Pain between the shoulder blades, also known as interscapular pain, is common. This discomfort can range from a mild ache to sharp pain. Causes vary from benign issues like muscle fatigue to more significant health concerns. Understanding these origins helps determine if professional evaluation is needed.
Musculoskeletal Factors
Musculoskeletal issues frequently cause pain between the shoulder blades, often stemming from muscles, bones, and joints in the upper back. Muscle strain commonly occurs from lifting heavy objects, repetitive movements, or poor posture. The trapezius and rhomboid muscles, connecting the shoulder blades to the spine, are susceptible to strain, resulting in sharp pain, spasms, or weakness.
Myofascial pain syndrome can cause persistent discomfort. This chronic pain disorder involves trigger points—tender spots within muscles and fascia—that cause localized or referred pain. Muscle overuse, trauma, or poor posture can contribute to these trigger points, leading to stiffness, fatigue, and disrupted sleep.
Problems within the thoracic spine (middle back) can also cause pain between the shoulder blades. Stiff or inflamed facet joints, connecting the vertebrae, can cause localized pain or pain spreading to the shoulder blade, often worsening with back extension or twisting. Similarly, costovertebral joints, where ribs attach to the spine, can become irritated or misaligned, leading to a dull ache around the shoulder blade that intensifies with deep breathing, coughing, or trunk rotation.
Scapular dyskinesis involves altered shoulder blade movement, often appearing as “winging” or an uneven position. This can cause pain and tenderness around the scapula, along with weakness and reduced arm range of motion. Muscle imbalances, poor movement mechanics, or overuse from repetitive overhead activities can contribute to it.
Nerve Compression and Irritation
Pain between the shoulder blades can also arise from nerve compression or irritation. Thoracic radiculopathy occurs when nerve roots exiting the thoracic spine are compressed or irritated, often due to disc herniation or spinal stenosis. This can lead to radiating pain, sometimes felt as a burning, stinging, or electric sensation between the shoulder blades.
Less common, nerve entrapment can also contribute to this pain. For example, the suprascapular nerve, which supplies muscles around the shoulder blade, can become compressed, causing pain perceived in the interscapular area. Nerve-related pain may include numbness, tingling, or muscle weakness, helping distinguish it from musculoskeletal discomfort.
Pain Originating from Other Body Systems
Pain between the shoulder blades can be referred pain, originating from an internal organ or system elsewhere in the body. This occurs because the brain interprets pain signals from internal organs as coming from a different body part due to shared nerve pathways. Recognizing these patterns is important, as they can indicate serious underlying conditions.
Cardiac issues are a notable cause of referred pain to the upper back. A heart attack or angina (chest pain from reduced heart blood flow) can manifest as discomfort between the shoulder blades, alongside chest pain, arm pain, or shortness of breath. Gastrointestinal problems can also refer pain to this area. Conditions like GERD, gallstones, pancreatitis, or ulcers may cause upper back or interscapular pain, sometimes with digestive symptoms like heartburn, nausea, or abdominal discomfort.
Lung conditions may also cause interscapular pain. Pleurisy (inflammation of the lung lining) or pneumonia (lung infection) can cause sharp chest or back pain that worsens with breathing or coughing. Rarely, lung cancer can present with shoulder blade pain. Aortic dissection, a serious tear in the body’s main artery, can cause sudden, severe back pain, including between the shoulder blades.
When to Seek Professional Medical Advice
While much interscapular pain is due to musculoskeletal strain and resolves with rest, certain symptoms warrant prompt medical attention. It is advisable to consult a healthcare professional if pain is severe, persistent, or worsens. Immediate medical evaluation is necessary if accompanied by red flag symptoms.
Urgent indicators include chest pain, shortness of breath, dizziness, excessive sweating, or pain radiating down an arm or into the jaw, as these could signal a cardiac event. Other concerning symptoms are numbness, tingling, or weakness in limbs, unexplained weight loss, fever, or pain not improving with rest. Timely medical advice ensures accurate diagnosis and appropriate management, especially for serious underlying conditions.