Pain is the body’s way of telling you something is wrong regardless of what part of the body is affected.
Pain between the shoulder blades, also known as interscapular pain, is a common type of pain many people experience.
This type of pain can be as serious as a heart attack—no pun intended.
According to Medical News Today, the pain is often due to minor issues such as tension from stress or from simple muscle strains. Other times, it can signal a serious condition such as an imminent heart attack.
It could be noticeable soreness, a sharp shooting or stabbing pain, or a dull and aching pain. Pain may start suddenly and persist or come and go.
To avoid medical complications or even death, you should never dismiss pain between the shoulder blades as something minor.
Seek medical attention as soon as possible, especially if the pain is accompanied by other symptoms discussed later in this article.
Understanding the Shoulder Blades
The shoulder blades, or scapulae, are the large triangular bones located at each side of the upper shoulder.
They are connected to the collarbone and allow a range of motions such as pivoting up or down, side to side, and shoulder rotation. But the flexibility of the blades is what makes them susceptible to injury or trauma.
15 Causes of Pain Between the Shoulder Blades
1. Poor Posture
Sitting in the wrong positions for an extended time is one of the easiest ways and most common cause of pain between the shoulder blades.
According to Advanced Spine and Sports Care, sitting slumped or with shoulder hunched forward on a regular basis can compress the spinal nerves or cause misalignment of the spine.
Muscles, tendons, and ligaments may also be affected causing pain. Persons who have rounded shoulders may find it difficult to maintain proper posture and often experience shoulder pain.
Here is a YouTube video by The Mayfair Clinic illustrating, using a human spine model, how bad posture may be causing your pain and how you can prevent it.
2. Pulled or strained a muscle
Muscle injury such as a strain or pulled muscle can cause pain between the shoulder blades.
The injury can happen from poor posture, exercise, lifting heavy objects the wrong way, or working on a computer for a long period of time without taking breaks. Muscle strains can also occur if you sleep in the wrong position.
3. Injury or trauma
A fall, hard hit, or a vehicular accident can injure the shoulder blades and cause pain.
According to VeryWell Health, injuries such as a fracture, rotator cuff tear, and snapping scapula syndrome are bone or muscular conditions stemming from trauma.
Snapping scapula syndrome result in snapping and popping alongside the shoulder blades.
4. Herniated disc
Medical conditions can refer pain to the shoulder blades. For example, a sharp or dull pain in the upper neck, between the shoulder blades, may be felt due to a herniated or “slipped” disc.
This is according to the Spine Universe. A herniated disc causes irritation or compression of the spinal nerves resulting in pain.
Pain may travel to other parts of the body, including the shoulder blades, and may be accompanied by muscle spasms.
5. Spinal stenosis
Pain in the shoulder blade muscles or beneath the shoulder blades may be due to spinal stenosis. This condition is caused by narrowing of the spine resulting in pressure on the spinal nerves.
Severe back pain is the main symptom of spinal stenosis and this pain can radiate to the region between the shoulder blades. Muscles, joints, and soft tissues located in other parts of the back may also be affected.
Fibromyalgia is a condition known to cause widespread pain in the body. It is diagnosed by assessing pain at various tender points or pain spots on the body.
Four of the 18 pain points are located in the middle region of the upper back, between the shoulder blades. Thus, a person with fibromyalgia may experience pain that starts in this region and spread to the blades.
7. Abdominal conditions
Gallstones, gallbladder disease, acid reflux, peptic ulcer disease, liver disease, and pancreatitis are medical conditions known to cause referred pain in other parts of the body.
Pain may radiate to the left or right shoulder blade but sometimes the pain is felt between the blades.
Direct or referred pain from osteoarthritis can cause you to feel pain in between your shoulder blades.
Arthritis is caused by inflammation and pain in the joints and can affect the neck, shoulder or shoulder blades.
Arthritis pain in other parts of the body, e.g., the ribs, chest, or spine, can also radiate to the shoulder blades.
Shingle is a viral infection that may occur in people who were infected with the chicken pox virus.
A rash on one side of the body or the area of the affected nerve is a common symptom of shingles, but pain between the shoulder blades can also occur.
It could a tingling or burning pain which tend to be felt days after the rash first appears.
When the spine’s formation is curved or twisted, the condition is called scoliosis. Common symptoms are uneven hips, uneven shoulder blades, and back pain due to a strain on the back muscles.
Because the condition affects posture, it can put pressure on the upper body and shoulders and result in pain between the shoulder blades.
11. Nerve compression
A bone or tense muscles can cause a pinched or compressed nerve between the shoulder blades.
This condition is called peripheral neuropathy and may cause pain, tingling, numbness, or weakness in the muscles between the shoulder blades.
Medical conditions such as osteoarthritis and rheumatoid arthritis can damage the nerves and increase the risk of nerve compression and pain between the shoulder blades.
12. Myofascial pain syndrome
Myofascial pain syndrome is a condition caused by the overuse of muscles or repetitive injuries to the muscles.
Common symptoms are muscle knots and pain. The myofascial trigger points (knots) can occur and cause pain in any part of the body, including between the shoulder blades.
