Pain in and around your scapula — the triangle-shaped bone on either side of your upper back — is usually an orthopedic issue. However, there are times when it can be related to breast cancer.

Pain in your shoulder blade can be a result of breast cancer treatment or, in rare cases, an indication that cancer has spread from your breast to other areas of your body.

Research shows that nearly 35 percent of people who have been treated for breast cancer have moderate shoulder pain afterward. Post-treatment pain can limit your ability to lift your arms, cause you to lose muscle strength, and make it harder to do job-related or leisure activities.

If you’re experiencing pain in one or both of your shoulder blades, it’s important to talk with a doctor or healthcare professional about it sooner rather than later. Here’s why.

The type of pain you feel usually depends on what’s causing it. Some people have shoulder pain due to nerve damage from radiation therapy or a lumpectomy, mastectomy, or lymph node removal.

If you have neuropathic pain, you may feel a shooting or burning sensation. Some people describe the discomfort as an intense tingling or itching feeling.

You might also experience sharp pain when you try to move your arms up or down. This pain can be accompanied by swelling, stiffness, or numbness.

If your pain is caused by cancer that has spread (metastasized), it might feel like a deep, dull ache in your joints or bones. Pain near your right shoulder blade could mean that your liver is involved.

You may also feel depressed or anxious, and your sleep may be disrupted as a result of your pain. Not getting enough sleep may make your pain feel even worse.

Your shoulder is a complex, interconnected group of bones, muscles, ligaments, tendons, nerves, and blood vessels. These structures work together to align your posture and help you move your arms.

Your scapula serves several important functions:

  • It cups the ball-shaped end of the humerus bone in your upper arm.
  • It serves as an attachment plate for several muscles and ligaments.
  • It moves in several directions as you use your arms, providing stability and flexibility.

Cancer therapies can affect your scapula and many of the other structures in your upper back and arm. Some cancer therapies change the size of ligaments and muscles, which can make moving your shoulder painful. These changes can also make a shoulder injury more likely.

Other treatments damage the nerves around your shoulder blade, causing long-lasting pain in your shoulders, arms, hands, and feet.

Sometimes, shoulder blade pain is caused by cancer itself. When cancer spreads from your breast to your bones, liver, or other body parts, one of the symptoms of that metastasis is shoulder pain. This pain can be near your shoulder blade or in your shoulder joint or upper back.

Pain is not a common symptom of breast cancer. However, breast cancer that has metastasized (spread to other body parts) can sometimes cause shoulder blade pain.

One of the most common locations for breast cancer metastasis is in the bones. Pain can be related to the cancer itself or fractures that happen when bones weaken.

Bladder, prostate, thyroid, uterus, lung, and kidney cancers can also spread to your bones. Lung and kidney cancers are also known to spread to the shoulder joint and shoulder blade.

It is also possible that pain near your right shoulder could be an indication that breast cancer has spread to your liver, because some of the nerve networks around the liver originate from the same nerves that attach near your right shoulder blade.

If you’ve had breast cancer in the past, and you’re now experiencing shoulder pain, it’s a good idea to see a doctor about it as soon as possible. If it is a cancer relapse, treatment may help slow the cancer’s growth, relieve your symptoms, and protect your bones.

When to seek medical care for breast cancer symptoms

If you’ve had breast cancer before, call your doctor if you experience any of these symptoms, which could indicate that breast cancer has spread to your bones or liver:

  • bone pain
  • yellow skin or eyes (jaundice)
  • pain in your abdomen
  • nausea and vomiting
  • loss of appetite
  • feeling itchy

If cancer has spread to other places in your body, early treatment may help you feel better and live longer.

Healthline

Yes. If you’ve had chemotherapy, radiation, or surgery, you may have pain around your shoulder blade because of those treatments.

Postoperative pain

Breast cancer surgery often involves one or more of these surgical procedures:

If you’ve had any of these surgeries, you’ll likely have some pain during your recovery.

Studies have shown, perhaps unsurprisingly, that the more extensive your surgeries were, the worse your arm and shoulder pain is likely to be afterward. For example, people who’ve had surgery on their breasts typically have less shoulder and arm pain than people who’ve had breast surgery along with axillary lymph node dissection (ALND).

Around 20 to 30 percent of women who’ve had ALND develop a condition known as postmastectomy pain syndrome (PMPS). The exact cause of PMPS isn’t known, but symptoms include pain in your chest, armpit, arm, or shoulder. You may also feel itchiness in those areas as well.

Pain after breast cancer surgery can last a while. Although it may decrease as you recover, many people who have survived breast cancer report pain in their shoulder area years later.

