Myofascial-Related Shoulder/Scapular Pain
Myofascial related pain around the scapula or shoulder blade can be very distressing and is frequently seen in clinical settings. Depending on the presentation, this pain is often diagnosed as myofascial in nature. The prevalence of myofascial pain ranges from 30% to 85%, and it most commonly affects individuals aged 30-50.
The scapula as a structure is part of the shoulder joint and a site of attachment for many muscles in the area - including muscles that control the neck, thorax and shoulders. Because the area is primarily controlled by muscular tension, a change in tension or a change in muscular balance may sometimes be associated with overuse/overload of the area.
Risk factors contributing to myofascial pain include:
Posture and Repetitive Movements: There are numerous theories about why repetitive motions lead to increased tightness and pain. While this is beyond the scope of this post, it is generally agreed that prolonged poor posture or repetitive movements can contribute to this type of pain. Therefore, it is common to see these symptoms in inactive individuals or those who spend long hours working at a computer.
Systemic Factors: Conditions like hypothyroidism, vitamin D deficiency, and iron deficiency may be associated with the development of myofascial pain. These deficiencies are common and supported by research.
Trauma and Stress: Stress-related hormones, particularly those associated with the fight-or-flight response, may also contribute to the development of myofascial pain.
Clinical Presentation:
Individuals with myofascial pain typically present with tightness and pain in the muscle belly. Pain may be less intense at the beginning of the day but often worsens over time, becoming more intense toward the end of the day. Palpation of one area may refer pain to more distant areas, making it common for palpation in one region to trigger symptoms in others.
Treatment:
Treatment for myofascial pain in the shoulder typically includes:
Mitigating Risk Factors: Consulting with a medical doctor or nutritionist if a metabolic deficiency is found, and being mindful of posture and prolonged positions, which should be avoided or changed regularly. Managing stress or trauma should also be addressed to alleviate symptoms.
Soft Tissue Mobilization: Physical therapists can apply soft tissue mobilization techniques, including manual interventions, light stretches, or stabilization exercises, depending on the presentation.
Modalities: Adjunct treatments like heat, shockwave therapy, or electrotherapy may also be used.
A combination of these treatments, rather than relying on any single intervention, is essential for a successful recovery.
References:
https://www.ncbi.nlm.nih.gov/books/NBK499882/
Cao QW, Peng BG, Wang L, et al. Expert consensus on the diagnosis and treatment of myofascial pain syndrome. World J Clin Cases. 2021;9(9):2077-2089. doi:10.12998/wjcc.v9.i9.2077
