Your Scapular Pain is Probably Coming From Your Neck (Research Review)

By Grant Frost · Physiotherapist • Last clinically reviewed: 25 June 2026

If you have pain between your shoulder blades - that nagging, deep ache that just won't shift - you might be experienced referred pain. Perhaps you've tried stretching it, giving it a massage or seeking specific treatment. Maybe it's been weeks or months, and it's still there.

But what if that pain is actually coming from your neck?

A new scoping review published in North American Spine Society Journal (Carmichael et al., 2025) has mapped the evidence on scapular pain in cervical dysfunction. And the findings are striking: scapular pain is the third most commonly reported pain location in cervical radiculopathy (when a nerve root in the neck is annoyed, overloaded or irritated), appearing in 72% of studies reviewed .

But perhaps the most clinically important finding is this: scapular pain may be a symptoms of hidden neck dysfunction. In other words, if you only wait for more obvious neck or arm pain to appear, you could be missing the earliest - and potentially most treatable - window of opportunity.

What the study found

The researchers conducted a scoping review of 86 studies published between 1957 and 2022. They mapped the literature describing pain distribution in patients with cervical radiculopathy, with a specific focus on scapular pain.

Pain distribution by region

Among the 81 studies that described pain distribution by region, the findings were clear :

The most common concurrent pain patterns were:

• Neck and arm pain: 80% of studies
• Neck and scapula pain: 63% of studies
• Arm and scapula pain: 61% of studies
• All three regions together: 58% of studies

Importantly, only 2% of studies reported isolated scapular pain without concurrent pain elsewhere . This means that while scapular pain is common, it rarely occurs in isolation - which actually makes clinical sense. The neck, the arm, and the scapula are all connected through the nerve roots and biomechanical structures.

Why this matters for diagnosis

The traditional view of cervical radiculopathy is that it requires pain in the arm. Many definitions in the literature explicitly state this. For example, one definition cited in the review describes cervical radiculopathy as "pain arising in the arm caused by irritation of a cervical spinal nerve". Another states that patients "typically present with neck pain, arm pain, or both" .

The implication is clear: if you don't have arm pain, it can't be cervical radiculopathy, or your neck may not be as important to this conversation. 

But this review challenges that assumption. The evidence suggests that scapular pain can be a symptom of cervical radiculopathy even in the absence of arm pain. In fact, one study found that neck or scapular pain preceded arm or finger symptoms in 70% of cases .

This has profound implications for early diagnosis. If a patient presents with isolated scapular pain, a clinician who is only looking for arm symptoms might dismiss the possibility of neck dysfunction. But the evidence suggests that this patient could be in the early stages of cervical radiculopathy, and that intervening early could prevent progression to more disabling symptoms.

A clinical perspective: if you don't check the neck, you could be missing everything

Clinically, this speaks to the exact situation many people I treat end up in.

People come in with pain between their shoulder blades. Sometimes it's a deep ache. Sometimes it's a sharp, catching pain. Sometimes it's been there for weeks, months, or even years. They've tried everything - massage, dry needling, stretching, strengthening. Sometimes it helps a bit. But it never fully goes away.

And almost always, when I examine their neck, I find something.

Maybe it's restricted cervical rotation. Maybe it's pain on cervical extension. Maybe it's tenderness over the facet joints. Maybe it's a positive joint test that reproduces their scapular pain.

But more importantly, when I treat the neck - with some gentle joint mobilisation, soft-tissue massage, etc, - the scapular pain often improves.

This review validates what I see clinically: the neck and the scapula are intimately connected. And if you don't check the neck, you could be missing the source of the problem.

This is not to say that all scapular pain is neck-related. There are plenty of other causes - thoracic spinal and rib joint dysfunction, myofascial pain, shoulder pathology, and more. But the evidence is clear: neck dysfunction is a common and under-recognised cause of scapular pain, and it should be on the radar for anyone presenting with pain in that region.

Which nerve root levels are involved?

Among the 57 studies that reported pain distribution by nerve root level, the most common levels were :

• C6: 82% of studies
• C7: 77% of studies
• C8: 63% of studies

The C7 nerve root level had the highest proportion of scapular pain descriptions compared to all other levels .

This is clinically relevant. If you know that C7 radiculopathy often presents with scapular pain, you can look for other signs of C7 involvement - such as weakness in the triceps or wrist extensors, or altered sensation in the middle finger.

Better still, if you take a lacrosse ball, lie down and let it press into different parts of your neck, you might find those levels stiff, tight, restricted, or even tender - even without any actual overt neck pain to note.

Some studies have also suggested that the specific location of scapular pain may help localise the involved nerve root . For example, suprascapular pain was linked to C5 or C6 radiculopathy, while lower scapular or intrascapular pain was linked to C7 or C8 radiculopathy .

However, the review also notes that there is considerable overlap between radicular and facet pain patterns . This means that distinguishing between the two based on pain location alone can be challenging. Clinical examination - including provocation tests, neural tension tests, and neurological examination - remains important .

Implications for you

So, what does this mean for you?

For patients:

• If you have pain between your shoulder blades that isn't improving, don't assume it's just a muscle strain. It could be coming from your neck.
• Pay attention to whether neck movements change your scapular pain. If they do, that's a clue. Grab a ball and see if you can find any local restricted spots at the base of your neck.
• Don't wait for arm or neck pain to appear. Early intervention could make a big difference.

Frequently asked questions

Living With Persistent Pain?

If your pain has lasted longer than expected, feels disproportionate to injury, or hasn't responded to standard treatment, you may benefit from a broader approach. Learn more about our shoulder pain physiotherapy services in Port Macquarie.

Want personalised guidance?

If you would like help making sense of your aches, pains, or ongoing symptoms, you can book with Grant either in Port Macquarie or via telehealth.

Book In-Person (Port Macquarie) Book Online Telehealth Consultation