Table of ContentsView AllTable of ContentsCausesDiagnosisTreatmentPrevention
Table of ContentsView All
View All
Table of Contents
Causes
Diagnosis
Treatment
Prevention
Pain between the shoulder blades can occur suddenly, as with a muscle strain when lifting heavy objects or a sudden, serious heart attack. It can also develop over time with a condition such as arthritis. Differenttypes of pain(sharp, throbbing, intermittent) are among the symptoms.
Treatment for pain between the shoulder blades depends on the cause. It may include physical therapy for an injury, medication foracid reflux, or surgery for your gallbladder.It’s important to have your healthcare provider diagnose the cause in order to ensure accurate and timely care.
Possible Causes
Pain between the shoulder blades can develop from a problem with any body parts located between the shoulder blades, such as:
Some of these causes are more serious than others. A sudden fracture can suggest underlyingosteoporosis(bone disease), for example. You might also havereferred painfrom other organs in the body. When this happens, nerves send signals that cause pain near the shoulder blades, even though the original source of pain is somewhere else, like in your heart or gallbladder.
When to Worry About Upper Back Pain Between Shoulder Blades
Some causes of pain between the shoulder blades are serious and can be life-threatening. Call 911 right away if your shoulder blade pain happens with:
Muscle Strain
Trauma
Trauma may cause pain between the shoulder blades due to:
Trauma can lead to shoulder pain with injuries such as a dislocated shoulder,shoulder joint separation, orrotator cuff tear.These injuries can affect spinal bones, muscles, nerves, and/or other soft tissues.
Herniated or Bulging Discs
Degenerative disc diseasein the cervical spine or thoracic spine can irritate or press on your nerves or spine. This can lead to pain between your shoulders.
Other symptoms of aherniated discinclude:
Arthritis
Arthritismay cause interscapular pain if it occurs in or spreads to the neck and spine. Spinal arthritis is inflammation of the facet joints in the spine and/or inflammation at the sites where ligaments and tendons attach to the bones of the neck and spine.
Osteoarthritis (a type that develops with wear and tear) is the most common type of spinal arthritis. Rheumatoid arthritis, an autoimmune disorder, can also affect the neck and spine.
Heart Attack
Heart attacks don’t always begin with chest pain. This is particularly true in females, with 2020 research findings that support observations about different heart attacksymptoms in femalesand males.
The study authors note that females are more likely to have pain between their shoulder blades before a heart attack than males. The pain is often dull, but persistent. Other symptoms include chest pain, shortness of breath, or lightheadedness; immediate evaluation is needed.
Cancer
Lung cancer, especiallyPancoast tumors(a rare form of lung cancer), may cause referred pain. The tumors push on nerves near the top of the lungs, which can refer pain to the area between the shoulders.
Other cancers that may cause pain in this region include:
Breast cancer and other cancers that spread to the bones in the neck may also cause pain between the shoulder blades, sometimes without other symptoms.
Gallbladder Disease
Referred pain fromgallbladder diseaseoften occurs after eating a fatty meal. It comes as a stabbing pain between the shoulder blades, along with nausea and pain in the right upper quadrant of the abdomen.
Myofascial Pain Syndrome
Myofascial pain syndromeis a condition that causes muscle spasms and pain, often in the shoulder and neck. People who work for long periods at the computer may be more likely to develop myofascial pain syndrome.
It also is a common cause of pain that is referred to another site, like the shoulders.Apinched nervemay be involved.
Acid Reflux
Gastroesophageal reflux disease(GERD) may cause referred pain between the shoulder blades, affecting the back. Other symptoms of GERD include:
Inflammation in the pancreas may also cause this pain.The pancreas is close to thediaphragm, a muscle important for breathing that sits just above your abdomen and is partially attached to your spine.
Scoliosis
Scoliosis(curvature) in the thoracic spine might cause pain in between the shoulder blades if the condition is serious. Some people experience an imbalance in shoulder structure because of the spinal curvature, which can lead to pain.
In other cases, neck and shoulder pain may occur after surgeries used to correct scoliosis.
