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What is Scapulocostal Syndrome? Understanding Causes and Targeted Treatment to Stop Chronic Pain

Scapulocostal syndrome, or dull ache around the scapula caused by muscle dysfunction, is a condition where patients experience pain around the shoulder blade area with radiating pain to various locations depending on the affected trigger points in the muscle. This condition is considered one of the symptoms of myofascial pain syndrome.
Scapulocostal syndrome patients typically experience a dull ache around the scapula and radiating pain to other areas. This may be accompanied by movement restrictions in the shoulder blade or shoulder joint, and may affect rib cage movement during breathing in some cases.
Scapula pain and surrounding muscle pain primarily stem from improper usage, muscle tension around the shoulder blade from other conditions, and acute injuries.
For diagnosing patients with scapulocostal syndrome, doctors will take a medical history, perform physical examinations, and may prescribe X-rays or MRI scans of the cervical spine or shoulder area to achieve more accurate diagnosis.
Treatment for scapulocostal syndrome at kdms Hospital in Bangkok, Thailand, involves a comprehensive treatment team that covers all aspects of scapula pain or scapulocostal syndrome diagnosis. We have skilled rehabilitation medicine physicians, orthopedic surgeons, and highly capable physical therapists. Additionally, if there are concerns about symptoms from other conditions, we can immediately conduct examinations using advanced equipment such as MRI and X-ray machines.

The scapula, or shoulder blade, is a triangular bone located at the upper posterior rib area on both sides. There are multiple muscle groups attached around the shoulder blade, helping with scapular and shoulder joint movement in various directions.

Many patients visit doctors with scapula pain and muscle pain under the scapula, commonly referred to as “scapulocostal syndrome.” This condition is frequently found in middle-aged adults and people who work or perform activities in improper postures. They often experience shoulder blade pain and radiating pain to other parts of the body, requiring prompt treatment before it becomes a major problem. Let’s learn about scapulocostal syndrome, its causes, and treatment approaches in this article.

What is Scapulocostal Syndrome?

Scapulocostal syndrome is a term commonly used by people to describe general shoulder blade pain. However, in medical terms, several research studies define scapulocostal syndrome as “scapula and peri-scapular pain from muscle dysfunction.” The muscles involved include levator scapulae, rhomboid, trapezius, serratus anterior, and serratus posterior superior. These muscles connect from the shoulder blade area to various parts of the body, including the spine, neck, chest, and ribs. When pain or stiffness occurs in these areas, along with difficulty moving in the shoulder blade region, patients commonly refer to it as scapulocostal syndrome.

What are the Symptoms of Scapulocostal Syndrome?

Patients with scapula pain and surrounding muscle pain, or scapulocostal syndrome, present with pain around the shoulder blade area and may affect movement around the scapula, shoulder, and rib cage movement during breathing. Furthermore, scapulocostal syndrome is considered part of the myofascial pain syndrome group, characterized by trigger points found in the muscle in the shoulder blade area along with radiating pain to nearby regions.

Causes of Scapulocostal Syndrome

As mentioned above, scapulocostal syndrome, or scapula and peri-scapular pain from muscle dysfunction, is one of the symptoms of myofascial pain syndrome. There are hypotheses which explain the disease mechanism suggesting it results from muscle spasms caused by prolonged muscle contractions. This leads to insufficient blood and energy supply to nourish that muscle area. Therefore, the muscle becomes increasingly tense because it lacks energy to help with relaxation, causing accumulated tension in the muscle that forms trigger points. The causes can be categorized as follows:

Usage-related causes

This involves repetitive strain injuries from muscle overuse in the same postures for extended periods. Some posture examples include working at a computer screen, sitting with rounded shoulders, forward head posture, or constantly shrugging shoulders while typing. These postures cause muscle tension around the shoulder blade. When accumulated over time, they both make posterior muscles tight and weaken the muscles around the shoulder blade, making the muscles even tighter.

Causes from muscle tension around the shoulder blade due to other conditions

In groups of patients with herniated discs compressing nerves, degenerative spine conditions compressing nerves, or even rotator cuff tendon disorders that cause pain, the pain will stimulate surrounding muscles to tighten. The affected muscles include muscles around the shoulder blade as well, resulting in pain around the shoulder blade similar to scapulocostal syndrome.

Causes from acute injury

Acute injuries, such as twisting the body incorrectly or lifting heavy objects improperly, cause sudden muscle spasms and result in pain in muscles around the shoulder blade.

Diagnosis of Patients with Scapulocostal Syndrome

Scapulocostal syndrome has radiating pain similar to other conditions such as shoulder joint disorders, spinal conditions, or disc herniation compressing nerves. Therefore, diagnosis focuses on accuracy in identifying the condition for precise treatment. The diagnosis of scapulocostal syndrome for proper treatment includes:

Patient history taking

The doctors will inquire about pain characteristics, such as where the pain is located, whether there is radiating pain to other areas, what activities make the pain worse or better, and whether there are accompanying numbness or weakness symptoms. This helps differentiate the condition from other diseases with similar shoulder blade pain, such as disc-related diseases or rotator cuff tendon conditions.

