Pain Between Shoulder Blades

What causes pain between Shoulder Blades?

Pain between the shoulder blades are a common, manageable problem.Image of a painful back. 

Do You Have Pain Between Your Shoulders?

It is important to understand that there are many different types of shoulder pains. There is shoulder pain which occurs on the front of the shoulder, on the back of the shoulder, and between the shoulders. Experiencing the symptoms of pain between the shoulder blades, otherwise know as interscapular pain, can range from mild discomfort to debilitating and concerning. It can also lead to right shoulder pain or left shoulder pain.  In order to determine the severity of the condition, the source of the pain must be identified. The purpose of this article is to explore two common musculoskeletal causes of pain between shoulder blades, as well as mention other conditions that may cause pain between shoulder blades.

Pain Between Your Shoulder Blades: Causes

In order to differentiate causes of interscapular pain, one must be familiar with the anatomical structures of the region. These anatomical structures reside near the interscapular region:

  • Cervical and Thoracic spine, including vertebral bodies and intervertebral discs.
  • Scapula or shoulder girdle.
  • Ribs.
  • Muscles, such as the rhomboids, lower trapezius, middle trapezius, upper trapezius, and the Paraspinal muscles.
  • Spinal, and peripheral nerves.
  • Skin.
  • Thoracic Aorta.
  • Esophagus.
  • Portions of the lungs.
  • A portion of the heart.

While this list of anatomical structures is not exhaustive, it serves as a baseline for possible causes of pain between the shoulder blades. One of the most common causes of interscapular pain is muscular pain, due to muscle strain, trauma, or posture strain. This can not only result in interscapular pain, but can also result in combined neck and shoulder pain as well. The severity of muscular pain is typically mild, and temporary. A strain of the rhomboids or trapezius muscles can be the result of repetitive pulling movements, such as pulling a starter on a lawn mower, or performing rows at the gym. A muscle strain is typically the result of an excessive load placed on the muscle, causing inflammation and tearing of the muscle belly. 

Pain Between The Shoulder Blades 

Trauma to the muscles of the interscapular region can also cause inflammation and bruising, resulting in pain. Mechanism of injury of this condition is typically while playing contact sports, or being involved in a motor vehicle accident. Moreover, a postural strain can cause musculogenic pain in the interscapular region. This typically arises when a specific posture against gravity is maintained for a long period of time without a change in position. The best example of this is posture is prolonged sitting at a computer without changing positions for extended periods of time. Muscular pain can typically be managed well with conservative measures. Often, symptoms can be easily reproduced with palpation of the muscles, as well as loading of the muscle at fault. Physical medicine, such as massage, ice and heat can provide short-term relief of pain, while strengthening and range of movement exercises can reduce poor movement patterns contributing to muscle and postural strains, and provide longer term relief. 

Dr. Kamal Bohsali

Dr. Kamal Bohsali states, "Pain between the shoulder blades usually indicates a neck or upper back issue. Pain in these areas can usually be relieved with moist heat, over-the-counter anti-inflammatory medication, and physical therapy. Sometimes x-rays and advanced imaging such as an MRI are performed to evaluate for spinal disc damage. There are less common, but potentially emergent conditions, that can result in acute shoulder blade pain such as heart attack, thoracic aorta rupture, cancer, and even gall bladder disease. These problems are generally managed through the emergency department, your primary care physician, cardiologist, oncologist or general surgeon." 

Dr. Kamal Bohsali, is a board certified, fellowship trained orthopedic surgeon with special interests in the management of pathologic conditions of the shoulder and elbow.

Other Common Causes

Another common cause of pain between the shoulder blades is due to a disc herniation in the cervical or thoracic spine, causing nerve root impingement and radiculopathy. When this occurs, inflammation of the spinal nerve causes symptoms to travel to other areas, such as the hand, elbow, and shoulder region. Typically, these symptoms reside once the compression and the inflammation of the nerve is reduced. Resolution of inflammation and decompression o f the nerves can be facilitated by a number of non-invasive and invasive procedures, and dependent on a number of factors and indications. Treatment typical begins with conservative care, through physical therapy interventions. Often treatments, such as mechanical traction or manual therapy is indicated, and accompanied by therapeutic exercises to address deficits in mobility and strength. If conservative care fails to restore function, then the physician may elect to perform injections or surgery

There are several other causes of pain between the shoulder blades that should be mentioned, as many are medical emergencies. Medical conditions, such as a heart attack, thoracic aorta rupture, cancer, and even gall bladder disease can cause pain between the shoulder blades. Often these conditions are accompanied by other symptoms, and symptoms are often more difficult to reproduce with movement. It is very important to seek proper medical advice, if you are concerned about these types of symptoms. It is very important to seek proper medical advice, if you are concerned about these types of symptoms.


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By: Drew Heideman, PT ATC

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