Upper back pain between the shoulder blades is also known as interscapular pain. Fifteen percent of the population suffers from chronic upper back pain. 
Finding the source of interscapular pain can be tricky because the upper back houses many important structures like the heart, the upper lobes of the lung, the cervical spine, the scapulas, and a dozen or so of muscles and nerves.
This article goes over what can cause upper back pain between your shoulder blades and how to treat it.
Upper Back Pain Points Between Shoulder Blades
Pain in between the shoulder blades can be attributed to different structures, including organs, muscles, and other soft tissue within the upper chest and back. A brief look at the anatomy of the upper back can help you understand what can cause pain in this region. The parts of the upper back are listed below. Let’s look at each of them to understand how they can cause pain between the shoulder blades.
The Skin Between The Shoulder Blades
The skin between the shoulder blades overlies several back and shoulder muscles. The skin itself may itch and experience pain in conditions like notalgia paraesthetica. It is commonly observed between T2 and T6 thoracic spine. A rash, for example from shingles, can also be a source of upper back pain. Before you go deeper, first examine the skin for any abnormalities, like itchiness, lesions, and pain.
Muscles Of The Upper Back
The superficial extrinsic muscles of the back include the trapezius, latissimus dorsi, rhomboid major, rhomboid minor, and levator scapulae. They all work together to move the shoulder by raising the scapula, and pulling it inside towards the body.
The intermediate extrinsic muscles of the back include the serratus posterior superior and serratus posterior inferior muscles. These muscles raise and depress the ribs.
Below these muscles lie the muscles of the spinal column. The semispinalis capitis, iliocostalis cervicis, longissimus cervicis, longissimus capitis, longissimus thoracis, iliocostalis thoracis, and semispinalis thoracis play a role in moving the spine and head. In addition to the above, there are a host of other smaller muscles that engage in the movement of the spine.
The thoracic spine in the upper back has twelve vertebrae. They are numbered T1- T12. Each number has a corresponding bundle of nerves for that section of the spinal cord.
Nerves from T1-T5 supply the upper back, chest, and some parts of the abdomen. These nerves carry pain and sensations to and from the spine. For this reason, pain from the abdomen can radiate to the upper back due to the shared nerve supply.
The largest artery of the body, namely the aorta, has a section running through the chest called the thoracic aorta. Three branches arise from the thoracic aorta which supply blood to the heart, lungs, and esophagus. Weakening of the walls of the thoracic aorta can lead to dissection or aneurysm that compromises blood supply to these organs and causes upper back pain. These conditions are life threatening and must be seen by a doctor immediately.
The Esophagus, Heart, Or The Lungs
The esophagus travels through the upper chest. This muscular tube connects the stomach with the mouth. Acid reflux into the esophagus can cause upper back pain.
The lungs and heart sit within the rib cage. Any pathology of the upper lobes of the lungs or the heart can also radiate to the upper back due to their proximity and shared nerve supply.
A reduction of the space within the rib cage due to scoliosis or a poor posture can also affect the lungs resulting in shortness of breath. Interscapular pain results from pressure on the intervertebral discs, joints and the overstretched muscles.
Why Does My Back Hurt Between My Shoulder Blades?
Now that you understand the anatomy of the upper back, you may be asking why does my back hurt between my shoulder blades? The primary causes of upper back pain are listed below.
Poor posture is one of the primary causes of upper back pain between the shoulder blades. Staying hunched and sitting for extended periods, or standing with a bad posture, can strain the back and core muscles.
The blood supply to your spine and the organs it supplies can be compromised due to the strain. Gradually, they become weak. A lack of exercise can further weaken these muscles and can lead to upper back pain.
A muscle strain or a ligament tear due to trauma (whiplash from car accident) or contact sports can cause upper back pain. An injury to the back can affect the nerve roots and the vertebrae, leading to sharp upper back pain.
