When pain localizes in the upper right back, often around the shoulder blade, and intensifies with breathing, it is known as thoracic pain. This discomfort is frequently exacerbated by the expansion and contraction of the rib cage during inhalation and exhalation. The pain can stem from mechanical issues involving muscle and bone, problems with the lungs and their lining, or conditions originating in the abdomen. Understanding the diverse anatomical structures in this region helps assess the source of the pain.
Musculoskeletal and Postural Explanations
The most frequent causes of upper back pain that worsen with breathing relate to the muscles, joints, and alignment of the thoracic spine and rib cage. The intercostal muscles between the ribs facilitate respiration. Strain from a sudden, forceful movement, repetitive coughing, or heavy lifting can lead to an intercostal muscle strain. This results in sharp pain, particularly noticeable when taking a deep breath or sneezing.
Poor or sustained static postures, such as slouching over a desk, place chronic stress on the muscles and ligaments of the upper back. This strain creates tension and muscle imbalances that can become inflamed, causing a dull ache that sharpens with chest wall movement during inhalation. Inflammation of the cartilage connecting the ribs to the breastbone, called costochondritis, can also project pain to the back. Minor rib or thoracic joint dysfunction, where the rib connects to the vertebrae, causes localized, sharp pain because the joint must articulate slightly with every breath.
Respiratory and Pleural Conditions
When pain is aggravated by breathing, the lungs and their protective membranes are a significant potential source. The lungs are encased by a membrane called the pleura; inflammation of this lining is known as pleurisy. Pleurisy causes sharp, stabbing pain that worsens with deep breaths, coughing, or movement because the inflamed layers rub against each other.
Infections like pneumonia inflame the lung tissue, which can irritate the pleura and refer pain to the chest and back. This pain is often accompanied by systemic symptoms like fever, chills, and a productive cough.
Serious Respiratory Conditions
More serious conditions include a pulmonary embolism, a blockage in the lung’s arteries often caused by a blood clot. This presents as sudden, sharp chest or back pain worsened by breathing, often accompanied by shortness of breath and an elevated heart rate. A pneumothorax, or collapsed lung, occurs when air leaks into the space between the lung and chest wall. This causes sudden, sharp back pain and difficulty breathing as the lung cannot fully inflate.
Referred Pain from Upper Abdominal Organs
Pain felt in the upper right back can be referred pain originating from internal organs. This occurs because the nerves supplying internal organs share pathways with the sensory nerves of the back. Issues in the upper right abdominal quadrant specifically project pain to the upper right back.
The gallbladder, located beneath the liver, is a frequent source of referred pain, especially with gallstones or inflammation (cholecystitis). When irritated, the pain often radiates from the upper abdomen to the right shoulder blade area. This pain feels related to breathing because the diaphragm, the primary muscle of respiration, sits adjacent to these organs. Deep inhalation causes the diaphragm to press down on the inflamed structures. Similarly, conditions affecting the liver, such as hepatitis, can cause swelling that irritates surrounding tissues and nerves, leading to discomfort perceived in the upper right back.
Warning Signs and When to Consult a Doctor
While many instances of back pain when breathing are muscular and resolve with rest, certain accompanying symptoms suggest a serious medical issue requiring attention. Any sudden onset of severe, crushing, or ripping pain in the back or chest should prompt immediate medical evaluation.
Consult a healthcare professional if the pain is accompanied by:
- Shortness of breath
- A rapid or irregular heartbeat
- Lightheadedness or dizziness
- A persistent fever or chills
- Coughing up blood
- Pain that does not improve after a few days of self-care
Timely diagnosis is important for distinguishing between a simple muscle strain and conditions like a pulmonary embolism or acute cholecystitis.