Question: Pain felt at the medial border of the scapula can be caused by four different types of injuries. What are they?

Answer: An injury to the sixth or seventh intertransverse ligament, a thoracic ligament injury, a displaced rib or an injury to the rhomboid muscles.

The most common cause of pain at the medial scapula is a sprain of the intertransverse ligament at the C7 level (going from the sixth intertransverse process to the seventh), sometimes referred to as TP7. The second most common cause is a sprain of the thoracic ligaments, which are quite painful when injured. They refer pain laterally toward the scapula, along the lines of the ribs. The third cause of medial scapular pain is a slightly misaligned rib. In this case, the pain is less likely to be long-lasting. The final possible cause is a strain to the rhomboid muscles. These muscles have very broad attachments and are the least likely site of injury.

When pain is referred to the scapula from TP7 or from the thoracic ligaments, the discomfort tends to make all the muscles in the upper back contract, causing specific points of muscle tension or trigger areas. These generally respond well to massage therapy and they often subside when the primary cause of the pain is successfully treated.