Upper back pain between the shoulder blades: causes and when to worry

Pain between the shoulder blades is most often muscular or comes from the joints of the upper back. A pinched nerve in the neck is another common cause, and it often refers pain here weeks before any arm symptoms. The heart, aorta, gallbladder, and lungs can also refer pain to this area, so sudden, severe, or exertional pain needs emergency evaluation first.

First: when pain between the shoulder blades is an emergency

The interscapular area shares nerve pathways with several internal organs. Call 911 for any of the following:

• Sudden, severe, tearing or ripping pain in the chest or back, especially with high blood pressure. This can signal acute aortic dissection, where back pain is a common presenting symptom¹.
• Pain with chest pressure, shortness of breath, sweating, nausea, or pain brought on by exertion. This can signal a heart attack. Women are more likely than men to have symptoms other than classic chest pain, such as back, jaw, or upper-abdominal discomfort².

See a doctor the same day for pain with fever, pain after fatty meals or with right upper-abdominal pain (possible gallbladder disease), sharp pain worse with breathing, or pain with a history of cancer, osteoporosis, or recent trauma³.

How common is pain between the shoulder blades?

Thoracic spine pain is common across the lifespan. It is associated with concurrent neck or low back pain, psychological stress, and physical and postural factors⁴. In working adults, one-year prevalence varies widely by occupation, with medians around 30% in many occupational groups⁵.

Common musculoskeletal causes

• Muscle strain and myofascial pain: the rhomboid, trapezius, and levator scapulae muscles are frequently involved after unaccustomed lifting, long desk sessions, or sleep position.
• Thoracic facet and rib joints: irritation of the small joints of the upper back produces predictable, localized pain patterns near the spine⁶.
• Referred pain from the neck joints: the lower cervical facet joints can refer pain down to the shoulder-blade region⁷.
• Pinched nerve in the neck (cervical radiculopathy): in 50 surgical patients, neck or shoulder-blade pain came before arm symptoms in 70%. Pain between the shoulder blades pointed to the C7 or C8 nerve root, and it resolved after the nerve was decompressed⁸. An anatomic and clinical study confirmed this mapping⁹.
• Thoracic disc herniation or compression fracture: less common. A fracture is suspected with osteoporosis, steroid use, or a fall.

“Text neck” is widely blamed, but in young adults, phone-use neck posture was not associated with neck pain¹⁰. Sustained static positions can still aggravate symptoms, so movement breaks help.

Could my neck be the cause?

Often, yes. Suspect a cervical source in these situations:

• Shoulder-blade pain changes with neck movement, especially looking up or turning toward the painful side.
• You later develop arm pain, tingling in the fingers, or grip weakness.
• Pain eases when you rest your hand on top of your head.

NASS guidelines support MRI when cervical radiculopathy is suspected and symptoms persist or are severe¹¹. Hand clumsiness, balance problems, or dropping objects can indicate spinal cord compression and need prompt evaluation. See our herniated disc guide.

Treatment for upper back pain between the shoulder blades

1. Self-care and activity: keep moving, use heat, take short movement breaks during desk work, and try short courses of anti-inflammatory medication when appropriate.
2. Physical therapy: exercise targeting the neck, shoulder-blade muscles, and thoracic mobility, combined with manual therapy. Clinical practice guidelines support this for neck-related pain¹².
3. Image-guided injections: for pain traced to an irritated cervical nerve root or facet joint, performed under fluoroscopy in our Westbury C-arm suite.
4. Surgery: for cervical radiculopathy with persistent arm pain or weakness despite conservative care, or for spinal cord compression^11,13.

Upper back and neck pain care in Westbury

Our Westbury office is open Monday to Friday, 9 a.m. to 5 p.m., and Saturday, 9 a.m. to 3 p.m. It houses the practice’s fluoroscopy (C-arm) suite, where image-guided spine injections are performed. Spine evaluations are also available at our East Meadow main office, and at our Lindenhurst and Elmhurst/Queens satellite offices. When you need an MRI or CT scan, we arrange it at an outside imaging center and review the images with you in person.

The practice accepts New York workers’ compensation and no-fault (auto accident) claims. Translation in Spanish, Punjabi, Hindi, and Urdu is available at all four offices. To book, call (516) 743-9450.

Frequently asked questions

What causes pain between the shoulder blades?

Most often muscle strain or irritation of the small joints of the upper back or neck. A pinched nerve in the neck (C7 or C8) is another common cause and can produce pain there before arm symptoms appear. Less commonly, the heart, aorta, gallbladder, or lungs refer pain to this area.

When should I worry about pain between my shoulder blades?

Call 911 for sudden, severe, tearing pain, or for pain with chest pressure, shortness of breath, sweating, nausea, or exertion. See a doctor promptly for pain with fever, pain related to meals, pain worse with breathing, or pain with a history of cancer or osteoporosis.