Thoracic Aorta Tear
A thoracicaortic dissectionoccurs when a tear in the inner wall of the blood vessel allows blood to leak between the walls of the aorta.A thoracic aorta rupture is when there is a tear through all of the layers of the vessel.
The pain that goes along with these is rapid and severe. It can feel like a sudden sharp and tearing pain in the upper middle back. These conditions are medical emergencies.
Pulmonary Embolism
Apulmonary embolism (PE)is a life-threatening condition. It can occur when a blood clot breaks off in the body’s vascular system and travels to the lungs.
Conditions that can increase your risk of a pulmonary embolism include:
The pain is sharp and happens suddenly. Some people also experience severe shortness of breath, while others only have mild discomfort.
Before a pulmonary embolism occurs, you might have signs of a blood clot in your legs, such as pain, redness, and swelling.
Thoracic Vertebral Compression Fractures
Compression fracturesof the back are broken vertebrae (bones of the spine). They can occur as a result ofmetastatic cancer(cancer that has spread) or osteoporosis.
These fractures can cause shoulder blade pain. Since fractures in this region aren’t as common as those in the cervical or lumbar spine, the diagnosis may be delayed.
Shingles
Shinglescan cause pain almost anywhere in the body. It affects certain nerve pathways, typically on one side of the body, including one that runs through the shoulder blades.
In addition to a rash, you may experience lasting pain as a result of shingles—a condition calledpostherpetic neuralgia. It can feel like a burning or stabbing pain in specific areas of the body where you had shingles.
Epidural Anesthesia
People who have an epidural (pain relief injection) for labor or for a cesarean delivery (C-section) might feel intense interscapular pain.
This pain gets better when theanesthesia dripslows down. It goes away soon after delivery.
If you have pain between your shoulder blades, your healthcare provider will ask you about your medical history and symptoms. Some common questions focus on the quality of the pain (burning, sharp, etc.) and when it started. Others might include:
You may also need imaging tests such as an X-ray ormagnetic resonance imaging(MRI) before a diagnosis can be confirmed.
Treatment will depend on the underlying cause of your pain. If your pain is related to muscle strain, this may include over-the-counter pain relievers like Advil (ibuprofen). Stretching exercises, ice, and avoiding activities that put strain on the area can relieve the pain and help you recover.
Not all causes of pain between the shoulder blades can be prevented, but some ways to reduce upper back pain may include:
Maintaining a healthy weight also can help you to reduce strain on the back, while yoga and stretching exercises can help to keep you more flexible.
Summary
If you’re feeling this type of pain, particularly if it’s worsening or persistent, see your healthcare provider. And if you have other symptoms like chest pain or shortness of breath, call 911.
