If neck, mid, back, or shoulder blade symptoms are worse with driving or after driving, it’s worth considering your car posture. The same applies to symptoms anywhere in the head, face, shoulder or arm, all the way to your fingers. (The lower portion and bottom seat can play a role in low back and leg problems.) Most cars put the mid back in flexion and the neck in flexion and/or protrusion. In other words, the mid back joints are rounded and the joints of the neck are either bent forward or pushed forward.
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If a posture has no effect on symptoms while you’re in the position nor after, and if your movement ability is not negatively affected, then there’s no problem. For a lot of patients with upper body complaints, though, posture in the car does warrant discussion. Many patients note driving is exacerbating and many patients spend a fair amount of time in their cars. The good news? With all of the patients’ cars I’ve assessed, adjusting the ergonomics of the car is easy and inexpensive. The theme is usually (if not always) to get the upper body straight, not flexed. The hardest part is for patients to get used to it - but that beats symptoms! -- Laura

Differential orthopedic diagnoses for shoulder blade pain include a strain/pull/tear to any of the muscles in the area (there are many) and a shoulder joint disturbance. It’s very rare that you injure one of those muscles - and shoulder joint derangements only infrequently refer pain posteriorly to the shoulder blade. Can a frozen shoulder refer pain back there as well? Sure. But that’s not usually going to be the chief complaint of someone with a frozen shoulder.
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The joints in the cervical spine and the thoracic spine can refer symptoms to many areas, and the shoulder blade is a big player. With altered electricity coming from irritated spinal nerves, it’s not uncommon to find spasms or trigger points in the shoulder blade muscles. Those findings are the symptoms, not the culprit. Local weakness can also be a finding due to spinal nerve irritation. I find that in nearly every case I’ve seen in which the person complains of shoulder blade pain (or ache or tightness), we can fix it with repeated or sustained movements of the spine - in the sagittal, frontal, or transverse plane. -- Laura