Causes of Pain Between the Shoulder Blades

Upper back pain between the shoulder blades has many causes, including muscle strain, herniated discs, arthritis, or, less often, a serious health problem. Treatment for pain between the shoulder blades depends on the cause but frequently includes stretching and medications for pain.

This article goes over some of the reasons you might be experiencing pain between your shoulder blades, and when you should see a doctor.

Possible Causes of Pain Between the Shoulder Blades

Pain between the shoulder blades can develop from a problem with any body parts located between the shoulder blades, such as:

• The skin between the shoulder blades
• Muscles like the rhomboids, middle trapezius, and lower trapezius, which all help keep your shoulder blades back and down
• The thoracic spine (center portion of the spine)
• The thoracic aorta, which is part of the largest blood vessel that carries blood from the heart to the rest of the body
• Part of the esophagus 
• Part of the heart
• A portion of the lungs
  

You might also have referred pain. When this happens, nerves send signals that cause pain near the shoulder blades, even though the original source of the pain is somewhere else.

Muscle Strain

Muscle strain (pulled muscle) is the most common cause of pain between the shoulder blades. You can pull a muscle from:

• Poor posture, especially when you lean forward while you sit or stand for long periods of time
• Lifting heavy objects
• Activities that involve twisting, like golf or tennis
• Sleeping on a mattress that doesn't give you adequate support

Trauma

Trauma can cause injuries that lead to shoulder pain, such as shoulder joint separation and rotator cuff tears.

A shoulder joint separation is different than a dislocated shoulder, which you might feel in the shoulder joint.

Herniated or Bulging Discs

Degenerative disc disease in the cervical spine or thoracic spine can irritate or press on your nerves or spine. This can lead to pain between your shoulders.

Other symptoms of a herniated disc include:

• Numbness
• Tingling
• Pain in one or both arms
  

Sometimes pain caused by disc disease in the neck is positional, meaning it can get better or worse when you flex or extend your neck.

Arthritis

Arthritis in the neck or the ribs may cause interscapular pain, even without any neck pain.

Heart Attack

Heart attacks don't always begin with chest pain. This is particularly true in women, whose heart attack symptoms can differ from the "classic" ones most associate with the condition.

A 2020 analysis in the Journal of the American Heart Association found men and women often have different heart attack symptoms. For example, men experience chest pain as a symptom more often than women.

The study authors also reported that women are more likely to have pain between their shoulder blades before a heart attack than men. The pain is often dull, but persistent. Other symptoms include chest pain, shortness of breath, or lightheadedness.

Symptoms of heart disease in women are hard to recognize, and women are more likely to die from heart attacks than men.

Cancer

Lung cancer, especially Pancoast tumors (a rare form of lung cancer), may cause referred pain. The tumors push on nerves near the top of the lungs, which can refer the pain to the area between the shoulders.

Other cancers that may cause pain in this region include:

• Esophageal cancer
• Mesothelioma
• Lymphomas
• Liver cancer

Breast cancer and other cancers that spread to the bones in the neck may also cause pain between the shoulder blades, sometimes without other symptoms.

Gallbladder Disease

Referred pain from gallbladder disease often occurs after eating a fatty meal. It comes as a stabbing pain between the shoulder blades, along with nausea and pain in the right upper quadrant of the abdomen.

Pinched Nerve

Another cause of the pain is a pinched nerve. One example is myofascial pain syndrome, a condition that causes muscle spasms and pain.

Acid Reflux

Gastroesophageal reflux disease (GERD) may cause referred pain to the back in the area between the shoulder blades. Other symptoms of GERD include:

• Chest discomfort or ache
• Hoarse voice
• Swallowing problems
  

Inflammation in the pancreas may also cause this pain because of its proximity to the diaphragm, a thin muscle in your chest that is partially attached to your spine.

Scoliosis

Scoliosis (curvature) in the thoracic spine might cause pain in between the shoulder blades if the condition is serious. However, this is rare.