Can a pinched nerve in the neck cause pain between the shoulder blades?

Yes. Research in patients with cervical radiculopathy showed interscapular pain commonly comes from the C7 or C8 nerve root, often preceding arm pain, and it resolved after the nerve was decompressed.

Can pain between the shoulder blades be a heart problem?

It can be. Heart attack symptoms may include upper-back pain, particularly in women, often with chest pressure, shortness of breath, sweating, or nausea, or brought on by exertion. Treat these symptoms as an emergency.

Is pain between the shoulder blades a sign of gallbladder problems?

Gallbladder pain can refer to the right shoulder blade or between the shoulder blades, typically with right upper-abdominal pain, often after fatty meals. See a doctor promptly if this pattern sounds familiar.

How do I relieve upper back pain between my shoulder blades?

Keep moving, use heat, take frequent breaks from static desk positions, and consider a short course of anti-inflammatory medication if appropriate. Persistent pain benefits from physical therapy targeting the neck, shoulder blades, and thoracic spine.

Can bad posture cause pain between the shoulder blades?

Sustained static positions can aggravate upper back pain, but research does not show that phone-related neck posture alone causes neck pain in young adults. Movement variety matters more than holding a perfect posture.

How long does pain between the shoulder blades last?

Muscular pain often improves within days to a few weeks. Pain lasting more than four to six weeks, pain that spreads into the arm, or pain with numbness or weakness should be evaluated by a spine specialist.

What doctor should I see for pain between my shoulder blades?

After serious medical causes are excluded, a spine specialist can evaluate muscular, joint, and nerve sources, including the neck, and coordinate physical therapy, injections, or surgery if needed.

Where can I get upper back pain treated near Westbury, NY?

Grewal Orthopedic & Spine Care evaluates upper back and neck pain at its Westbury office and in East Meadow, Lindenhurst, and Elmhurst/Queens. Call (516) 743-9450.

References

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2. Gulati M, Levy PD, Mukherjee D, et al. 2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR guideline for the evaluation and diagnosis of chest pain. Circulation. 2021;144(22):e368-e454. Link
3. Finucane LM, Downie A, Mercer C, et al. International framework for red flags for potential serious spinal pathologies. J Orthop Sports Phys Ther. 2020;50(7):350-372. Link
4. Briggs AM, Smith AJ, Straker LM, Bragge P. Thoracic spine pain in the general population: prevalence, incidence and associated factors in children, adolescents and adults. A systematic review. BMC Musculoskelet Disord. 2009;10:77. Link
5. Briggs AM, Bragge P, Smith AJ, Govil D, Straker LM. Prevalence and associated factors for thoracic spine pain in the adult working population: a literature review. J Occup Health. 2009;51(3):177-192. Link
6. Dreyfuss P, Tibiletti C, Dreyer SJ. Thoracic zygapophyseal joint pain patterns: a study in normal volunteers. Spine. 1994;19(7):807-811. Link
7. Dwyer A, Aprill C, Bogduk N. Cervical zygapophyseal joint pain patterns. I: A study in normal volunteers. Spine. 1990;15(6):453-457. Link
8. Tanaka Y, Kokubun S, Sato T, Ozawa H. Cervical roots as origin of pain in the neck or scapular regions. Spine. 2006;31(17):E568-E573. Link
9. Mizutamari M, Sei A, Tokiyoshi A, et al. Corresponding scapular pain with the nerve root involved in cervical radiculopathy. J Orthop Surg (Hong Kong). 2010;18(3):356-360. Link
10. Damasceno GM, Ferreira AS, Nogueira LAC, Reis FJJ, Andrade ICS, Meziat-Filho N. Text neck and neck pain in 18-21-year-old young adults. Eur Spine J. 2018;27(6):1249-1254. Link
11. Bono CM, Ghiselli G, Gilbert TJ, et al. An evidence-based clinical guideline for the diagnosis and treatment of cervical radiculopathy from degenerative disorders. Spine J. 2011;11(1):64-72. Link
12. Blanpied PR, Gross AR, Elliott JM, et al. Neck pain: revision 2017. Clinical practice guidelines linked to the International Classification of Functioning, Disability and Health from the Orthopaedic Section of the American Physical Therapy Association. J Orthop Sports Phys Ther. 2017;47(7):A1-A83. Link
13. Fehlings MG, Tetreault LA, Riew KD, et al. A clinical practice guideline for the management of patients with degenerative cervical myelopathy: recommendations for patients with mild, moderate, and severe disease and nonmyelopathic patients with evidence of cord compression. Global Spine J. 2017;7(3 Suppl):70S-83S. Link