Pain in the right upper back, which includes the thoracic spine and the area around the shoulder blade, is a common complaint. Although the sensation may feel localized to the muscles and bones, the origins of this discomfort vary significantly. Causes range from simple, self-resolving muscular issues to complex problems involving the spine, nerves, or internal organs. Understanding the possible sources of right upper back pain is the first step toward finding appropriate relief.
Common Muscular and Postural Causes
Most upper back pain stems from soft tissue issues and mechanical problems, often involving the rhomboid and trapezius muscles. The rhomboids connect the shoulder blade (scapula) to the spine and help retract the shoulders. Strain often results from sudden, unaccustomed movements like heavy lifting or repetitive motions, which can cause micro-tears in the muscle fibers.
Poor posture is a primary driver of muscular pain, especially with prolonged sitting and screen use. Hunching over a computer, often called “tech neck,” forces the upper back muscles into a chronically lengthened and fatigued state. This continuous strain can lead to painful knots, or trigger points, which feel like a tight, aching spot between the right shoulder blade and the spine.
Psychological stress also manifests physically, causing involuntary muscle guarding and tension in the upper back and neck. When the body is stressed, the upper trapezius muscles tighten significantly, leading to stiffness and spasm that radiates downward. This muscular discomfort is generally dull and aching, often worsening toward the end of the day or during periods of high anxiety.
Skeletal and Nerve-Related Issues
Pain that feels deeper or sharper than a typical muscle ache may originate from the bony structures of the spine and ribs. Dysfunction in the small joints connecting the vertebrae, known as facet joints, can cause localized irritation. This irritation leads to stiffness and pain that is often exacerbated by specific movements like twisting or extending the back.
A distinct, sharp pain can result from rib subluxation, where the head of a rib moves slightly out of alignment where it connects to the spine. This misalignment irritates local tissues and nerves, frequently causing a sharp, catching pain intensified by taking a deep breath or coughing. Rib problems are often triggered by awkward twisting or sudden, forceful movements.
Nerve impingement, or a “pinched nerve,” typically involves nerves branching from the cervical (neck) or upper thoracic spine. A bulging or herniated disc can press on a spinal nerve, causing pain that radiates into the upper back, shoulder blade, or down the arm. Unlike muscle pain, nerve compression often presents with neurological symptoms like numbness, tingling, or a burning sensation.
Referred Pain from Internal Organs
Pain felt in the right upper back can be referred pain, where the brain misinterprets nerve signals originating from an internal organ. The most common visceral cause is related to the gallbladder, located in the upper right quadrant of the abdomen. Gallbladder issues like gallstones cause severe pain that radiates consistently to the right shoulder blade or the area between the shoulder blades.
This referred pain often occurs after a fatty meal, as the gallbladder contracts to release bile, and may be accompanied by nausea or vomiting. Conditions affecting the lungs, such as pneumonia or pleurisy (inflammation of the lung lining), can also manifest as upper back pain. This pain is typically sharp and may worsen with deep breathing, coughing, or sneezing.
Severe inflammation or issues with the liver, which sits beneath the rib cage on the right side, can cause a dull ache in the corresponding area of the back. Since the liver and gallbladder share common nerve pathways, pain signals can be mistakenly localized to the back. If back pain is accompanied by systemic symptoms like fever, unexplained weight loss, or jaundice (yellowing of the skin), it suggests a non-musculoskeletal cause.
Recognizing Serious Symptoms
While most upper back pain is benign, certain “red flag” symptoms indicate a serious underlying medical condition requiring immediate professional evaluation. Sudden, severe, or crushing chest pain accompanying back pain should prompt an immediate medical visit, as it may relate to a cardiac event. Pain that is unrelenting and does not change with rest, position, or activity suggests a non-mechanical cause.
Other serious symptoms include a high fever, unexplained chills, or night sweats occurring alongside the back pain, which could signal an infection. Neurological symptoms, such as a sudden loss of bowel or bladder control, require emergency attention, as they may indicate spinal cord compression. Back pain accompanied by unexplained weight loss should be investigated to rule out systemic disease.