A whiplash injury, caused by the rapid back and forth movement of the neck like a whip, can also stretch the muscles of the neck very quickly. Commonly seen in rear-end accidents, the forces of this event causes the muscles to accelerate and decelerate. This may lead to a tear or stretch, causing upper back pain.
Conditions Of The Spine
Scoliosis, herniated discs, and vertebral fractures can cause upper back pain. For example, the misalignment of the spine from scoliosis can strain the spinal and paraspinal muscles. The constant strain can lead to intense back pain between the shoulder blades.
Overuse of the back due to work or sports can strain the back, core, and abdominal muscles. Some abdominal muscles attach to the spine. They are responsible for the curvature of your spine and maintain a neutral pelvic tilt which prevents back pain. Repeated use can also weaken the muscles which are unable to support the spine.
Any injury or weak abdominal muscles cannot support the spine and this results in back pain. There may be tenderness or pain on touching the strained area. Strained muscles have limited mobility and need time to heal. Activity may only worsen this pain.
Stress causes the body to release stress hormones like cortisol and adrenaline. These stress hormones involuntarily tighten the muscles of the body, as they would for a fight or flight response.
Stressed people often hunch their shoulders and experience a tightness in their shoulder muscles. Prolonged strain and tension of these muscles can lead to upper back pain between the shoulders.
Lifting Or Carrying Something Heavy
Lifting or carrying something heavy, particularly without good manual handling techniques, can also cause upper back pain. Most individuals usually simply bend down to carry a heavy load without any care for their spine. However, lifting heavy objects or even carrying an overloaded backpack requires a certain posture so that the load is well distributed across the pelvis, the knees, and the spine.
Tears to the muscle fibers can cause upper back pain. Sudden injuries to the back or gradual overuse can shear the muscle fibers and cause pain. Muscle fibers that are stretched beyond their tensile strength can result in a back sprain.
The upper back is supported by many muscles and any one of them could get injured during sports or when lifting heavy objects.
Minor or major trauma can also shear the tendons of the muscle where they attach to the bone leading to back pain. Pain and loss of function would be the principal symptoms of tendon injuries, especially if the bone is intact.
Upper back pain occurs when nerves are compressed or pinched. This can occur at the root of the spine where the spinal nerves that supply various parts of the body originate or as they travel to the muscles and organs they innervate.
Stretching, damage, infection of the nerves, or inflammation can compress the nerves and lead to severe back pain along with numbness, tingling, and weakness.
Herniated discs, vertebral fractures, and trauma to the back are common causes of pinched or compressed nerves. Vertebral fractures and trauma are serious medical conditions that require acute care.
How Does Interscapular Pain Feel Based On What Is Injured?
Interscapular pain can range from dull ache to a sharp severe pain, depending on what is causing the back pain. In addition to the characteristics of pain, there are other telltale symptoms that indicate the source of your upper back pain. Here are some ways you may experience pain, along with some other accompanying symptoms:
- Muscle strains, poor posture, and lifting heavy objects can lead to dull aches that can be episodic and worsen with activity.
- Symptoms such as joint stiffness and pain, particularly if relieved when sitting or lying down, are common in osteoarthritis and inflammatory conditions.
- Sharp burning pain is usually associated with shingles, pinched nerves, and compression fractures.
- Accompanying symptoms further offer a clue about what is causing your interscapular pain. For example, nausea and vomiting could indicate a gastrointestinal cause.
- Breathing difficulties, chest pain, and palpitations are cardiopulmonary symptoms that accompany upper back pain due to scoliosis, dissection of the aorta, or an aneurysm.
- Interscapular pain can be referred from the stomach, the gallbladder, and the spine.
It is important to take note of all the symptoms along with the pain between the shoulder blades and report it to a doctor. This will help the doctor make an accurate diagnosis and determine the most suitable course of action.
Possible Conditions That May Cause Upper Back Pain
Many conditions may cause upper back pain. Since the upper back contains the upper lobes of the lung, the heart, the spinal column, and the scapulae, there are many etiologies for upper back pain. We have listed some of the specific conditions that may cause upper back pain below.
