What Causes Pain Between the Shoulder Blades?

Possible Reasons for Interscapular Pain

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Pain between the shoulder blades, otherwise known as interscapular pain, can have many causes. While this symptom is commonly caused by muscle strain, it's important to be aware that it may also be a sign of something more serious, such as a heart attack or lung cancer.

Pain is your body's way of letting you know that something is wrong, so it's important to find a reason for what's troubling you.

causes of pain between the shoulder blades
 Illustration by Joshua Seong, Verywell

Anatomy

Pain in between the shoulders is often associated with one or more of the structures that lie between the shoulders.

Structures between the shoulder blades include:

  • Skin
  • Muscles, including the rhomboids and middle and lower trapezius muscles, all of which play a key role in keeping your shoulder blades back and down
  • The thoracic spine
  • The thoracic aorta (part of the largest blood vessel that carries blood from the heart to the rest of the body)
  • Part of the esophagus 
  • Part of the heart
  • A portion of the lungs

Possible Causes

Pain that occurs between the shoulder blades can develop due to a problem with any of the structures that are located between the shoulder blades.

Sometimes the problem can begin in different areas of the body that are located some distance from the shoulder blades and can cause pain near the shoulder blades due to the way the nerves transmit pain signals. This is described as referred pain.

Muscle Strain

Muscle strain is the most common cause of pain between the shoulder blades. This can develop from poor posture (especially leaning forward with prolonged sitting or standing), excess lifting, activities that involve twisting such as golf or tennis, or sleeping on a mattress that doesn't give you the right support.

Trauma

Trauma can cause injuries that lead to shoulder pain, such as acromioclavicular joint separation and rotator cuff tears. A shoulder joint separation is different from a shoulder dislocation (which is felt more commonly in the shoulder joint).

Herniated or Bulging Discs

Degenerative disc disease in the cervical spine or thoracic spine can cause pain between the shoulders due to nerve or spine irritation or pressure.

Other symptoms may include numbness, tingling, and/or pain in one or both arms. Sometimes pain that's caused by disc disease in the neck is positional, and it may improve or get worse when you flex or extend your neck.

Arthritis

Arthritis in the neck or the ribs may cause interscapular pain, sometimes in the absence of any neck pain.

Heart Attack

Heart attacks, especially in women, don't always begin with chest pain. In one study looking at people with heart attacks, 3% had pain confined to the area between the shoulder blades. This pain tends to be nagging and may be accompanied by chest pain, shortness of breath, or lightheadedness.

It's important for everyone to be familiar with how the symptoms of heart attacks differ between women and men. Symptoms of heart disease in women are not always recognized, and women have a higher death rate from heart attacks than men.

Cancer

Lung cancer, especially Pancoast tumors, may cause referred pain between the shoulder by pushing on nerves near the top of the lungs. Other cancers that may cause pain in this region include esophageal cancer, mesothelioma, lymphomas, and liver cancer.

Cancers that spread to the bones in the neck, such as breast cancer, may also cause pain between the shoulder blades, sometimes without any other symptoms. 

Gallbladder Disease

Referred pain from gallbladder disease often occurs as a stabbing pain between the shoulder blades and may be associated with nausea and pain in the right upper quadrant of the abdomen. It commonly occurs after eating a fatty meal.

Nerve Entrapment

Nerve entrapment, such as in myofascial pain syndrome of the rhomboids can cause pain between the shoulder blades.

Acid Reflux

Gastroesophageal reflux disease (GERD) may cause referred pain to the back in the region between the shoulder blades. Symptoms of GERD may also include chest discomfort, hoarseness, and difficulty swallowing.

Inflammation of the pancreas may also cause this type of pain due to irritation to the underside of the diaphragm.

Scoliosis

Scoliosis of the thoracic spine may rarely cause pain in this region if the condition is severe.

Thoracic Aorta Rupture or Aortic Dissection

The pain that goes along with a thoracic aortic dissection (when a tear in the wall of the blood vessel allows blood to leak between the walls of the aorta) is often rapid and very severe. It can feel like a sudden sharp and tearing pain in the upper middle back.

This condition is a medical emergency.

Pulmonary Embolism

A pulmonary embolus is a life-threatening condition that can occur when a clot in the legs (deep venous thrombosis) breaks off and travels to the lungs. Some risk factors for pulmonary emboli include medical conditions such as cancer, prolonged travel by car or plane, prolonged bed rest, pregnancy, and recent surgery.

The pain is often sudden in onset, sharp, and may be associated with severe shortness of breath, although sometimes people only experience mild discomfort.

A pulmonary embolus is sometimes preceded by symptoms of a blood clot in the legs, including pain, redness, and swelling.

Thoracic Vertebral Compression Fractures

Compression fractures, which can occur due to metastatic cancer or osteoporosis, may cause interscapular pain. Since fractures in this region are less common than fractures in the cervical or lumbar spine, the diagnosis may be delayed.

Shingles

Shingles can cause pain nearly anywhere in the body, depending on the location of the virus in the nerve roots. Pain can occur before the rash develops. The pain may be most pronounced in the region between your shoulder blades, and it typically affects only one side of the body.

Epidural Anesthesia

People who have an epidural for labor or for a C-section sometimes experience intense interscapular pain. This pain resolves when the anesthesia drip is slowed down and it goes away fairly rapidly after delivery.

When to Call Your Healthcare Provider or 911

Some of the causes of pain between the shoulder blades are serious and can be life-threatening.

If your symptoms are accompanied by shortness of breath, chest pain, lightheadedness, or even if you just have a "gut feeling" that something bad is happening in your body, call 911 right away. Don't wait. Many of the serious causes of pain between the shoulders require urgent medical treatment.

Diagnosis and Treatment

Treatment of your pain will depend on the underlying cause of your symptoms.

Common questions your healthcare provider will ask during your medical evaluation include:

  • When did the pain begin?
  • Did the pain begin suddenly or more gradually?
  • How severe is the pain?
  • What other symptoms are you experiencing, such as chest pain, shortness of breath, unexplained weight loss, difficulty swallowing, pain in your jaw, or arm pain?
  • Is the pain burning in character, sharp or dull, stabbing, or nagging?
  • Is there anything that makes the pain worse or better?
  • Have you experienced any trauma?
  • Did you begin any new exercise or have you done any heavy lifting?
  • Do you have any risk factors for heart disease such as family history, high cholesterol, or high blood pressure?
  • Do you or have you ever smoked?

A Word From Verywell

There are many causes of pain in the region between your shoulder blades. If you're feeling this type of pain, it's important to make an appointment to see your healthcare provider. And if you have other symptoms, such as chest pain or shortness of breath, you should call 911.

Pain is the way our body lets us know that something is wrong. Listen to your body. Many medical conditions, even those that are serious, are most treatable in the early stages.

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Article Sources
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