Pain felt between the shoulder blades, medically termed interscapular pain, is a common complaint, especially with sedentary habits and desk work. This discomfort occurs in the upper back, encompassing the thoracic spine, shoulder blades, and a dense network of muscles, nerves, and ligaments. While the pain can range from a dull ache to a sharp, burning sensation, it often signals a problem within this region. Causes vary from simple muscle strain to more complex underlying conditions.
Most Common Causes: Posture and Muscle Strain
The majority of interscapular pain cases trace back to the cumulative effects of daily habits, particularly chronic poor posture. When sitting with a rounded back or hunched shoulders, chest muscles like the pectorals become tight and shortened. This forces the opposing upper back muscles, such as the rhomboids and middle trapezius, into a state of constant fatigue.
This muscular imbalance leads to strain and the development of myofascial trigger points, which are hyperirritable spots within muscle tissue. These trigger points generate the characteristic deep, nagging ache reported between the shoulder blades. The “tech neck” posture, where the head is bent forward while looking at a screen, compounds this issue by placing excessive strain on the upper thoracic spine and neck muscles.
Repetitive movements or improper lifting can acutely strain the rhomboids and trapezius muscles. For instance, repeatedly reaching forward or carrying a heavy bag over one shoulder causes muscle fibers to overwork, resulting in sudden, sharp pain. A lack of sufficient core and back muscle strength forces the small stabilizing muscles of the shoulder blades to take on too much load, leading to quicker fatigue and localized pain.
Structural and Neurological Contributors
Persistent pain between the shoulder blades can stem from issues with the spine and nervous system. The thoracic spine consists of twelve vertebrae that articulate with the ribs at costovertebral joints. Dysfunction in the facet joints of the thoracic vertebrae or irritation of the costovertebral joints can cause localized sharp pain. This pain is often exacerbated by deep breathing or specific twisting movements.
Pain can also be referred to the shoulder blades from the neck, a phenomenon known as cervical radiculopathy. A herniated or bulging disc in the lower cervical spine (C5-C7) can compress a nerve root. This sends pain signals that radiate down the nerve pathway, manifesting as a deep, burning discomfort between the shoulder blade and the spine. This pain may be accompanied by neurological symptoms, such as tingling, numbness, or weakness in the arm or hand.
Thoracic outlet syndrome occurs when nerves or blood vessels are compressed between the collarbone and the first rib. This compression can lead to pain that projects into the upper back and is often worsened by poor posture. Identifying these structural or neurological origins is important because they often require targeted physical therapy or medical intervention to resolve the underlying mechanical issue.
Referred Pain and Urgent Symptoms
While musculoskeletal problems are the most frequent culprits, pain between the shoulder blades can occasionally be referred pain originating from internal organs. Visceral pain is often poorly localized and felt far from its source due to shared nerve pathways. For example, issues with the gallbladder, such as gallstones or inflammation, typically cause pain in the right upper abdomen. However, this pain can be referred to the right shoulder blade or the area between the shoulder blades.
Gastrointestinal issues, including severe acid reflux (GERD) or peptic ulcers, can present as a burning sensation in the upper back due to esophageal irritation. More concerning, the pain can be a symptom of a cardiopulmonary condition. In women experiencing a heart attack, pain may manifest solely in the upper back or jaw rather than classic chest pain. Conditions like a pulmonary embolism or an aortic dissection can also cause sudden, severe interscapular pain.
Certain “Red Flag” symptoms demand immediate medical attention, as they may indicate a life-threatening emergency. Seek urgent care if the pain is sudden and severe, or if it is accompanied by:
- Shortness of breath
- Chest pain
- Dizziness
- Excessive sweating
- Pain that radiates down the arm
Pain that is constant and does not change with movement, or pain accompanied by fever or unexplained weight loss, also warrants prompt medical evaluation.
Immediate Relief and Ergonomic Adjustments
For common causes related to muscle strain and posture, immediate relief can often be found through simple self-management techniques. Applying heat, such as a warm compress or heating pad, helps relax tight muscles by promoting blood flow. Alternatively, using a tennis ball or a foam roller placed between the back and a wall can provide targeted pressure to release muscle knots and trigger points.
Simple stretches can help alleviate the tension created by prolonged sitting. A door stretch, where you place your forearms on a doorframe and lean forward, effectively stretches the tight pectoral muscles, allowing the upper back muscles to relax. Regularly performing “shoulder blade squeezes,” where you gently pinch your shoulder blades together and down, helps activate and strengthen the often-weak rhomboid muscles.
Long-term prevention requires making ergonomic adjustments to your workspace to support a neutral spine position. Ensure your computer monitor is at eye level to prevent the head from tilting forward into the “tech neck” posture. Your chair should provide adequate lumbar support, and your elbows should rest comfortably at a 90-degree angle while typing. Taking frequent, short breaks to stand and move every 30 to 60 minutes is an effective way to prevent cumulative strain.