Due to continuous wear and tear or trauma, an intervertebral disc may herniate. This occurs when the soft inner content of the disc, namely the nucleus pulposus, bulges out.
A herniated disc can pinch the spinal nerves and compress them. The location of the pain along the upper back, neck, and pain depends on which disc has herniated and which corresponding nerve is compressed.
Upper back pain between the shoulder blades can be due to a fractured vertebra. Weak or osteoporotic bones fracture easily. Fractures can also occur due to injury or trauma.
In the thoracic spine, compression fractures of the vertebrae are quite common. About 700,000 people experience compression fractures in the US alone.  In a compression fracture the vertebral bones can lose about 15-20% of their height. This changes the sagittal spinal alignment. The adjacent normal vertebrae lose their mobility and flexibility. Over time, the loss in height leads to increased pressure and hairline fractures.
There are many types of vertebral fractures, including wedge fractures, crush fractures, and burst fractures. All of them will cause upper back pain.
Wedge fractures are the most common type of vertebral fracture. They occur when the front of the vertebrae is fractured causing the front of the bone to collapse. The back of the bone remains unchanged, resulting in a wedge-patterned fracture. Pain is the first sign of a fracture along with loss of function.
Scoliosis is a condition where the spinal curvature is altered. As the spine twists, there is increased pressure on the spinal vertebrae, intervertebral discs, and joints.
As a result, the muscles are also strained as they try to support the misaligned spine. The nerves are often stretched or affected.
This can lead to upper back pain in the shoulder. In addition to their effect on the spine, pressure also builds on the heart and lungs as the space within the chest cavity is restricted.
It is quite common for patients to develop difficulty breathing and other cardiopulmonary symptoms in addition to upper back pain.
Myofascial Pain Syndrome
Myofascial pain syndrome (MPS) is a musculoskeletal disorder that is induced by a trigger point in the muscles. A myofascial trigger point is a hyperirritable spot within a taut muscle.
The trapezius and paraspinal muscles are located in the upper back. Intercsapular pain is a common symptom of myofascial pain syndrome within these muscles.
Myofascial trigger points can develop with time as we age. It can result from poor posture, stress, or overuse of the muscle and joints. These trigger points then cause MPS.
Degenerative arthritis of the spine can make the vertebrae stiff. This is because as the cartilage between the joints degenerates over time, the bone starts to rub. The body also stops producing as much synovial or joint fluid as we get older. Osteoarthritis typically affects the facet joints between the vertebrae. Mobility can be limited due to the lack of joint fluid and roughness of the bones. This leads to inflammation. Chronic inflammation makes the bones stiff.
When the muscles supporting the spine are activated while sitting or standing, the stiffness can cause upper back pain. The pain is often relieved by lying down. When you’re lying down the muscles are inactive. However, when you sit or stand, the muscles have to work to maintain a sitting or standing posture. Since these muscles attach to the spinal vertebrae, any activity of the muscles can cause back pain.
If the osteoarthritis is severe, then it may be accompanied by numbness and weakness of the arms.
Chronic upper back between the shoulder blades, or right upper back pain, is a common symptom of gallstones lodged in the bile duct. Additionally, chronic inflammation of the gallbladder can cause interscapular pain. This is called referred pain.
Referred pain from the gallbladder can occur because the spinal nerves that innervate the gallbladder also innervate the lower thoracic spine and ribs. So, any pain from the gallbladder can be referred to the spine, the right shoulder, or the ribs, leading to upper back pain. In gallbladder disease, the pain evolves very quickly from upper back pain to abdominal pain, along with nausea and vomiting.
Acid reflux is the backflow of gastric acid into the esophagus. Ulcers in the stomach can lead to acid reflux which causes referred pain in the upper back.
Many pain medications like Ibuprofen and non-steroidal anti-inflammatory drugs (NSAIDs) used to treat back pain may cause acid reflux, resulting in a vicious cycle. People who take pain medications often complain of acid reflux, since these medications increase acid production in the stomach.
