Hello and welcome to HCM, A hard lump on the shoulder blade is most probably a lesion arising from bone. a X-ray of the back is required to know whether the lesion is arising from the bone or from area surrounding the shoulder blade. Since, the lesion is hard, there is likelihood of the lump arising from the shoulder blade. Pain in the lesion suggests involvement of nerve by the lump. A cyst is unlikely to produce a hard painful swelling. Thus, there is more possibility of a solid swelling. An aspiration cytology is the next investigations required. In aspiration cytology, cells are aspirated from the swelling, spread on slide, stained with appropriate stains and studied microscopically. On the basis of all these investigations, diagnosis will be made and thus management. Thanks and take care Dr Shailja Puri