Pain in the shoulder and breast area may be due to breast cancer surgery or radiation therapy. People might also experience pain if the cancer has spread.

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.

Read on to learn more about the connection between breast cancer and shoulder pain.

When you’re living with breast cancer, pain in your shoulder blade can result from treatment. Cancer therapies can affect the scapula and other upper back and arm structures, causing pain and potential injury. Nerves can also be damaged, leading to persistent pain in different areas.

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.

Skeletal pain, such as shoulder pain, can also indicate that cancer may have spread from your breast to other areas of your body.

If you’re experiencing pain in one or both shoulder blades, it’s important to talk with a doctor or healthcare professional about it as soon as possible.

If you’ve had chemotherapy, radiation, or surgery, you may have pain around your shoulder blade because of the treatment. These may include the following:

  • Postoperative pain: Surgery such as a lumpectomy can lead to some pain during recovery. The more extensive your surgery is, the more painful your arm and shoulder may feel.
  • Postmastectomy pain syndrome (PMPS): This chronic nerve pain is a common disorder that develops in people who have had a mastectomy due to breast cancer.
  • Axillary web syndrome: After breast cancer surgery, between 6% and 86% of people may develop tight bands of fibrous tissue under their skin, known as axillary web syndrome. These bands can cause pain in the shoulder area when you try to raise or extend your arm.
  • Radiation-induced fibrosis: Radiation therapy targets cancer cell DNA to stop growth but can also affect surrounding tissues. Studies show that it can change the elasticity, or stretchiness, of the muscles in the radiation area. This can lead to pain and organ dysfunction, which can cause pain and organ dysfunction.
  • Scapula alata: After breast cancer surgery, the shoulder blade near the spine may jut out and cause limited movement, swelling, and pain. Scapula alata is also called winging and typically resolves within a few months.

Depending on the cause, pain after breast cancer surgery may 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.

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.

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. If you haven’t experienced shoulder pain related to breast cancer before, or your doctor doesn’t believe it’s related to treatment, it may be a sign the cancer has spread.

One of the most common locations for breast cancer metastasis is in the bones. It’s also possible that pain near your right shoulder could be an indication that breast cancer has spread to the liver. This is because some of the nerve networks around the liver originate from the same nerves that attach near your right shoulder blade.

If it is a cancer relapse, treatment may help slow the cancer’s growth, relieve your symptoms, and protect your bones.

When should you not ignore shoulder pain?

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.

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 intense tingling or itching.

You might also experience sharp pain when you try to move your arms up or down. Swelling, stiffness, or numbness may also be present.

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

You may also feel depressed or anxious, and the pain may disrupt your sleep. Not getting enough sleep may make your pain feel worse.

Reducing shoulder pain after breast cancer treatment can take time, patience, and support. Your cancer care team can offer guidance, especially the healthcare professionals specializing in rehabilitation.

Here are some therapies that may help you:

  • Manual therapy: A physiotherapist performs this type of hands-on treatment. It’s particularly effective in helping drain fluid that can accumulate in the arm (lymphedema) and mobilizing joints and tissues. Research indicates it can help reduce pain and increase range of motion.
  • Therapeutic exercises: Active therapeutic exercises can aid in recovery. Better results are seen when people begin about 28 to 42 days after surgery, once the risk of damaging drainage points has passed.
  • Massage: Once your wounds have healed, massage may help relieve pain and increase your flexibility. A 2018 study found that 30 minutes of targeted (chest and shoulder) massage twice a week for 8 weeks reduced the intensity of pain and increased participants’ range of motion.

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

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 or radiation therapy. This therapy can affect 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, it’s advisable to contact a doctor.

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