Physical examination

The doctors will observe scapular movement whether there are restrictions or movement limitations, shoulder joint and upper cervical movement whether they function normally, and palpation for trigger points in muscles around the shoulder blade. The examination combines with muscle strength testing and sensory examination to differentiate scapulocostal syndrome from cervical nerve conditions.

Using medical diagnostic equipment

The equipment will be used when doctors suspect other accompanying conditions. Doctors may order X-rays or MRI scans of the cervical spine or shoulder area for more accurate diagnosis.

How to Treat Scapulocostal Syndrome

Step-by-step treatment for scapulocostal syndrome begins with supportive care by reducing pain for patients with severe pain symptoms, along with behavioral modification to correct the root cause of the problem. Then, strengthening exercise programs are prescribed for muscle strength and flexibility to prevent recurrence as follows:

Pain reduction

In the initial phase, if patients feel pain or tightness around the shoulder blade, they can first perform self-care by applying warm compresses for 15-20 minutes, then stretching muscles around the shoulder blade and taking pain medications for symptom relief. However, if self-care doesn’t improve symptoms, it’s recommended to see a doctor for clearly identifying the disease and receiving treatment using appropriate medications and physical therapy equipment.

Exercise postures for muscle stretching

Pain medications

After clear disease identification, doctors will prescribe medications to relieve pain and relax muscles, such as anti-inflammatory drugs and muscle relaxants.

Treatment with medical equipment

Medical therapists use an ultrasound machine to apply high-frequency sound waves on the affected area to reduce inflammation, relax muscles, and improve blood circulation to the muscle areas. Shock wave therapy is also used to stimulate the release of inflammatory substances (Substance P) while stimulating tissue recovery in inflamed areas.

Dry needling

If trigger points are found, treatment can include Western-style dry needling. This involves stimulating muscle knots to release tension and increase blood circulation to tight muscle areas.

Behavioral modification

After receiving treatment, doctors will recommend behavioral changes to reduce the likelihood of inflammation recurrence, such as adjusting work sitting postures, modifying work desks to fit ergonomically. It is recommended to change postures every 30 minutes to 1 hour during work to prevent muscles from remaining tense for too long.

Exercises for strength and flexibility of muscles around the shoulder blade

Once pain treatment improves symptoms, patients should begin muscle strengthening exercises for increased muscle strength, enabling proper daily activity postures, reducing muscle tension, and preventing pain recurrence.

The Perks of Treating Scapulocostal Syndrome at kdms Hospit

At kdms Hospital in Bangkok, Thailand, we have a comprehensive treatment team covering all aspects of accurate scapula pain or scapulocostal syndrome diagnosis. We have skilled rehabilitation medicine physicians, orthopedic surgeons, and highly capable physical therapists. Additionally, if there are concerns about symptoms from other conditions, we can immediately conduct examinations using advanced equipment such as MRI and X-ray machines.

Furthermore, kdms Hospital has comprehensive medical equipment for pain reduction, including ultrasound machines, shock wave therapy, laser therapy, and needling services, which readily provide complete, one-stop care.

Beyond pain reduction, we also focus on effectively preventing recurrence through behavioral modification, exercise recommendations, advanced exercise assessment equipment such as Red Cord Exercise, and exercise position guidance that can be adapted for home use.

In Summary

Scapulocostal syndrome refers to pain around the shoulder blade from muscle dysfunction, causing radiating pain to various locations, trigger points, and movement restrictions in the scapula or shoulder joint. In some cases, there may be radiating pain around the rib cage during breathing. This is considered one of the symptoms of myofascial pain syndrome. The main causes include usage-related symptoms, muscle tension around the shoulder blade from other conditions, and acute injuries.

For scapulocostal syndrome treatment at kdms Hospital in Bangkok, Thailand, we have a comprehensive treatment team covering all aspects of accurate scapulocostal syndrome diagnosis. Together with complete medical teams and equipment, we provide treatment until patients fully recover and recommend guidelines to prevent recurrence.

Q & A

If scapulocostal syndrome is caused by muscle dysfunction, it can be completely cured using the treatment methods mentioned above. However, in cases where other underlying causes exist, they may prevent complete recovery of the symptoms. For example, if patients have disc diseases, degenerative spine conditions compressing nerves, or rotator cuff tendon conditions, it’s necessary to treat these conditions first before completely resolving scapulocostal syndrome.

Nevertheless, scapulocostal syndrome can still recur if patients don’t modify their behaviors, such as improper sitting postures, maintaining the same position for long periods, and improper lifting techniques.

In terms of daily living, doctors recommend behavioral modifications. For people with scapula and peri-scapular muscle pain, most causes stem from office syndrome and prolonged work sitting at the office. Therefore, work desks and monitor levels should be adjusted to eye level, a keyboard at elbow level, and avoid rounded shoulder and forward head postures. Posture changes every 30 minutes should be implemented, along with muscle stretching exercises around the shoulder blade.

Additionally, muscles around the shoulder blade, such as rhomboid, lower trapezius, and infraspinatus muscles, should perform strengthening exercises to maintain good muscle health and prevent recurrence of pain around the shoulder blade.

An article by Aksarapak Panompornpanich, M.D., Experienced Rehabilitation Medicine Physician