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The never-ending shoulder blade pain could be caused by your Neck

Updated: Mar 24, 2023

Signs and Symptoms: Shoulder blade pain, neck pain, back pain, headache and poor sleep due to the pain.

Type of Trauma: Car accident at the age of teenager and fall from a push bike during the teenager period.


Adjustments: Specific atlas correction.


Outcome: All of the complaints have been resolved in two visits.




Patient in her mid 30s visited the Headache and Neck Clinic for her headache, neck pain, mid back pain and more. There were many traumatic events (From mild to moderate-severe). Also, during the physical examination her rotation of the C1 to the right was restricted more than the left. Left was also limited. Incidentally, at the end of the cervical rotation to the right side, her vision became blurry. Among all the symptoms, her chief complaint was the pain in between her shoulder blades. More specifically it is where the lower part of the neck transits into the shoulder level (Just like the above photo, the pain travels down to the shoulder blade area). It is an achy, pulling and tight sensation at the shoulder and the shoulder blade region, sometimes on both sides or on the left side only. It manifests intermittently and appears to be more noticeable with any physical activities. (Such as prolonged seated or standing posture, exercise etc).

Cone Beam CT was ordered to investigate the cause of the problems.

Following are the revealed findings.




  1. The space between the styloid process and the C1 TVP is narrowed. This can put mechanical pressure directly onto the left internal jugular vein and cause distended jugular bulb at the level of the jugular foramen.

  2. Agenesis of the posterior arch C1 (Incomplete fusion). This is a normal variant that could have resulted the anterior winging of the C1 TVP anteriorly. This is why the advanced imaging studies are such vital tool to screen out or investigate if there is any normal variants or anatomical anomalies because there is absolutely no method to reveal them, or you have to guess which is not possible.


Finding number 1 is a most common reason for the internal jugular vein compression and depending on how and where the venous structure is affected and altered, the clinical presentation varies. So far in the Headache and Neck Clinic, the most common phenomenon is the achy or something is not-at-ease sensation at the mid back/shoulder blade/scapular region.



SAN: Spinal Accessory Nerve

IJV: Internal Jugular Vein.


IJV and SAN exit through the hole in the skull called “Jugular foramen”. There are other cranial nerves passing the hole but let's focus on the Spinal Accessory Nerve for this article.

SAN is the primary nerve that innervates two muscles, first is trapezius and the second is sternocleidomastoid muscle. If the SAN is affected mechanically by the distended IJV at the level of the jugular foramen or the atlanto-occipital joint and by removing the pressure off from the IJV can result lots of positive clinical outcomes but most commonly observed, mid back pain (scapular region) relief.


The patient’s complaints, I mean all of it, disappeared in just two visits with the specific neck corrections.



If you suffer from shoulder blade pain for a long time or have them for all the time, On/Off - constant, think about this. If It was there for such a long time, why doesn’t it heal? You would wonder, Is there something wrong with the actual physical painful area? If you have tried everything and haven’t found your answer, why don’t you try to investigate the upper neck area?




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