Shingles occurs when the spinal nerves get infected by the herpes virus. It causes painful blisters along the nerve and the body part it supplies.
People with shingles can experience severe pain in the upper back and itching along that area of the nerve supply. So for example, you may see it along a single rib or a specific strip of the back.
The pain is usually sharp and severe, and some people may experience burning pain along with tingling or numbness. This pain is due to the infection of the nerves.
There are other various underlying causes of upper back pain. An improper sleeping position, cancers in the spine, stenosis of the vertebral canal, aortic dissection, are all causes of upper back pain.
If the pain is severe, unrelenting, or persistent, it is important to speak to a doctor and look beyond a sprain or poor posture.
Learn More About Each Condition
To understand annular tears, let us first review the anatomy of the spine. The lumbar spine is comprised of 5 boney building blocks called vertebral bodies. Sandwiched between the vertebral bodies are the lumbar discs. Each disc is comprised of an outer fibrous ring, the annulus fibrosis that surrounds the inner gelatinous center, which is called the nucleus. The disc absorbs the forces of daily living. The annulus has multiple layers of collagen that provide important support. The annulus is similar to the sidewall of a tire which provides important stability for the tire. Through trauma or degeneration, the outer annular fibers can become injured and or weakened.
Read More About Annular Tear
Degenerative Scoliosis, also known as Adult-onset Scoliosis, is a medical condition that involves a side bending in the spine. The bending can be mild, moderate, or severe with side-bending to either the right or the left. The term degenerative means generalized wear and tear and is common as we get older. Degenerative scoliosis is the curvature of the spine that occurs as a result of degeneration of the discs, small joints, and building blocks. The Degenerative Scoliosis curve is often located in the low back and forms a ‘C” shape. There is a convex and a concave side. The convex side is the open side where it curves outward.
Read More About Degenerative Scoliosis
Facet Joint Syndrome
Injury or inflammation of the cervical facet can led to neck, shoulder and headache pain – called “cervical facet syndrome.” Cervical facet syndrome largely involves a joint in the posterior aspect of the cervical spine. It functions to provide stability and guide motion. cervical facet joint injection for cervical facet syndrome Cervical facet pain is common in patients who have sustained a whiplash injury, trauma to the neck or undergone cervical fusion. Physical examination is typically significant for restriction in range of motion along with pain. Each joint has a distinct referral pattern illustrated below. The Centeno-Schultz Clinic are experts at diagnosing and treating cervical facet dysfunction. Injury to the joint is not commonly detected by conventional radiographic studies.
Read More About Facet Joint Syndrome
Spondylolisthesis means that one vertebra is slipping forward or backwards on another. This causes the hole where the nerve exits (foramen) to get smaller (also called foraminal stenosis). It also causes more wear and tear on the facet joint which can lead to arthritis or what’s called “facet hypertrophy”.
The amount of slippage is graded 1-4, with grade 1 meaning that the one vertebra has slipped up to 25% on the other vertebra. Grade 2 means that one bone has slipped from 25-50% with higher grades indicating more slippage. The vast majority of patients are grade 1 to 2.
Read More About Spondylolisthesis
Other Risk Factors That Might Make You More Susceptible To Upper Back Pain
Several factors can increase your chances of having upper back pain between the shoulder blades.
When it comes to the back, muscle overuse, osteoarthritis, and age-related disc degeneration, and this causes upper back pain.
The older you are, the more likely the wear, and so the higher the chances of back pain.
Lack Of Fitness
A lack of a structured exercise program can lead to weaker bones and muscles. This can cause misalignment of the spine and poor muscular support for the back.
People who do not exercise are more susceptible to back pain. Studies show that exercising helps to improve mobility and prevent back pain. 
Being overweight can make you more susceptible to upper back pain. The heavier you are, the more stress on your spine and joints.
The higher the waist circumference, the more the pelvis and the back must slant forward to support your frame, thus leading to back pain.