24 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Abuahmed MY, Wuheb A, Eskandar G, Parameswaran R, Masters A, Javed M,et al.The Management of Dysfunctional Gallbladder Disease and the Role of Laparoscopic Cholecystectomy on Symptom Improvement: A Retrospective Cohort Study.Cureus. 2024 Jul 17;16(7):e64726. doi:10.7759/cureus.64726Crookes T, Wall C, Byrnes J, Johnson T, Gill D.Chronic shoulder pain.Aust J Gen Pract. 2023 Nov;52(11):753-758. doi:10.31128/AJGP-04-23-6790Fennell J, Phadke CP, Mochizuki G, Ismail F, Boulias C.Shoulder retractor strengthening exercise to minimize rhomboid muscle activity and subacromial impingement.Physiotherapy Canada. 2016;68(1):24-28. doi:10.3138/ptc.2014-83American Academy of Orthopaedic Surgeons.Common Shoulder Injuries.Monica J, Vredenburgh Z, Korsh J, Gatt C.Acute Shoulder Injuries in Adults.Am Fam Physician.2016 Jul 15;94(2):119-27. PMID: 27419328American Academy of Orthopaedic Surgeons.Rotator cuff tears: frequently asked questions.Penn Medicine.Herniated disc disorders.Johns Hopkins Medicine.Spinal arthritis (arthritis in the back or neck).van Oosterhout REM, de Boer AR, Maas AHEM, Rutten FH, Bots ML, Peters SAE.Sex differences in symptom presentation in acute coronary syndromes: a systematic review and meta-analysis.JAHA. 2020;9(9). doi:10.1161/JAHA.119.014733Munir M, Jamil SB, Rehmani S, Borz-Baba C.Pancoast-Tobias Syndrome: A Unique Presentation of Lung Cancer.Cureus. 2021 Feb 3;13(2):e13112. doi:10.7759/cureus.13112Cancer Research UK.Symptoms of oesophageal cancer.Beutler BD, Krishan R, Parafianowicz P, et al.ABC‐type diffuse large B‐cell lymphoma presenting as rotator cuff tendinopathy: A diagnostic dilemma and review of the literature. Clinical Case Reports. 2020;8(2):327-332. doi: 10.1002/ccr3.2630MD Anderson Cancer Center.Liver cancer symptoms.Jun JH, Park GY, Chae CS, Suh DC.The Effect of Extracorporeal Shock Wave Therapy on Pain Intensity and Neck Disability for Patients With Myofascial Pain Syndrome in the Neck and Shoulder: A Meta-Analysis of Randomized Controlled Trials.Am J Phys Med Rehabil. 2021 Feb 1;100(2):120-129. doi:10.1097/PHM.0000000000001493Medline Plus.Gastroesophageal reflux disease.Zhong R, Hu Z, Zhao D, Wang F, Zhao H, Liang Y.Shoulder imbalance treated with scapuloplasty surgery in scoliosis patients: a clinical retrospective study.J Orthop Surg Res. 2020 Apr 16;15(1):149. doi: 10.1186/s13018-020-01676-9Ohashi M, Watanabe K, Hirano T, Hasegawa K, Tashi H, Makino T,et al.Neck and shoulder pain in thoracic adolescent idiopathic scoliosis 10 years after posterior spinal fusion.Eur Spine J. 2024 Jun;33(6):2522-2529. doi: 10.1007/s00586-024-08233-6MedlinePlus.Thoracic aortic aneurysm.Fukui T.Management of acute aortic dissection and thoracic aortic rupture.J Intensive Care. 2018;6(1):15. doi:10.1186/s40560-018-0287-7Harvard Medical School.Pulmonary embolism: symptoms, causes, risk factors, and treatment.Penn Medicine.Compression fracture.Nomura H, Nomura S.Simultaneous herpes zoster rash in the upper extremity and interscapular region that resembles innervation zone of the dorsal ramus of the cervical nerve root: a case report.AME Case Rep. 2021 Jul 25;5:25. doi:10.21037/acr-21-1Klumpner TT, Toledo P, Wong CA, Farrer JR.Interscapular pain associated with neuraxial labour analgesia: a case series.Canadian Journal of Anesthesia. 2016;63(4):475-479. doi:10.1007/s12630-015-0540-7Texas Department of Insurance.Shoulder Injury Prevention Fact Sheet.
