Pain between the shoulder blades, known anatomically as interscapular or thoracic pain, is a common complaint. This region of the upper back is complex, involving the thoracic spine, muscles, and nerves connected to internal organs. While most discomfort is due to simple, mechanical causes, sources range from benign soft-tissue irritation to serious, sometimes life-threatening, internal conditions.
Muscular and Postural Stressors
The majority of interscapular pain originates from the soft tissues stabilizing the shoulder blades and spine. The large, superficial trapezius muscle, the deeper rhomboids, and the erector spinae group constantly work to maintain upright posture and control arm movements. Prolonged positions, such as those adopted during desk work or driving, place these muscles under sustained tension, leading to fatigue and strain.
Poor ergonomics is a primary contributor, often resulting in a forward head posture or thoracic slouch, sometimes referred to as “tech neck.” This slumped position lengthens the muscles of the mid-back while shortening the chest muscles, placing constant strain on the rhomboids and middle trapezius. Over time, this chronic stress can lead to the formation of localized, highly irritable spots known as myofascial trigger points.
These trigger points are tense knots within the muscle fibers that can cause localized pain or refer discomfort to surrounding areas. This often manifests as the sharp, burning sensation felt directly between the shoulder blades. Repetitive motions, like those involved in certain sports or occupational tasks, can also induce micro-trauma and inflammation in these muscles. When these tissues are overworked or held in awkward positions, their blood supply can be reduced, causing muscle spasms that manifest as a dull, persistent ache or a sudden, sharp catch.
Thoracic Spine Structural Issues
Pain can also arise directly from the skeletal components of the thoracic spine, which consists of twelve vertebrae (T1-T12) connected to the rib cage. This segment of the spine is naturally more rigid than the neck or lower back, making degenerative disc disease or disc herniation less common but still possible. When a thoracic disc bulges or herniates, it can press on the spinal nerves, causing sharp pain that may radiate around the rib cage or feel concentrated in the interscapular area.
The small, paired facet joints located on the back of each vertebra can also become a source of discomfort. Over time, these joints may develop osteoarthritis, a condition characterized by the breakdown of cartilage, which causes friction and local inflammation. Degenerative changes in the facet joints can lead to stiffness and a deep, aching pain in the middle back that is often aggravated by twisting or arching motions.
Alignment conditions, such as an exaggerated forward curvature of the upper back called thoracic kyphosis, place uneven mechanical stress on the entire structure. This postural deviation forces the vertebrae and their supporting ligaments to bear weight abnormally, which can lead to chronic, structural pain. In cases of significant trauma or underlying conditions like osteoporosis, a vertebral compression fracture can occur, resulting in sudden, severe pain localized to the area of the collapsed vertebra.
Non-Spinal Referred Pain
Pain felt between the shoulder blades may be referred pain, where a problem in an internal organ is perceived in a distant location. Nerves supplying visceral organs share pathways with back nerves, causing the brain to misinterpret the signal source. This type of pain is a significant warning sign that requires immediate medical attention.
One serious example is pain referred from a cardiac event, which can present as a sudden onset of severe, crushing pressure in the chest that radiates to the upper back, especially in women. Similarly, an acute aortic dissection, a tear in the body’s main artery, frequently causes an excruciating, tearing pain felt classically in the middle of the back between the shoulder blades. This pain is typically sudden and maximal at its onset, distinguishing it from musculoskeletal strain.
Referred pain can also originate from the upper abdomen, such as in cases of gallbladder inflammation, where pain may be felt in the right shoulder blade or interscapular region. Pulmonary issues, including a pulmonary embolism or pleurisy, can also cause sharp pain felt in the upper back or shoulder. These are often accompanied by shortness of breath or pain that worsens with deep breathing. Recognizing these associated “red flag” symptoms alongside back pain is paramount for a timely diagnosis of an internal condition.