Conditions that affect the spine, such as arthritis, inflammatory conditions, diabetes, and hypertension can make a person more susceptible to upper back pain. Diabetes and hypertension affect the blood vessels by constricting them over time. This compromises the blood supply to the spine slowing down healing and worsening back pain. Inflammatory conditions like ankylosing spondylitis cause the vertebrae to fuse leading to back pain.
Smoking can affect blood circulation as cigarette smoke contains many substances that damage the arteries.
As the blood supply to the spinal vertebrae is compromised, parts of the bone start dying which leads to upper back pain. This is a very slow process and back pain is one of the first symptoms.
Injuries in contact sports, such as weight training, swimming, tennis, and basketball, are common. This may include overuse injuries, strains, sprains, and more, and could affect the upper back.
Contact sports like mixed martial arts, wrestling, and rugby are a few examples where direct trauma and injury can affect the back and shoulder leading to upper back pain. This could be a direct blow to the back, an awkward fall, an opponent driving their knee into the back, grappling, or a build up of micro injuries over time.
Another factor to keep in mind is that most athletes have very intense training with a short recovery period. This may not allow the tissues to adequately regenerate between sessions, making them susceptible to further injury.
Examination And Diagnosis
Once you meet with a board-certified doctor, they will try and find out what is causing the pain between your shoulder blades. They will examine you, assess your pain, and conduct different tests to diagnose the cause. This is important because the cause determines the treatment.
After a detailed history, a doctor will conduct a thorough physical exam of the neck, shoulder, and spine. They will perform provocative tests which are specific to certain conditions.
Because the upper back contains so many vital organs like the heart and lungs, they may also examine the chest and do a full cardiac and pulmonary exam.
Assessment Of The Pain Intensity
To understand how debilitating the upper back pain is between your shoulder blades, the doctor will ask detailed questions about the pain. This helps them understand the severity of the pain, its chronicity, and how the pain experience is affecting your physical and emotional health.
There are various instruments to assess the intensity of the pain like the Visual Analog Scale or Graphic Rating Scale. Doctors also use a Numerical Rating Scale (NRS), which asks a patient to rate their pain on a scale between 0 and 10.
The Verbal Rating Scale and pain drawing are two other instruments to rate the intensity of the pain. McGill Pain Questionnaire may be used to determine how the pain is affecting you.
Depending on the suspected diagnosis, a doctor may order X-rays, MRIs, or a CT scan. If they suspect a cardiac cause, they could order an ECG. Or, if acid reflux is being considered, they may request an esophageal manometry.
For older patients, a doctor may order a bone scan to check the severity of osteoporosis. It all depends on what the physical examination reveals.
Common Treatment Options For Interscapular Pain
To treat the pain between shoulder blades, there are many different treatment options you can try. If they do not work or you start having severe interscapular pain your doctor may suggest trying alternative treatments. Here are some recommended treatments.
So, you have your first brush with upper back pain. You hit the internet with your question, “why does my upper back hurt between my shoulder blades?” The very first step to treating it will most likely be conservative management or home remedies. Here are some home remedies you can try out.
Rest your back and avoid lifting any heavy weights. This will give your body time to heal and allow the relevant structures to recover.
Eat a healthy diet, with plenty of fruits and vegetables. Food that is rich in nutrients, vitamins, and minerals can help your body heal faster. Avoid spices, carbonated drinks, and processed food that can cause acid reflux and weight gain, which will further exacerbate back pain for those conditions.
Do gentle shoulder stretches to get rid of any shoulder tension. These are 30-second exercises that can help improve shoulder flexibility and strengthen the muscles as well.
Hot Or Cold Compress
Hot are useful to improve circulation in the upper back area. Once the circulation improves, the blood brings nutrients with it to repair any injuries in the shoulder area.
Cold compresses reduce the blood circulation for a brief period so that the pain is less.