24 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Abuahmed MY, Wuheb A, Eskandar G, Parameswaran R, Masters A, Javed M,et al.The Management of Dysfunctional Gallbladder Disease and the Role of Laparoscopic Cholecystectomy on Symptom Improvement: A Retrospective Cohort Study.Cureus. 2024 Jul 17;16(7):e64726. doi:10.7759/cureus.64726Crookes T, Wall C, Byrnes J, Johnson T, Gill D.Chronic shoulder pain.Aust J Gen Pract. 2023 Nov;52(11):753-758. doi:10.31128/AJGP-04-23-6790Fennell J, Phadke CP, Mochizuki G, Ismail F, Boulias C.Shoulder retractor strengthening exercise to minimize rhomboid muscle activity and subacromial impingement.Physiotherapy Canada. 2016;68(1):24-28. doi:10.3138/ptc.2014-83American Academy of Orthopaedic Surgeons.Common Shoulder Injuries.Monica J, Vredenburgh Z, Korsh J, Gatt C.Acute Shoulder Injuries in Adults.Am Fam Physician.2016 Jul 15;94(2):119-27. PMID: 27419328American Academy of Orthopaedic Surgeons.Rotator cuff tears: frequently asked questions.Penn Medicine.Herniated disc disorders.Johns Hopkins Medicine.Spinal arthritis (arthritis in the back or neck).van Oosterhout REM, de Boer AR, Maas AHEM, Rutten FH, Bots ML, Peters SAE.Sex differences in symptom presentation in acute coronary syndromes: a systematic review and meta-analysis.JAHA. 2020;9(9). doi:10.1161/JAHA.119.014733Munir M, Jamil SB, Rehmani S, Borz-Baba C.Pancoast-Tobias Syndrome: A Unique Presentation of Lung Cancer.Cureus. 2021 Feb 3;13(2):e13112. doi:10.7759/cureus.13112Cancer Research UK.Symptoms of oesophageal cancer.Beutler BD, Krishan R, Parafianowicz P, et al.ABC‐type diffuse large B‐cell lymphoma presenting as rotator cuff tendinopathy: A diagnostic dilemma and review of the literature. Clinical Case Reports. 2020;8(2):327-332. doi: 10.1002/ccr3.2630MD Anderson Cancer Center.Liver cancer symptoms.Jun JH, Park GY, Chae CS, Suh DC.The Effect of Extracorporeal Shock Wave Therapy on Pain Intensity and Neck Disability for Patients With Myofascial Pain Syndrome in the Neck and Shoulder: A Meta-Analysis of Randomized Controlled Trials.Am J Phys Med Rehabil. 2021 Feb 1;100(2):120-129. doi:10.1097/PHM.0000000000001493Medline Plus.Gastroesophageal reflux disease.Zhong R, Hu Z, Zhao D, Wang F, Zhao H, Liang Y.Shoulder imbalance treated with scapuloplasty surgery in scoliosis patients: a clinical retrospective study.J Orthop Surg Res. 2020 Apr 16;15(1):149. doi: 10.1186/s13018-020-01676-9Ohashi M, Watanabe K, Hirano T, Hasegawa K, Tashi H, Makino T,et al.Neck and shoulder pain in thoracic adolescent idiopathic scoliosis 10 years after posterior spinal fusion.Eur Spine J. 2024 Jun;33(6):2522-2529. doi: 10.1007/s00586-024-08233-6MedlinePlus.Thoracic aortic aneurysm.Fukui T.Management of acute aortic dissection and thoracic aortic rupture.J Intensive Care. 2018;6(1):15. doi:10.1186/s40560-018-0287-7Harvard Medical School.Pulmonary embolism: symptoms, causes, risk factors, and treatment.Penn Medicine.Compression fracture.Nomura H, Nomura S.Simultaneous herpes zoster rash in the upper extremity and interscapular region that resembles innervation zone of the dorsal ramus of the cervical nerve root: a case report.AME Case Rep. 2021 Jul 25;5:25. doi:10.21037/acr-21-1Klumpner TT, Toledo P, Wong CA, Farrer JR.Interscapular pain associated with neuraxial labour analgesia: a case series.Canadian Journal of Anesthesia. 2016;63(4):475-479. doi:10.1007/s12630-015-0540-7Texas Department of Insurance.Shoulder Injury Prevention Fact Sheet.