Shoulder blade pain may result from various types of cancers. They include lung cancer, and cancers of the esophagus, liver, stomach, and pancreas.
14. Pulmonary conditions
Blood clots can form in the body and travel to the lungs causing pulmonary embolism. In addition to experiencing shortness of breath, some people who suffered a pulmonary embolism said they felt a sudden, sharp pain between their shoulder blades.
Pulmonary embolism is a serious condition that requires urgent medical attention. Lung cancer or a collapsed lung are other pulmonary conditions that can cause similar pain.
15. Heart attack and other heart conditions
Back spasms during a heart attack or oncoming heart attack can cause pain between the shoulder blades. This is according to Pain Doctor.
The pain may be accompanied by tightness or squeezing in the chest or arms that may spread to the jaw, neck, or back.
Studies show that pain between the shoulder blades associated with an impending heart attack mostly affect women.
Because back spasm symptoms are rarely associated with a heart attack, it can be easily dismissed as “nothing,” when in fact it can be a life-threatening symptom.
Additionally, other heart conditions such as inflammation of the lining of the heart (pericarditis) or a tear in the aorta (aorta dissection) may cause symptoms such as pain between the shoulder blades.
When to See a Doctor for Pain Between the Shoulder Blades
You should take pain between the shoulder blades serious, particularly if the pain is unusual, moderate, or severe.
This way, you can err on the side of caution if it turns out to be a minor problem.
Pain accompanied by other symptoms is a strong indication that there may be an underlying, possibly life-threatening, the condition causing the pain.
Seek medical attention immediately if you have pain between your shoulder blades and one or more of these symptoms:
- Pain or tightness in the chest, arms, neck, or jaw
- Coughing up blood
- Excessive sweating
- Rapid or irregular heartbeat
- Shortness of breath
- Redness, swelling, or pain in your legs
- Paralysis on the left or right side of your body
- Difficulty speaking
- Vision loss
- Loss of consciousness
Diagnosing Pain Between the Shoulder Blades
Your doctor will do a physical examination along with other tests to determine the cause of pain between the shoulder blades.
The doctor typically assesses the range of shoulder motions and check for tenderness, swelling, muscle weakness, and physical abnormalities.
Tests could include an X-ray, CT, MRI, or PET scan, arthrogram, or arthroscopy. Imaging tests can detect musculoskeletal problems such as muscle strains or myofascial knots that cause pain between the shoulder blades.
You may be required to do a stress test or a heart test (EKG).
If necessary, blood tests may be done to check for inflammation and signs of health conditions such as arthritis or liver disease. Your doctor may also evaluate your stomach and intestine by performing an endoscopy.
Treating Pain Between the Shoulder Blades
Treatment for your shoulder blade pain will depend on the cause and severity of the pain and whether there are underlying conditions that also need to be treated.
The rest, ice, compression, and elevation (RICE) methods may be used for pain between the shoulder blades caused by muscle tension or minor injuries such as a muscle strain or pulled muscle.
Resting the shoulders by avoiding activities that use shoulder muscles may reduce pain and allow healing.
You can also ice the affected area for 15-20 minutes, several times a day. To reduce swelling, compress the muscles by wrapping the upper shoulder with a compression bandage.
Elevate or keep the shoulders in an upright position as much as is practical when lying down.
Over-the-counter painkillers or non-steroidal anti-inflammatory drugs (NSAIDs), e.g., ibuprofen and naproxen, are generally used to relieve pain.
NSAIDs also reduce inflammation if present in the joints, muscles, tendons, or ligaments. In the case of severe pain, steroid injections or narcotic painkillers may be prescribed.
Massage therapy or heat therapy may help relieve pain caused by repetitive use of shoulder muscles or minor joint injury.
Nerve compression in the neck or nerve entrapment such as that caused by myofascial pain syndrome or herniated discs can be treated with chiropractic care.
Chiropractic adjustment, also known as spinal manipulation, may be performed by a certified chiropractor to decompress the nerves, align the spine, and reduce pain and inflammation.
Simple exercises that target affected muscles may help relieve pain. However, care should be taken to perform the exercises correctly to avoid irritating the muscles or causing further injury.
Exercise should be avoided in cases of a rotator cuff tear or shoulder dislocation. Surgery may be an appropriate treatment instead.
Treat underlying condition
Sometimes simply treating existing medical conditions, e.g., cancer, arthritis, herniated disc, or shingles may relieve pain between the shoulder blades.
Surgery is rarely needed to correct pain between the shoulder blades. According to the American Academy of Orthopaedic Surgeons, non-surgical options often relieve pain in most people.
Injuries that involve a fractured or dislocated shoulder or severe damage to musculoskeletal tissues may require surgery.
Surgery is performed to repair torn or scarred tissues or realign and reconstruct the shoulders. Sometimes, surgery is also needed to correct a herniated disc.
As you can see, pain between the shoulder blades can be actual pain or referred pain from an underlying medical condition.
It can be caused by a list of things including something as simple as a bad posture to something very serious such as a heart attack.
While you may be tempted to dismiss this pain as something trivial, it is always recommended you speak with your doctor if the pain persists, is moderate to severe, or accompanied by certain symptoms.
This can prevent health complications, or fatality, in the case of a heart attack.