If you are feeling pain between your shoulder blades you’re likely a little worried. What could that kind of pain be coming from? Could it be something serious that could be an emergency?
Pain between the shoulder blades, otherwise known as interscapular pain, can have many causes. While this symptom is commonly caused by something as minor as a muscle strain, it’s important to be aware that it may also be a sign of something more serious, sometimes something as serious as a heart attack or lung cancer. Pain is our body’s way of letting us know that something is wrong, but it’s sometimes hard to know if that something is only a nuisance or something that needs urgent attention. One way or the other, however, it’s important to find a reason for what’s troubling you.
When considering pain in any region of the body, it’s helpful to think about the structures that lie in that area. Structures between the shoulder blades include:
- Muscles: The muscles present in the region between the shoulder blades include the rhomboids and middle and lower trapezius muscles. These muscles play a key role in keeping your shoulder blades back and down.
- The thoracic spine
- The thoracic aorta (the thoracic part of the largest blood vessel which carries blood from the heart to the rest of the body.
- Part of the esophagus
- Part of the heart
- A portion of the lungs
Pain that occurs between the shoulder blades may begin in any of these structures or instead may occur in regions some distance from the area due to the way that nerves transmit pain signals.
There are many possible causes of pain that are felt between the shoulder blades. Pain may be felt from conditions affecting the structures located in this region, or can instead be referred pain—pain that is felt between the shoulder blades but arises from another area. Some possible causes of pain between the shoulder blades include:
- Muscle strain: The most common cause of pain between the shoulder blades is a muscle strain. This can result from poor posture (especially leaning forward with prolonged sitting or standing,) excess lifting, activities that involve twisting such as golf or tennis, or even sleeping on a poor mattress.
- Trauma: Conditions which may result in pain between the shoulder blades following trauma commonly include acromioclavicular joint separation and rotator cuff tears. A shoulder separation is different from a shoulder dislocation which is felt more commonly in the shoulder joint.
- Herniated or bulging discs: Degenerative disc disease in the cervical spine and thoracic spine can cause referred pain to this region. It’s not uncommon for people with disc disease in their neck to feel pain only in other regions, and this can result in a delay in diagnosis. Other symptoms may include numbness and tingling, or pain in one or both arms. Sometimes pain due to disc disease in the neck is positional, for example, it may improve or get worse with flexing or extending your neck.
- Arthritis: Arthritis in the neck or even the ribs may cause interscapular pain. As with disc disease, arthritis in the neck may cause pain between the shoulder blades or other regions even in the absence of any neck pain.
- Heart attack: Heart attacks, especially heart attacks in women, don’t always begin with chest pain. In one study pain looking at people with heart attacks, three percent had pain confined to the area between the shoulder blades.This pain tends to be nagging and may be accompanied by chest pain, shortness of breath, or lightheadedness. It’s important for everyone to be familiar with how the symptoms of heart attacks in women differ from those in men. Symptoms of heart disease in women are often atypical and vague, which is felt to be responsible for the higher death rate for women who have a heart attack.
- Cancer: Lung cancer, especially Pancoast tumors, may cause referred pain between the shoulder pain by pushing on nerves near the top of the lungs. Other cancers which may cause pain in this region include esophageal cancer, mesothelioma, lymphomas, and liver cancer. Cancers which spread to the bones in the neck such as breast cancer may also cause pain between the shoulder blades, sometimes without any other symptoms.
- Gallbladder disease: Referred pain from gallbladder disease often occurs as a stabbing pain between the shoulder blades, and may be associated with pain in the right upper quadrant of the abdomen and nausea. It commonly occurs after eating a fatty meal.
- Nerve entrapment: Nerve entrapment such as in myofascial pain syndrome of the rhomboids can cause pain between the shoulder blades.
- Acid Reflux: Gastroesophageal reflux disease (GERD) may cause referred pain to the back in the region between the shoulder blades. Symptoms of GERD may also include chest pain, hoarseness, and difficulty swallowing. Not only can untreated GERD cause discomfort, but is associated with the later development of strictures and esophageal cancer. Inflammation of the pancreas may also cause this type of pain due to irritation to the underside of the diaphragm.
- Scoliosis: Scoliosis of the thoracic spine may cause pain in this region. Often times people are aware that they have a curvature of their spine, but not always.
- Thoracic aorta rupture or aortic dissection: The pain that goes along with a thoracic aortic dissection (when a tear in the wall of the blood vessel allows blood to leak between the walls of the aorta) is often rapid and very severe, and is a medical emergency. This is often felt as a sudden sharp and tearing pain in the upper middle back.
- Pulmonary Embolism: Pulmonary emboli occur when clots in the legs (deep venous thrombosis) break off and travel to the lungs. The pain is often sudden in onset, sharp, and may be associated with severe shortness of breath, although sometimes people notice only mild discomfort. It is often preceded by symptoms of blood clots in the legs including pain, redness, and swelling. Some risk factors for pulmonary emboli include medical conditions such as cancer, prolonged travel by car or plane, prolonged bedrest, pregnancy, and recent surgery.
- Thoracic vertebral compression fractures: Compression fractures, often due to osteoporosis, may cause interscapular pain.
- Shingles: Shingles can cause pain nearly anywhere in the body, depending upon which nerve roots the virus affects, and may occur before a rash is noticed. The pain may be most pronounced in the region between your shoulder blades, but tends to concentrate on one side of the body or the other.
- Epidural anesthesia: Women who have an epidural for labor or for a C-section sometimes experience intense interscapular pain. Thankfully, this pain resolves when the drip is slowed down and goes away fairly rapidly after delivery.