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Abuahmed MY, Wuheb A, Eskandar G, Parameswaran R, Masters A, Javed M,et al.The Management of Dysfunctional Gallbladder Disease and the Role of Laparoscopic Cholecystectomy on Symptom Improvement: A Retrospective Cohort Study.Cureus. 2024 Jul 17;16(7):e64726. doi:10.7759/cureus.64726Crookes T, Wall C, Byrnes J, Johnson T, Gill D.Chronic shoulder pain.Aust J Gen Pract. 2023 Nov;52(11):753-758. doi:10.31128/AJGP-04-23-6790Fennell J, Phadke CP, Mochizuki G, Ismail F, Boulias C.Shoulder retractor strengthening exercise to minimize rhomboid muscle activity and subacromial impingement.Physiotherapy Canada. 2016;68(1):24-28. doi:10.3138/ptc.2014-83American Academy of Orthopaedic Surgeons.Common Shoulder Injuries.Monica J, Vredenburgh Z, Korsh J, Gatt C.Acute Shoulder Injuries in Adults.Am Fam Physician.2016 Jul 15;94(2):119-27. PMID: 27419328American Academy of Orthopaedic Surgeons.Rotator cuff tears: frequently asked questions.Penn Medicine.Herniated disc disorders.Johns Hopkins Medicine.Spinal arthritis (arthritis in the back or neck).van Oosterhout REM, de Boer AR, Maas AHEM, Rutten FH, Bots ML, Peters SAE.Sex differences in symptom presentation in acute coronary syndromes: a systematic review and meta-analysis.JAHA. 2020;9(9). doi:10.1161/JAHA.119.014733Munir M, Jamil SB, Rehmani S, Borz-Baba C.Pancoast-Tobias Syndrome: A Unique Presentation of Lung Cancer.Cureus. 2021 Feb 3;13(2):e13112. doi:10.7759/cureus.13112Cancer Research UK.Symptoms of oesophageal cancer.Beutler BD, Krishan R, Parafianowicz P, et al.ABC‐type diffuse large B‐cell lymphoma presenting as rotator cuff tendinopathy: A diagnostic dilemma and review of the literature. Clinical Case Reports. 2020;8(2):327-332. doi: 10.1002/ccr3.2630MD Anderson Cancer Center.Liver cancer symptoms.Jun JH, Park GY, Chae CS, Suh DC.The Effect of Extracorporeal Shock Wave Therapy on Pain Intensity and Neck Disability for Patients With Myofascial Pain Syndrome in the Neck and Shoulder: A Meta-Analysis of Randomized Controlled Trials.Am J Phys Med Rehabil. 2021 Feb 1;100(2):120-129. doi:10.1097/PHM.0000000000001493Medline Plus.Gastroesophageal reflux disease.Zhong R, Hu Z, Zhao D, Wang F, Zhao H, Liang Y.Shoulder imbalance treated with scapuloplasty surgery in scoliosis patients: a clinical retrospective study.J Orthop Surg Res. 2020 Apr 16;15(1):149. doi: 10.1186/s13018-020-01676-9Ohashi M, Watanabe K, Hirano T, Hasegawa K, Tashi H, Makino T,et al.Neck and shoulder pain in thoracic adolescent idiopathic scoliosis 10 years after posterior spinal fusion.Eur Spine J. 2024 Jun;33(6):2522-2529. doi: 10.1007/s00586-024-08233-6MedlinePlus.Thoracic aortic aneurysm.Fukui T.Management of acute aortic dissection and thoracic aortic rupture.J Intensive Care. 2018;6(1):15. doi:10.1186/s40560-018-0287-7Harvard Medical School.Pulmonary embolism: symptoms, causes, risk factors, and treatment.Penn Medicine.Compression fracture.Nomura H, Nomura S.Simultaneous herpes zoster rash in the upper extremity and interscapular region that resembles innervation zone of the dorsal ramus of the cervical nerve root: a case report.AME Case Rep. 2021 Jul 25;5:25. doi:10.21037/acr-21-1Klumpner TT, Toledo P, Wong CA, Farrer JR.Interscapular pain associated with neuraxial labour analgesia: a case series.Canadian Journal of Anesthesia. 2016;63(4):475-479. doi:10.1007/s12630-015-0540-7Texas Department of Insurance.Shoulder Injury Prevention Fact Sheet.
