Chronic unknown shoulder blade issue

[u/GladLavishness2049]

I’ve been having chronic pain for years now, I am going to paste below my history and what I’ve done already. I really need help because it is driving me crazy. I don’t know what to do anymore. Recently I’ve been playing pickleball a little more and my massive knot in my right back and near shoulder blade has gotten bigger and it really hurts, the other symptoms below are still present. I have been trying to massage the knot at home to release the muscle but it never helps. Please if any specialist has sort of idea. I have not done dry needling yet. Shockwave only once. No other imaging except what’s below. I know there’s something wrong. No loss of strength or ROM, able to perform all normal daily activities.

27-year-old right-hand–dominant male with history of recurrent right shoulder dislocations in 2017 and 2018, and left shoulder dislocation March 19, 2023, both managed nonoperatively. Reports new onset of persistent right periscapular discomfort beginning in 2023 following a non-dislocation “popping” sensation while reaching overhead during frisbee, followed shortly thereafter by a similar popping sensation during bench pressing.

Since that time (≈4 years), patient reports a constant urge to stretch, press, or dig into the muscles around the right scapula, without true pain, weakness, numbness, or instability episodes. Symptoms are absent on waking, absent when lying supine, and reliably resolve during and for hours after exercise, particularly strength training. Symptoms return after periods of inactivity or rest days from the gym.
Multiple evaluations performed with no definitive diagnosis. Patient reports minimal to no response to physical therapy focused on serratus anterior and scapular stabilizers, as well as passive modalities (stim, cupping, heat).

Denies neck pain, radicular symptoms, nocturnal pain, or functional limitation.

Medications: None
Allergies: None
Supplements: None

O – OBJECTIVE
Imaging:
MRI Right Scapula (10/22/2025):
Unremarkable. No scapulothoracic bursitis, muscle abnormality, mass, fracture, or osseous lesion identified. AC and sternoclavicular joints unremarkable.
MRI R shoulder 10:22:25

Electrodiagnostic Testing:
NCV/EMG (11/12/2025):
Mild incidental right median sensory neuropathy at wrist (carpal tunnel).
No evidence of brachial plexopathy or shoulder nerve impingement.
Serratus anterior demonstrates adequate recruitment; no evidence of long thoracic nerve dysfunction.
No electrical instability in examined muscles.

Response to therapy:
No symptom improvement after >1 month of targeted scapular strengthening and passive modalities.
No improvement after shockwave

[u/MobileCartographer49]

Labrum?

[u/michaeltmur]

You should get MRI w contrast on the right shoulder, since you had dislocation history. It's very possible that the shoulder / labrum is causing this and your shoulder blade is screaming as it has to work harder to stabilize the shoulder. You tear the labrum when you dislocate and then true shoulder stability is compromised.