Pain localized to the right upper back when breathing can be a perplexing symptom. This discomfort is often described as a sharp catch or a dull ache that intensifies with inhalation. The pain points toward an issue triggered by the mechanical movement of the chest cavity. Causes range from a simple muscle strain to conditions involving the lungs or internal organs. Because this symptom involves the respiratory system and structures near the spine, a professional medical evaluation is necessary to accurately identify the source of the pain.
Causes Linked to Muscles and Rib Structure
The most frequent source of upper back pain worsening with breathing is the musculoskeletal system, involving muscles or rib joints. The rhomboid muscles, connecting the shoulder blades to the thoracic spine, are a common site for strain or spasm. Overuse, poor posture, or prolonged sitting can injure these muscles. Movement during deep breathing stretches the affected tissue, causing pain between the shoulder blades.
The intercostal muscles, which run between the ribs, are susceptible to strain from sudden movements or forceful coughing. When inflamed, expanding the rib cage to draw a breath causes sharp, localized pain.
A common mechanical cause involves the costovertebral joints, where the ribs meet the vertebrae. Dysfunction occurs when a rib is misaligned or ligaments are strained, often from sudden movements. Since these joints are pivot points for the ribs during respiration, movement from deep breathing, coughing, or sneezing can create a sharp sensation near the spine. This mechanical pain is often reproducible by specific movements of the shoulder or trunk.
Pain Originating from the Lungs and Lining
Sharp upper back pain exacerbated by breathing often suggests an issue with the lungs or the pleural lining. Pleurisy (pleuritis) is inflammation of the pleura, the two thin layers of tissue separating the lungs from the chest wall. When inflamed, these layers rub together, causing a characteristic sharp, stabbing pain that worsens significantly with deep inhalation, coughing, or sneezing.
Pleurisy pain frequently radiates to the back or shoulder; if the right lung is affected, discomfort is felt in the right upper back. This inflammation is most often caused by a viral or bacterial infection, such as pneumonia. In these cases, the back pain is typically accompanied by a cough, fever, and shortness of breath.
Less common but more serious pulmonary conditions also cause this symptom. A pulmonary embolism (PE), a blood clot lodged in a lung artery, causes sudden, sharp pain in the chest or upper back that worsens with breathing. A pneumothorax (collapsed lung) occurs when air leaks into the space between the lung and chest wall, causing sudden pain and significant difficulty breathing. These serious causes are distinguished by the presence of respiratory distress and other systemic symptoms.
Referred Pain from Nearby Internal Organs
Pain in the upper right back can be referred pain, meaning the source is elsewhere in the body. The body’s nerves share pathways, leading the brain to misinterpret the pain signal. The primary internal organ causing referred pain to the right upper back and shoulder blade area is the gallbladder, located beneath the liver.
Conditions like cholecystitis (gallbladder inflammation) or gallstones can trigger this distant pain. The mechanism involves irritation of the diaphragm, the large muscle below the lungs used for breathing. The phrenic nerve, which supplies the diaphragm, shares nerve roots with the nerves supplying the right upper back. When the inflamed gallbladder irritates the diaphragm, the brain perceives the pain as originating in the shoulder or upper back.
This referred pain may be exacerbated by deep breathing because diaphragm movement further irritates the inflamed area. This pain often presents as a persistent ache that may intensify after eating, particularly fatty foods, which stimulate the gallbladder.
Warning Signs Requiring Immediate Medical Attention
While many causes of back pain when breathing are muscular, certain symptoms indicate a potentially serious condition requiring immediate medical attention. Any sudden, severe, or crushing chest pain that radiates to the arms, neck, jaw, or upper back should be treated urgently. This pattern can suggest a cardiac event or a condition like aortic dissection.
Sudden shortness of breath, especially when accompanied by pain, requires immediate evaluation. A high fever and chills alongside back pain and difficulty breathing may signal a significant infection, such as pneumonia or a pulmonary embolism. Other urgent indicators include coughing up blood, a rapid or irregular heartbeat, or feeling faint or confused. If these symptoms occur, seek emergency care immediately.