Back exercises strengthen the spinal muscles that support the back. Strong spinal muscles can help reduce the stress on the intervertebral discs. They also maintain the natural curvature of the spine to contribute to a better posture.
If there is too much muscle stiffness, then massage therapy, physical therapy, or occupational therapy can ease muscle tension.
The effects of massage therapy are temporary. However, a good massage can relieve muscle tension, loosen stiff muscles, and improve blood flow to the area.
Physical Or Occupational Therapy
Physical or occupational therapy involves both active and passive treatments.
While you have interscapular pain, the physical therapist might get you started on passive exercises where you do not have to actively participate in the movements or muscle activations. This may include a deep tissue massage, TENS therapy, or ultrasound therapy. After your muscles are relaxed and the pain improves, the physical therapist may start you on an active program to strengthen your back and shoulder muscles.
Occupational therapists usually work one on one with an individual to see how he or she engages in their everyday work. They also study how pain influences their occupation and offer solutions to reduce pain. Occupational therapy can help people with back pain re-engage with their occupation, address any issues with their occupational performance, and also provide specific vocational rehabilitation. This includes teaching patients proactive pain control, safe body, ergonomics, neuromuscular education, muscle tension reduction training, and a home exercise program.
If the pain is severe and prevents you from going about your daily activities, doctors may prescribe medications.
Anti-inflammatory drugs like ibuprofen and naproxen can help relieve the pain immediately. They do so by reducing the inflammation at the site of injury.
Oral steroids or steroid injections will also relieve pain and inflammation in the interscapular area. Steroid injections are given in the epidural space. The steroids are usually only prescribed for a brief period since long term use can make you susceptible to infections.
Muscle Relaxants And Antidepressants
For stiff muscles, doctors might need to prescribe a muscle relaxant like cyclobenzaprine (Flexeril) to relieve muscle tension.
Antidepressants like fluoxetine (Prozac), paroxetine (Paxil,), sertraline (Zoloft), citalopram (Celexa), and escitalopram (Lexapro) are given when nerve pain is suspected as the cause of the upper back pain.
It’s important to keep in mind that the above treatment may not be useful for shingles which requires an antiviral medication, or gallbladder disease which needs further evaluation before it is treated.
Things You Can Do To Prevent Pain Between The Shoulder Blades
To prevent pain between the shoulder blades, here are some things you can do:
Practice Good Posture
Good posture is not something that you just have, it is a habit that you develop over time. Be mindful of how you stand and sit. Square your shoulders, chin up and tuck your tummy inwards. Wear comfortable, low-heeled shoes to ensure you are not putting too much strain on your spine.
Avoid Lifting Heavy Items
Avoid lifting heavy items. If possible, get someone to help you. If you have to lift a load, here’s a nifty lifting technique: bend at your hips and knees, squat down to the load, keep it close to your body and lift.
Avoid Sitting for Too Long
Try to avoid prolonged periods of sitting, as this can contribute to upper back pain. Be sure to take regular breaks throughout the day, and use an ergonomic chair that supports your spine.
Switch sitting positions, do not cross your legs while sitting, take short walks during your break and stretch your muscles to relieve muscle tension.
Adopt healthy habits
Adopting healthy habits involves lifestyle changes like maintaining a healthy weight by eating healthy meals, avoiding processed and junk food, and starting a regular exercise program.
Studies show a link between back pain and smoking because nicotine can cause constriction of the blood vessels and damage the arteries. Smoking also increases the risk for osteoporosis, thereby thinning out the spinal bones. Therefore it’s important to cease smoking, and a doctor can help with this.
Take Your Symptoms Seriously And Get To The Root Of Your Pain
Pain between the shoulder blades can range from a simple ache to completely disabling pain. It is important to get the pain diagnosed and treated before it gets worse.
Do not ignore interscapular pain. Use some of the conservative treatments and if they don’t work seek medical advice. Get to the root of your problem without delay.
Want to know more about the pain in your upper back between your shoulder blades? Contact us and we will help you out.
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