Axillary web syndrome

Several weeks after breast cancer surgery, between 6 and 86 percent of people will develop tight, narrow bands of fibrous tissue under their skin. The bands often stretch across the chest wall or extend down the arm.

Although the pain isn’t always localized in the shoulder blade itself, these taut bands can cause pain in the shoulder area when you try to raise or extend your arm.

Axillary web syndrome can ease on its own, or it may come and go over a period of months or years. Physical therapy can often help “break” the bands to relieve the pain and improve your range of motion.

Radiation-induced fibrosis

Radiation therapy targets the DNA in cancer cells, destroying their ability to divide and grow.

Unfortunately, radiation also affects other surrounding tissues that are healthy. While these tissues can often rebuild, the new tissues can be thicker and more fibrous than they were before the treatment.

Studies show that radiation changes the elasticity, or stretchiness, of the muscles in the radiation field. Muscle stiffness may contribute to your pain.

In some cases, radiation therapy can lead to a condition called radiation fibrosis syndrome. This occurs when collagen fibrils continue developing, becoming increasingly tight over time.

Radiation fibrosis syndrome can keep your organs from working properly and affect your quality of life. It may even become life-threatening. If it is diagnosed and treated early, outcomes are generally much better.

Peripheral neuropathy

Sometimes shoulder pain is related to nerve damage that happened during cancer treatment.

Surgery, chemotherapy, and radiation can all do lasting damage to nerves in the treated area. The result can be pain, tingling, burning, or itching in your shoulders, arms, hands, and feet. It can also cause numbness or a loss of feeling in your hands and feet.

Some chemotherapy drugs can cause a nerve condition called chemotherapy-induced peripheral neuropathy (CIPN). CIPN can make it harder to perform simple tasks like writing and walking. It can also lead to more serious health issues, so it’s important to talk with your cancer care team if you’re having symptoms of nerve damage.

Scapula alata

After breast cancer surgery, the position of the scapula can sometimes shift. The edge of the shoulder blade closest to the spine can begin to jut outward slightly.

This condition is known as scapula alata or “winging.” One study estimated could occur in as many as 10 percent of cases.

When the position of your scapula changes, it affects the way your shoulder moves. It can also cause:

  • limited range of motion
  • pain, warmth, or burning as you lift or rotate your arm
  • swelling

Winging often resolves on its own within a few months after surgery, but physical therapy may be a good idea to help increase your mobility.

A note about health disparities

As is true for many health conditions, shoulder pain after breast cancer treatment can be worse for people with lower incomes and people of color. Researchers theorize this may be because cancer was not detected until a more advanced stage and therefore required more extensive treatment.

Reducing shoulder pain after breast cancer treatment can take time, patience, and support. Look for guidance from your cancer care team, especially the healthcare professionals who specialize in rehabilitation.

Here are some therapies that may help you.

Manual therapy

Manual therapy is a kind of physical therapy in which a physiotherapist provides hands-on treatment. It’s particularly effective in helping to drain fluid that can accumulate in the arm (lymphedema) and in mobilizing joints and tissues.

Research indicates that manual therapy helps reduce pain and increase your range of motion.

Therapeutic exercise

Research has found that active therapeutic exercises can aid in recovery. The best results are seen when people begin physical therapy roughly 28 to 42 days after surgery, once the risk of damaging drainage points has passed.

It’s a good idea to start this type of treatment slowly and gently. A good physical therapist can guide you through the proper exercises, and can ensure you’re moving your shoulder blade correctly with good posture.

Therapeutic exercise is not easy, but it’s worth sticking with it: Studies show that the results can take around a year to achieve.

Massage

Once your wounds have healed, massage may help relieve pain and increase your flexibility.

A 2018 study looked at 21 women who were still experiencing pain several months after breast cancer surgery. The researchers found that 30 minutes of targeted (chest and shoulder) massage twice a week for 8 weeks reduced the intensity of pain and increased their range of motion.

Medication

If over-the-counter medications aren’t enough to manage your pain, your doctor may prescribe opioid pain medications or corticosteroids to help.

If you’re in pain due to cancer that has moved to your bones, your oncologist can prescribe medications to slow the progression and help prevent bone fractures.

It’s common to have pain in and around the shoulder blade after breast cancer treatment.

The pain may be related to surgery, chemotherapy, or radiation therapy. Those treatments may have changed the muscles, ligaments, and collagen fibers in the treated area, making it harder to move your arm freely.

Less commonly, people may have shoulder blade pain if cancer has spread from the breast to other places in the body, especially the liver and bones.

If you need help regaining mobility in your shoulder after breast cancer treatment, or if you’re still having pain after the postoperative period, see a doctor.

Medication, massage, therapeutic exercise, and manual physical therapy can all help you feel and move better.