If the pain is felt in the back of the shoulder near or above the shoulder blade, it sometimes is due to a pinched nerve in the neck. Think of the nerve as a wire, conducting electricity to the muscles and skin. The spine in the neck area has seven bones, or vertebrae. The wire-like nerves leave the spine through small openings at each level between the vertebrae. When conditions in the neck cause pinching of a nerve, pain may radiate to the top or back of the shoulder, or down the arms. These conditions include bulging discs in the neck, or bone spurs from arthritis in that area called degenerative disc disease.
The pain may feel like a burning, shock-like electric pain, a 'hot poker' pain in the shoulder blade area, or sometimes an uncomfortable numbness or tingling sensation in the upper back, shoulder or arm. If a nerve is causing the pain, it is unusual for the shoulder to be swollen or to feel hot or stiff. In fact, sometimes massage or pressure on the area improves the pain temporarily.
The diagnosis is made usually from the type of pain (burning is very typical of nerve pain). The location of the pain is very helpful as well. X-rays may suggest there is the possibility that a nerve may be pinched, but also may not help. If weakness in the hand or arm is present, or the reflexes are not normal additional testing such as an MRI or nerve conduction tests may be necessary in order to prevent permanent nerve injury.
Pain may be improved by directing treatment to the neck region by physical therapy. If this is not successful or symptoms worsen other methods to reduce inflammation around the nerve (such as an injection of a cortisone-like medication near the nerve in the neck, often called epidural injection) may be tried. Sometimes surgery to relieve pinching on the nerve is necessary.
If you develop shoulder pain with exercise or exertion, please contact your physician as this may be a sign of heart disease.