Abuahmed MY, Wuheb A, Eskandar G, Parameswaran R, Masters A, Javed M,et al.The Management of Dysfunctional Gallbladder Disease and the Role of Laparoscopic Cholecystectomy on Symptom Improvement: A Retrospective Cohort Study.Cureus. 2024 Jul 17;16(7):e64726. doi:10.7759/cureus.64726
Crookes T, Wall C, Byrnes J, Johnson T, Gill D.Chronic shoulder pain.Aust J Gen Pract. 2023 Nov;52(11):753-758. doi:10.31128/AJGP-04-23-6790
Fennell J, Phadke CP, Mochizuki G, Ismail F, Boulias C.Shoulder retractor strengthening exercise to minimize rhomboid muscle activity and subacromial impingement.Physiotherapy Canada. 2016;68(1):24-28. doi:10.3138/ptc.2014-83
American Academy of Orthopaedic Surgeons.Common Shoulder Injuries.
Monica J, Vredenburgh Z, Korsh J, Gatt C.Acute Shoulder Injuries in Adults.Am Fam Physician.2016 Jul 15;94(2):119-27. PMID: 27419328
American Academy of Orthopaedic Surgeons.Rotator cuff tears: frequently asked questions.
Penn Medicine.Herniated disc disorders.
Johns Hopkins Medicine.Spinal arthritis (arthritis in the back or neck).
van Oosterhout REM, de Boer AR, Maas AHEM, Rutten FH, Bots ML, Peters SAE.Sex differences in symptom presentation in acute coronary syndromes: a systematic review and meta-analysis.JAHA. 2020;9(9). doi:10.1161/JAHA.119.014733
Munir M, Jamil SB, Rehmani S, Borz-Baba C.Pancoast-Tobias Syndrome: A Unique Presentation of Lung Cancer.Cureus. 2021 Feb 3;13(2):e13112. doi:10.7759/cureus.13112
Cancer Research UK.Symptoms of oesophageal cancer.
Beutler BD, Krishan R, Parafianowicz P, et al.ABC‐type diffuse large B‐cell lymphoma presenting as rotator cuff tendinopathy: A diagnostic dilemma and review of the literature. Clinical Case Reports. 2020;8(2):327-332. doi: 10.1002/ccr3.2630
MD Anderson Cancer Center.Liver cancer symptoms.
Jun JH, Park GY, Chae CS, Suh DC.The Effect of Extracorporeal Shock Wave Therapy on Pain Intensity and Neck Disability for Patients With Myofascial Pain Syndrome in the Neck and Shoulder: A Meta-Analysis of Randomized Controlled Trials.Am J Phys Med Rehabil. 2021 Feb 1;100(2):120-129. doi:10.1097/PHM.0000000000001493
Medline Plus.Gastroesophageal reflux disease.
Zhong R, Hu Z, Zhao D, Wang F, Zhao H, Liang Y.Shoulder imbalance treated with scapuloplasty surgery in scoliosis patients: a clinical retrospective study.J Orthop Surg Res. 2020 Apr 16;15(1):149. doi: 10.1186/s13018-020-01676-9
Ohashi M, Watanabe K, Hirano T, Hasegawa K, Tashi H, Makino T,et al.Neck and shoulder pain in thoracic adolescent idiopathic scoliosis 10 years after posterior spinal fusion.Eur Spine J. 2024 Jun;33(6):2522-2529. doi: 10.1007/s00586-024-08233-6
MedlinePlus.Thoracic aortic aneurysm.
Fukui T.Management of acute aortic dissection and thoracic aortic rupture.J Intensive Care. 2018;6(1):15. doi:10.1186/s40560-018-0287-7
Harvard Medical School.Pulmonary embolism: symptoms, causes, risk factors, and treatment.
Penn Medicine.Compression fracture.
Nomura H, Nomura S.Simultaneous herpes zoster rash in the upper extremity and interscapular region that resembles innervation zone of the dorsal ramus of the cervical nerve root: a case report.AME Case Rep. 2021 Jul 25;5:25. doi:10.21037/acr-21-1
Klumpner TT, Toledo P, Wong CA, Farrer JR.Interscapular pain associated with neuraxial labour analgesia: a case series.Canadian Journal of Anesthesia. 2016;63(4):475-479. doi:10.1007/s12630-015-0540-7
Texas Department of Insurance.Shoulder Injury Prevention Fact Sheet.
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