Causes of Pain Between the Shoulder Blades
Possible Reasons for Interscapular Pain
Medically reviewed by Amy Kwan, PTMedically reviewed by Amy Kwan, PT
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 addresses some of the reasons you might be experiencing pain between your shoulder blades, how it's treated, and when you should see a healthcare provider.
Verywell / Joshua Seong
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
Related: 5 Posture Training Exercises to Reduce Pain and Sagging
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.
Other injuries that may cause upper back pain between the shoulder blades include:
Car or bike accidents
Falling from a height (steps or ladder)
Slipping and falling
A sports collision (football, soccer, hockey)
These injuries can cause upper back pain by injuring spinal bones, discs, muscles, ligaments, nerves, and/or other soft tissues.
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 along your shoulder, elbow, forearm, and fingers
Tingling in the shoulder, arm, or fingers
Pain that moves to the upper arm, forearm, and fingers 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 may cause interscapular pain if it occurs in or spreads to the neck and spine. Spinal arthritis is inflammation of the facet joints in the spine and/or inflammation at the sites where ligaments and tendons attach to the bones of the neck and spine.
Osteoarthritis (develops with wear and tear) is the most common type of spinal arthritis. Rheumatoid arthritis, an autoimmune disorder, can also affect the neck and spine.
Related: What Is Cervical Spondylosis?
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 people associate with the condition.
A 2020 research analysis 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.
Related: Warning Signs of a Heart Attack in Women
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:
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:
Feeling that food is stuck behind the breastbone
Heartburn or a burning pain in the chest
Nausea after eating
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 occurs 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 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
Obesity
Smoking
Taking birth control pills or hormone replacement therapy
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 of the back are broken vertebrae (bones of the spine). They can occur as a result of metastatic cancer (cancer that has spread) or osteoporosis.
These fractures can cause shoulder blade 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.
Related: What Shingles Looks Like
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.
Takeaway
Call 911 right away if your shoulder blade pain happens with:
Shortness of breath
Chest pain
Lightheadedness
Even if you just have a "gut feeling" that something bad is happening, don't wait. You need urgent medical treatment for pain between the shoulders that is accompanied by these other symptoms.
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.
Prevention
Not all causes of pain between the shoulder blades can be prevented, but some ways to reduce upper back pain may include:
Maintaining good posture by avoiding hunching the shoulders or pushing the neck forward
Doing upper body exercises regularly to keep the muscles in the shoulders and upper back strong
Avoiding heavy lifting
Using a comfortable chair if you sit for long periods
Maintaining a healthy weight to reduce strain on the back
Doing yoga or stretching exercises to reduce tension and tight muscles in the upper back and shoulders
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.
Frequently Asked Questions
When should you worry about upper back pain between shoulder blades?
Upper back pain between the shoulder blades can be a symptom of a heart attack, stroke, or another serious cardiac event.
If you experience pain between your shoulder blades accompanied by chest pain, lightheadedness, or shortness of breath seek immediate medical attention.
Can pain between shoulder blades indicate a lung problem?
Yes, debilitating pain between the shoulder blades can indicate a pulmonary embolism. This occurs when a blood clot in the leg travels to the lungs. Other symptoms can include shortness of breath, dizziness, sweating, clammy skin, fever, and swelling in the legs and feet.
How do you relieve mild back pain between shoulder blades?
Musculoskeletal pain can be relieved with a combination of ice or heat, over-the-counter pain relievers, and prescription medications. Stretching exercises or chiropractic manipulations can also help.
If the pain is chronic, talk to your healthcare provider about getting a referral to physical therapy. A physical therapist can address the root causes and teach you exercises to help relieve the pain.
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