The area between the shoulder blades, known as the interscapular region, is a common site for discomfort and pain. Understanding the source of this discomfort requires recognizing that the area is a complex intersection of muscle, spine, and nerve pathways, which can also receive pain signals referred from internal organs. The specific nature of the sensation is an important clue in determining the cause.
Common Musculoskeletal and Postural Causes
The most frequent source of interscapular discomfort involves the muscles and soft tissues of the upper back, primarily the rhomboids and trapezius. Strain in these muscles often results from repetitive movements, lifting heavy objects, or activities that cause the muscle fibers to be overstretched or torn. This muscular pain is typically described as a dull ache or a burning sensation that worsens with movement of the arms or shoulders.
Prolonged poor posture, such as slouching over a desk or phone, places chronic strain on the upper back muscles. This sustained, rounded-shoulder position causes the rhomboid and middle trapezius muscles to remain constantly lengthened and fatigued. The resulting discomfort is often chronic, characterized by a persistent, low-level ache that may be temporarily relieved by stretching or changing position.
Another frequent cause is myofascial pain syndrome, which involves sensitive, contracted spots within the muscle tissue known as trigger points. These localized points in the trapezius or rhomboid muscles can cause pain that radiates to the area between the shoulder blades. The trigger points feel like knots under the skin and can produce a deep, aching discomfort that may be accompanied by muscle stiffness.
Structural Issues of the Spine and Nerves
Pain originating directly from the thoracic spine involves issues with the bony structures and the nervous system. The thoracic facet joints, which connect the vertebrae, can become irritated or inflamed, a condition known as thoracic facet joint dysfunction. This structural pain is often localized near the spine and may cause stiffness, muscle spasms, or pain that radiates around to the chest or ribs.
Joints that connect the ribs to the spine, called costovertebral joints, can also be a source of discomfort. Dysfunction in these joints causes a sharp or dull pain near the junction of the rib and the spine that can be exacerbated by deep breathing, coughing, or twisting movements. Since the rib cage needs to expand with every breath, any irritation in these joints can make respiration painful.
Pain that is sharper, more intense, and follows a distinct pathway may indicate nerve impingement, or radiculopathy. This occurs when a bulging or herniated disc, or bone spurs, places pressure on a nerve root exiting the spine. A compressed nerve in the upper back can cause pain, numbness, or tingling that radiates to the area between the shoulder blades or even around the chest wall.
Referred Pain from Internal Conditions
A less common, yet medically significant, cause of interscapular pain is referred pain, where the discomfort originates in an internal organ but is felt in the back. This misinterpretation by the brain happens because the nerves supplying the organs share common pathways with the sensory nerves of the upper back. Referred pain from these internal sources is typically described as deep, burning, or crushing, and it is usually not relieved by changing position or stretching.
Cardiac conditions are a serious cause of referred pain, as a heart attack or a tear in the aorta (aortic dissection) can manifest as severe pain between the shoulder blades. Other cardiac issues, like pericarditis, an inflammation of the sac surrounding the heart, can also cause pain that radiates to the upper back. Women are more likely than men to experience back, neck, or jaw pain instead of the classic chest pain during a heart attack.
Gastrointestinal problems frequently refer pain to the interscapular region. Gallbladder disease, such as gallstones, often causes a stabbing or aching sensation that radiates to the right shoulder blade, especially after eating a fatty meal. Severe gastroesophageal reflux disease (GERD) can also cause pain between the shoulder blades. Lung conditions, including pulmonary embolism or certain lung tumors, may also cause pain that is felt in the upper back due to the proximity of the lungs and the shared nerve supply.
Recognizing Urgent Symptoms and Next Steps
Although most interscapular pain is musculoskeletal and resolves with conservative care, certain accompanying symptoms require immediate medical attention. Any sudden onset of severe, crushing, or unrelenting pain between the shoulder blades should be treated as an emergency. This urgency is amplified if the pain is accompanied by chest tightness, shortness of breath, dizziness, or excessive sweating, as these can be signs of a life-threatening cardiac event or a pulmonary embolism.
Other “red flag” symptoms that necessitate an immediate emergency room visit include pain associated with neurological changes, such as sudden weakness, numbness, or tingling in the arms or legs. The sudden inability to control the bladder or bowels is also a medical emergency. For pain that is persistent, lasting more than a week, or that interferes with sleep or daily activities, consult a primary care physician for a thorough evaluation.