Pain between the shoulder blades, medically termed interscapular pain, is a common complaint. This discomfort is felt in the upper back, situated between the vertebral column and the scapulae, and often presents as a dull ache, tightness, or a sharper, burning sensation. Because this region is a neurological crossroads for structures from the neck, chest, and abdomen, the pain’s origin can be misleading.
Common Muscular and Postural Causes
The most frequent source of interscapular pain relates directly to the muscles and soft tissues of the upper back and shoulders. Poor posture is a primary contributor, especially for individuals who spend long hours seated at a desk or looking down at a screen. This prolonged forward head and rounded shoulder position significantly strains the muscles responsible for holding the shoulders back.
This static, strained position particularly affects the rhomboids and the middle trapezius muscle. These muscles become fatigued and overstretched from constantly resisting gravity, leading to a dull, persistent ache. The resulting muscle tension can also lead to the formation of myofascial trigger points, often described as painful, tender “knots” within the muscle tissue.
The phenomenon known as “tech neck” creates a substantial load increase on the cervical spine and surrounding musculature. This chronic strain is a direct mechanical cause of tension and localized pain in the interscapular region. If the underlying postural habits are not corrected, this pain can become chronic and limit mobility.
Structural Issues Originating in the Spine
When pain originates from the vertebrae or the nerves branching from the spinal cord, the sensation is more intense and can involve neurological symptoms. Issues in the cervical spine frequently refer pain to the area between the shoulder blades. This occurs because the nerves that exit the neck, particularly at the C6 and C7 levels, travel through or near the upper back region.
A common structural cause is cervical radiculopathy, often described as a pinched nerve. This condition arises when a nerve root is compressed by a herniated disc or by bone spurs from spinal arthritis. The irritation causes pain to radiate along the nerve’s pathway, resulting in a sharp, burning pain felt around the shoulder blade, often accompanied by numbness, tingling, or weakness extending into the arm or hand.
Problems in the thoracic spine are less common but can also cause localized interscapular discomfort. Conditions like thoracic facet joint dysfunction, where the small joints between the vertebrae become inflamed, create a sharp, localized pain that worsens with specific movements or twisting. Degenerative disc disease or spinal alignment issues like scoliosis can also place chronic strain on the ligaments and muscles, leading to persistent interscapular pain.
Referred Pain from Internal Organs
Pain felt between the shoulder blades can be a manifestation of visceral referred pain, meaning the sensation originates in a distant internal organ but is perceived in the back. This happens because the sensory nerves from the internal organs and the nerves from the back share common pathways in the spinal cord. When the brain receives these signals, it misinterprets the source of the pain.
Cardiac issues represent one of the most serious causes of referred interscapular pain. During a heart attack, many women experience atypical symptoms, including isolated pain in the upper back, jaw, or shoulder blades, rather than classic chest pressure. This cardiac-related pain may feel like a persistent ache or tightness and can occur with shortness of breath, nausea, or profound fatigue. The discomfort often does not change with movement or position, distinguishing it from musculoskeletal pain.
Digestive organs are another frequent source of referred pain to the back. Acute inflammation of the gallbladder, known as cholecystitis, often causes pain that radiates to the right shoulder blade or the space between the shoulder blades. This specific pattern is caused by the irritation of the phrenic nerve, which shares nerve roots (C3-C5) with the upper back. This pain is typically triggered within an hour or two of eating a fatty meal. Less commonly, peptic ulcers or severe gastroesophageal reflux disease (GERD) can also cause a burning sensation that projects into the upper back.
When to Seek Immediate Medical Attention
Although most interscapular pain is due to muscle strain or posture, certain accompanying symptoms constitute a medical emergency. Any sudden, crushing, or severe pain between the shoulder blades should be treated with urgency, especially if it is new and comes on without preceding physical activity or injury.
Specific red flag symptoms should prompt an immediate call to emergency services:
- Pain accompanied by shortness of breath, chest pressure or tightness, or pain that radiates into the jaw or down the arm.
- Sudden dizziness, excessive cold sweating, or unexplained nausea and vomiting occurring alongside the back pain.
- Pain that is related to exertion.
- Pain accompanied by a fever or unexplained weight loss.