What Causes Pain Between the Shoulder Blades?

Possible Reasons for Interscapular Pain

photo of man lying on stomach with shoulder blades protruding
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If you are feeling pain between your shoulder blades you're likely a little worried. What could that kind of pain be coming from?

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

What are some conditions that can cause this pain, what questions may your doctor ask you, and what tests might be recommended to get you answers?

Overview

When considering pain in any region of the body, it's helpful to think about the structures that lie in that area. Structures between the shoulder blades include:

  • Skin
  • Muscles: The muscles present in the region between the shoulder blades include the rhomboids and middle and lower trapezius muscles. These muscles play a key role in keeping the shoulder blades back and down.
  • The thoracic spine
  • The thoracic aorta (the thoracic part of the largest blood vessel which carries blood from the heart to the rest of the body.
  • Part of the esophagus 
  • Part of the heart
  • A portion of the lungs

Pain that occurs between the shoulder blades may begin in any of these structures, or instead may occur in regions some distance from the area due to the way that nerves transmit pain signals.

Possible Causes

There are many possible causes of pain that are felt between the shoulder blades. Pain may be felt from conditions affecting the structures located in this region, or can instead be referred pain—pain that is felt between the shoulder blades but arises from another area. Some possible causes of pain between the shoulder blades include:

  • Muscle strain: The most common cause of pain between the shoulder blades is a muscle strain. This can result from poor posture (especially leaning forward with prolonged sitting or standing,) excess lifting, activities that involve twisting such as golf or tennis or even sleeping on a poor mattress.
  • Trauma: Conditions which may result in pain between the shoulder blades following trauma commonly include acromioclavicular joint separation and rotator cuff tears. A shoulder 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 and thoracic spine can cause referred pain to this region. It's not uncommon for people with disc disease in their neck to feel pain only in other regions, and this can result in a delay in diagnosis. Other symptoms may include numbness of tingling or pain in one or both arms. Sometimes pain due to disc disease in the neck is positional, for example, it may improve or get worse with flexing or extending your neck.
  • Arthritis: Arthritis in the neck or even the ribs may cause interscapular pain. As with disc disease, arthritis in the neck may cause pain between the shoulder blades or other regions even in the absence of any neck pain.
  • Heart attack: Heart attacks, especially heart attacks in women, don't always begin with chest pain. In one study pain looking at people with heart attacks, three percent 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 in women differ from those in men.
  • Cancer: Lung cancer, especially Pancoast tumors, may cause referred pain between the shoulder pain by pushing on nerves near the top of the lungs. Other cancers which may cause pain in this region include esophageal cancer, mesothelioma, lymphomas, and liver cancer. Cancers which 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 pain in the right upper quadrant of the abdomen and nausea. 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 pain, hoarseness, and difficulty swallowing. Not only can untreated GERD cause discomfort, but is associated with the later development of esophageal cancer. 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 cause pain in this region. Often times people are aware that they have a curvature of their spine, but not always.
  • 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, and is a medical emergency. This is often felt as a sudden sharp and tearing pain in the upper middle back.
  • Pulmonary embolism: Pulmonary emboli occur when clots in the legs (deep venous thrombosis) break off and travel to the lungs. The pain is often sudden in onset, sharp, and may be associated with severe shortness of breath. It is often preceded by symptoms of blood clots in the legs including pain, redness, and swelling.
  • Thoracic vertebral compression fractures: Compression fractures, often due to osteoporosis, may cause interscapular pain. 
  • Shingles: Shingles can cause pain nearly anywhere in the body, depending upon which nerve roots the virus affects, and may occur before a rash is noticed. The pain may be most pronounced in the region between your shoulder blades, but tends to concentrate on one side of the body or the other.
  • Epidural anesthesia: Women who have an epidural for labor or for a C-section sometimes experience intense interscapular pain. Thankfully, this pain resolves when the drip is slowed down and goes away fairly rapidly after delivery.

When to Call Your Doctor 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 causes of pain discussed above are treatable with urgent medical treatment.

A few of the most serious conditions giving rise to pain in this area include heart attacks (myocardial infarctions), dissecting aortic aneurysms (a condition often found in men with Marfan's syndrome in which blood penetrates between the layers lining the aorta), and pulmonary emboli (blood clots (thromboses) in the legs which break off and travel to the lungs. Again, prompt medical attention can often affect the outcome of the disease.

Keep in mind that pain between the shoulder blades can often be more serious than pain felt in other regions of your body. The phrase "when in doubt, check it out" is very applicable in the setting of this kind of pain.

Questions Your Doctor May Ask 

  • When did the pain begin?
  • Did the pain begin suddenly or more gradually?
  • How severe is the pain? It can help if you describe your pain on a scale of 1 to 10, with 1 meaning you have minimal pain, and 10 describing the worst pain you can imagine.
  • 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?
  • Do you (or anyone in your family) have a history of disc disease or osteoporosis?
  • Is the pain burning in character, sharp or dull, stabbing or nagging?
  • Is there anything that makes the pain worse or makes the pain better?
  • Have you experienced any trauma?
  • Did you begin any new exercise?
  • Have you done any heavy lifting?
  • Do you have any risk factors for heart disease such as a family history, high cholesterol, or high blood pressure?
  • Do you or have you ever smoked?

Treatment

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

A Word From Verywell

There are a multitude of 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 doctor. If you have seen your doctor and don't have an answer, ask again, or seek out a second opinion.

Pain is the way our body let's 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.

Sources:

Klumpner, T., Toledo, P., Wong, C., and J. Farrer. Interscapular Pain Associated with Neuraxial Labour Analgesia: A Case Series. Canadian Journal of Anaesthesia. 2016. 63(4):475-9.

National Institute of Health. MedlinePlus. Thoracic aortic aneurysm. Updated 04/27/17. https://medlineplus.gov/ency/article/001119.htm

Sultan, H., and G. Younis-El-Tantawi. Role of dorsal scapular nerve entrapment in unilateral interscapular pain. Archives of Physical Medicine and Rehabilitation. 2013. 94(6):1118-25.

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