Persistent Shoulder Blade Discomfort? The Cause May Be in Your Neck

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.

A woman in her mid-30s visited the Headache and Neck Clinic with a range of symptoms, including headaches, neck discomfort, mid-back pain, and persistent tension between the shoulder blades. Her main concern was a recurring ache that extended from the lower neck region into the shoulder blade area—often described as tight,

pulling, and intermittently painful, especially with physical activity or prolonged postures.

During her initial evaluation, multiple previous physical traumas (ranging in severity) were noted. Clinical examination revealed reduced range of motion, especially with rightward cervical rotation, which also caused transient blurred vision near the end range—suggesting a potential neurological component.

Due to the combination of symptoms and examination findings, a Cone Beam CT (CBCT) scan was referred to investigate structural and anatomical contributors in greater detail.

Following are the revealed findings.

1. A narrowed space between the styloid process and the C1 transverse process (TVP) may place mechanical pressure on the internal jugular vein, potentially contributing to changes in blood flow—such as a distended jugular bulb near the jugular foramen

2. Agenesis of the posterior arch of C1 (incomplete fusion) is a normal anatomical variant that may cause the anterior winging of the C1 transverse process (TVP). This highlights the importance of advanced imaging techniques, such as CBCT, to accurately identify and investigate such variants or anatomical anomalies—conditions that may not be detectable through standard methods.

The first finding is a common cause of internal jugular vein compression. Depending on the location and nature of the compression, the clinical presentation can vary. In our experience at the Headache and Neck Clinic, the most common symptom observed is an achy or uncomfortable sensation in the mid-back, shoulder blade, or scapular region

SAN: Spinal Accessory Nerve

IJV: Internal Jugular Vein

The Internal Jugular Vein (IJV) and the Spinal Accessory Nerve (SAN) both pass through a structure in the skull called the "jugular foramen." While several cranial nerves pass through this area, we will focus on the SAN in this article.

The SAN is responsible for innervating two important muscles: the trapezius and the sternocleidomastoid. If the SAN is mechanically affected by pressure from the distended IJV or at the atlanto-occipital joint (where the skull meets the top of the neck), relieving this pressure can result in significant clinical improvements. One of the most commonly observed positive outcomes in our clinic is relief from mid-back and scapular pain.

In this patient's case, all complaints, including neck and shoulder blade pain, resolved in just two visits following specific neck corrections.

If you're struggling with persistent or intermittent shoulder blade pain that doesn't seem to heal, consider this: If the pain has lingered for so long, is it possible that the source of the problem isn't in the area that hurts? If you've tried numerous treatments without success, it may be time to explore the possibility of an issue in the upper neck area.