Pain below the left back scapula may have the following causes: 1. Herpes zoster, the early stage of herpes zoster can appear in the back of the shoulder pain, after the incubation period can appear in clusters of herpes, then you should go to the dermatology department for consultation. 2. Intercostal neuralgia, intercostal neuralgia can be in the intercostal nerve below the scapula, then you need to carry out nerve nutrition and closed treatment, often radiating pain, hidden pain or pins and needles pain. 3, 3, scapula or rib tumor, and cause pain below the scapula, then CT, ECT examination to diagnose. 4, lung disease, when the lung tumor or inflammation, can also appear in the back of the lower scapula pain, then the lung CT for diagnosis.