What Causes Back Pain Between Shoulder Blades

Back pain is such a common problem that almost everyone has experienced it at least once, if not on multiple occasions. Pain in the back can appear in different places, such as the lower back, mid back, or across the shoulder blades. What is sometimes a mystery is the root cause. 

Pain between the shoulder blades is a common occurrence which can often be chalked up to a long day of sitting at a screen or ‘shoulder day’ at the gym. While things like sports injury or overexertion can easily lead to a sensation of pain between your shoulder blades, the cause can also be less benign or may be indicative of an underlying injury or illness. 

Possible Causes for Pain Between the Shoulder Blades

• Poor Posture
  As you might expect, poor posture can lead to pain in the back, including the area between the shoulder blades. When sitting, standing, or carrying heavy objects for extended periods, the added strain on the muscles and ligaments of the upper back may start to ache. Over time, the spine may even change structurally.

  To determine whether pain is related to posture, a doctor will perform a physical exam of the area. In some cases, an X-ray or MRI can also be diagnostic.

• Arthritis
  Arthritis may cause pain between the shoulder blades when it affects the joints in the spine, particularly in the cervical or thoracic regions. In osteoarthritis, cartilage breakdown between vertebrae leads to inflammation and pain that may radiate to this area. Rheumatoid arthritis, an autoimmune disorder, inflames joint linings, including spinal joints, causing similar discomfort. Arthritis could also lead to bone spurs or spinal stenosis, which compress nerves and contribute to pain between the shoulder blades.

  Diagnosis typically involves imaging tests, such as X-rays or MRIs, to detect joint degeneration or inflammation in the spine. In cases where rheumatoid arthritis is suspected, blood tests may be conducted to identify specific inflammatory markers. These approaches help confirm whether arthritis is the underlying cause of the pain.

• Muscle Strain
  A muscle strain can at first feel like a pulled muscle.  Usually, they occur from overuse or repetitive activities that stress the muscles in the upper back and shoulders. Lifting heavy objects, or sports injuries are examples of common culprits. People who engage in sports may experience this type of pain but common, everyday tasks such as carrying groceries can initiate a strain. The discomfort from a muscle strain typically gets worse with movement and may feel like a dull, aching sensation that intensifies over time.

  Diagnosing a muscle strain usually begins with a physical examination where the healthcare provider evaluates your range of motion and identifies any sensitive spots in the upper back. Indicators such as muscle tightness, spasms, or localized discomfort can support the diagnosis. Typically, imaging tests like X-rays or MRIs are not required unless there is a suspicion of more serious underlying conditions. Treatment generally includes rest, stretching, and strengthening exercises, along with the application of heat or cold to reduce inflammation and alleviate pain.

• Herniated Disc
  A herniated disc happens when the soft center of a spinal disc pushes out through its tougher outer layer, which can press on nearby nerves. Sitting at length, lifting heavy objects, repetitive bending and twisting motions performed (as in sports), or being overweight can lead to a herniated disc, which in turn may cause pain between the shoulder blades.  In the case of a herniated disc,  you may feel pain that travels down the arms or experience numbness, tingling, or weak muscles. The pain usually gets worse when moving or changing positions.

  To diagnose a herniated disc, doctors will perform a physical exam to check a person’s reflexes and muscle strength. They may also use imaging tests like an MRI or CT scan to see the disc and determine how severe the herniation is.

• Myofascial Pain Syndrome
  Myofascial Pain Syndrome is a chronic condition that causes pain in the muscles and the fascia, the connective tissue surrounding them. It occurs when sensitive points, known as trigger points, develop in the muscles, often leading to referred pain in areas like between the shoulder blades. This pain can feel like a deep, aching discomfort and may be accompanied by muscle stiffness.

  Diagnosis typically involves identifying trigger points during a physical exam. Treatment includes trigger point therapy, stretching exercises, and sometimes medications to alleviate muscle pain and inflammation.

• Trauma or Fracture
  Trauma, such as falls, car accidents, or direct blows, can lead to pain in the area by injuring muscles, ligaments, or even the spine. Fractures or partial muscle tears can lead to intense pain, swelling, and limited movement.

  Diagnosis often includes physical exams and imaging, like X-rays, to assess the extent of the injury.

• Cardiovascular Conditions
  Cardiovascular conditions like heart attacks, aortic dissection, or pericarditis can cause pain between the shoulder blades. This pain may radiate from the chest and is often accompanied by symptoms such as shortness of breath, sweating, or dizziness.

  When diagnosing cardiovascular conditions as a possible cause of pain between the shoulder blades, the approach depends on the specific condition. For heart attacks, an electrocardiogram (EKG) is used to measure the heart’s electrical activity, detecting irregularities in rhythm or blood flow. Blood tests may also be performed to check for elevated cardiac enzymes, which signal heart muscle damage.

  For more severe conditions like aortic dissection, where a tear occurs in the aorta, urgent imaging, such as a CT scan or MRI, is often needed. Additionally, echocardiograms and chest X-rays can help identify structural issues or inflammation, such as in pericarditis, aiding in a precise diagnosis and timely treatment.

• Cancer
  While cancer is a less common cause of pain between the shoulder blades, it can occur, especially when a tumor spreads to the spine or ribs. Metastatic cancer, such as from the lungs, breasts, or esophagus, may cause pain in this area. Cancer as a cause of back pain occurs in around 1-5% of patients with back pain, but it can be an indicator if accompanied by other symptoms like weight loss or persistent fatigue.

  Diagnosis typically involves imaging tests like CT scans, MRIs, or bone scans to detect any abnormal growths, and biopsies may be used to confirm the presence of cancer cells. Blood tests may also assist in identifying cancer-related markers

When Should I Worry About Back Pain Between the Shoulder Blades?

If pain between your shoulder blades has been worsening over the course of a week and is disrupting daily activities, it’s important to be concerned. Additionally, if you experience symptoms like weakness, headache, swelling, or nausea, or if you begin to notice a sensation of worsening pain or stinging in the shoulders, you should seek prompt medical attention. More serious signs, such as shortness of breath, chest pain, or unexplained weight loss, could indicate conditions like a heart attack, infection, or cancer and require urgent evaluation​

Treatment of Back Pain Between the Shoulder Blades

The treatment for pain between the shoulder blades is heavily dependent on the cause. In some cases, there is no need for medical intervention because time and rest can alleviate the issue. Depending on the diagnostics, your doctor can work out a treatment plan that may include anything from exercise, hot or cold compresses, physical therapy, or surgery. The good news is that pain in this region is almost always treatable and in some cases, even lifestyle modification or incorporation of daily exercise may be preventative and help ward against future pain and injury.

Orthopedic Treatment in Illinois

As an established orthopedic surgeon, Dr. Chams has a proven track record of helping his patients get back to doing what they love. With over 20 years of experience and multiple clinics throughout Illinois, Dr. Chams will formulate the right treatment plan to get you back to your daily routine in no time. For more information, please contact us online today or give us a call at: (847) 247-4000.