Thoracic Aorta Tear

A thoracic aortic dissection is when a tear in the inner wall of the blood vessel allows blood to leak between the walls of the aorta. A thoracic aorta rupture is when there is such a tear through all of the layers of the vessel.

The pain that goes along with these is rapid and severe. It can feel like a sudden sharp and tearing pain in the upper middle back.

These conditions are medical emergencies.

Pulmonary Embolism

A pulmonary embolism (PE) is a life-threatening condition. It can occur when a clot in the legs breaks off and travels to the lungs.

Conditions that can increase your risk of a pulmonary embolism include:

• Traveling by car or plane for a long time
• Recent surgery
• Pregnancy
  
• Cancer

The pain is sharp and happens suddenly. Some people also experience severe shortness of breath, while others only have mild discomfort.

Before a pulmonary embolism occurs, you might have signs of a blood clot in your legs, such as pain, redness, and swelling.

Thoracic Vertebral Compression Fractures

Compression fractures are those that happen when the spine squeezes down to a shorter height. They can occur as a result of metastatic cancer (cancer that has spread) or osteoporosis.

These fractures can cause interscapular pain.

Since fractures in this region aren't as common as those in the cervical or lumbar spine, the diagnosis may be delayed.

Shingles

Shingles can cause pain almost anywhere in the body. It affects certain nerve pathways, typically on one side of the body, including one that runs through the shoulder blades.

This viral infection is caused by the varicella-zoster virus (VZV). If this virus sounds familiar, it's because it's also what causes chickenpox.

In addition to a rash, you may experience lasting pain as a result of shingles—a condition called postherpetic neuralgia. It can feel like a burning or stabbing pain in specific areas of the body where you had shingles.

Epidural Anesthesia

People who have an epidural (pain relief injection) for labor or for a C-section might feel intense interscapular pain.

This pain gets better when the anesthesia drip slows down. It goes away soon after delivery.

When to Call Your Healthcare Provider or 911

Some causes of pain between the shoulder blades are serious and can be life-threatening.

Diagnosis and Treatment

If you have pain between your shoulder blades, your healthcare provider will ask you about your medical history and symptoms. Some common questions might include:

• When did the pain start?
• Did the pain begin suddenly or more gradually?
• How intense is the pain?
• Is the pain burning, sharp or dull, stabbing, or nagging?
• Is there anything that makes the pain worse or better?
• What other symptoms do you have? For example, do you have chest pain, shortness of breath, unexplained weight loss, trouble swallowing, pain in your jaw, or arm pain?
  
• Have you experienced any trauma?
• Did you start any new exercise or have you done any heavy lifting?
• Do you or your family have a history of heart disease, high cholesterol, or high blood pressure?
• Do you smoke or have you ever smoked?

You may also need imaging tests such as an X-ray or MRI before a diagnosis can be confirmed. 

Treatment will depend on the underlying cause of your pain. If your pain is related to muscle strain, this may include over-the-counter pain relievers like Advil (ibuprofen). Stretching exercises, ice, and avoiding activities that put strain on the area can relieve the pain and help you recover. 

More serious conditions such as a rotator cuff injury may require surgery. If your pain is caused by something unrelated to the structures in the shoulder or back, such as a heart condition, you may require interventions like medication or lifestyle changes.

Summary

Pain between the shoulders is pretty common. Sometimes it's caused by a pulled muscle or an injury, such as a shoulder separation. But it can also be a sign of something more serious, like heart disease or cancer.

If you're feeling this type of pain, particularly if it's worsening or persistent, see your healthcare provider. And if you have other symptoms like chest pain or shortness of breath, call 911.

And remember that you are always free to seek a second opinion if you feel you could benefit from one. You might consider starting with an orthopedist, as this specialist focuses on the musculoskeletal system (i.e, your bones, joints, muscles, and so on).