical fixation of the scapula to the rib cage is necessary. Fibromyalgia by itself is not associated with joint or muscle inflammation or abnormalities in blood tests or X-ray images [14]. The scapula fracture healing time is 6-8 weeks, but rehabilitation may last for several months [9]. A sharp pain in the front of the shoulder and dull ache in the outer side of the upper arm radiating to the hand, and spasm of the shoulder muscles usually develops over the months; initially it can be relieved by warming up but often worsens after the exercise (at night and in the morning) [96,102].
Symptoms include deep, throbbing, poorly localized pain around the shoulder that can radiate down to the elbow [111].
When you stop wearing a sling, you need to start with shoulder exercises as instructed by your doctor, to prevent shoulder stiffness. I also fell backwards years ago and I remember I had to take a few days off work because of the injury (but the doctor never told me what exactly I had done to my shoulder). Common causes include bulging or herniated discs due to an injury, degenerative disc disease, spinal wear and tear (spinal osteoarthritis or spondylosis) [21] and cervical spinal stenosis [24]. I have gone to my doctor many times and him and my parents say the same thing its nothing just take some advil.
I’ve tried muscle relaxers oxycodone ibuprofen 800 nothing touched the pain for weeks. Recently saw my GP and told her I still had dull aches from time to time in left scapula and burning down both long muscles in back. Pain is aggravated by lifting an arm over the levels of the shoulder or reaching forward [102]. Nothing I can buy even eases the pain, it feels like someone has stabbed a knife into my back and left it. I have been sent to physio for it and that would help a little but they pain always comes back. Rotator cuff tear results in similar symptoms; chronic tear can cause a popping sound during moving a shoulder [96,97].
They had indicated that it could possibly be Fibromyalgia, that it would help if I changed my eating lifestyle so I did!
I’m still having terrible pain in my left shoulder blade and upper part of left arm, sometimes my left collarbone is extremely painful as well.
This makes me very happy that its not really a big deal and to just deal with the pain cause it will be over with eventually.
I have two of the symptoms above in the bullet points – blueness or paleness in few fingers and marked difficulty breathing. Jaime KI get this as well, and I always just figured it was just one of those things that some people have to deal with. I’ve never found anyone else who has had this, so makes me feel better to know I’m not the only one! My dad has a heart disease and due to some complications in pregnancy I’ve had echocardiograms done and everything is normal there.
The older I got I wondered if it was heart attack but I don’t have any of the other serious symptoms. I just keep taking shallow breaths, increasing the air I take in over time until the pain is gone, then I brave the huge breath to check. I’ve always described it to my parents and friends as a chest bubble that I have to pop before I can breathe normally again, but they always seemed to think I was crazy.
I know my mom never seemed interested in taking me to a doctor for it when I was little since it never really affected me for long.
Matthew LongI am 19 and I have been getting this pain for about two years… Sometimes it last a few minutes and sometimes it lasts hours or all day. Nothing relaxes the pain, no medicines help it always starts in the middle of my chest and ends up filling my chest, mid-back, and jaw with extreme pain. I usually just hold my breath and breath out slowly after a while and do a couple of short breaths. I actually view it as a stitch you get from running, which is just cramp in a tiny muscle, if you get a stitch, breath out completely and push your belly out and breath in whilst drawing in the belly. Jesse VaudoI’m 27 and I started feeling this striking pain in my chest and decided I needed to see if it was serious too. This is a huge relief that it isn’t due to any sort of deteriorating heart condition.
I went to see a doctor and took some chest x-rays but my chest was clear with no problems or complications. Stephen DaviesFantastic!I have had this random sharp stabbing pain since my early teens or maybe even earlier.
I am thirty years old now and have just experienced it whilst cleaning my cooker, it makes me freeze up and I am unable to breathe in, and the more I try the more painful it gets the deeper I breathe in.
This page is a massive relief to me as I smoke and drink an generally only exercise occasionally these days so I’m ecstatic to hear its just a pinched nerve. I was taking 1 every day for approximately 6 months straight and not once did I get the pain.
Last month I stopped taking my aspirins and as you would expect, today I just had an episode.
I was visiting my mother and all of a sudden I couldn’t move or breath and the pain was unbearable. That hasn’t happened in a while however it scares me to think I have angina or asthma or a heart attack or something else. It felt like a tiny fist with a lot of force behind it trying to escape the left side of my rib cage-under my heart when I finally took the deep breath.
I didn’t know what it was and threw my body into the most intense panic attack I have ever had. The popping was the worst pain I have experienced and I have broken bones, had concussions, cuts, sprains, torn ligaments, etc.



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