Pain Between Shoulder Blades

What Causes Pain Between Shoulder Blades?

In physical therapy we often have patients and athletes ask about the cause of their pain between their shoulder blades.  This article's goal is to answer this question. 

Do You Have Shoulder Blade Pain?

It is important to understand that there are many different types of shoulder pain. There is shoulder pain that 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 known as interscapular pain, can range from mild discomfort to debilitating and concerning. It can also lead to right shoulder pain or left shoulder pain.

image of pain between the shoulder blades and pain in shoulder bladePain between the shoulder blades

 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

To differentiate the causes of interscapular pain, one must be familiar with the region's anatomical structures. 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 pain causes 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 result in interscapular pain and 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 result from repetitive pulling movements, such as pulling a starter on a lawnmower or performing rows at the gym. A muscle strain is typically the result of an excessive load placed on the muscle, causing inflammation and the muscle belly's tearing. 

Pain Between The Shoulder Blades 

Trauma to the muscles of the interscapular region can also cause inflammation and bruising, resulting in pain. This condition's mechanism of injury is typical while playing contact sports or being involved in a motor vehicle accident. Moreover, a postural strain can cause a pain in the muscle 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 and 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 long-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, resulting 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 managing pathologic conditions of the shoulder and elbow.

Other Common Causes for Pain in Shoulder Blade

Another common cause of pain between the shoulder blades is a disc herniation in the cervical or thoracic spine, causing nerve root impingement and radiculopathy. When this occurs, the spinal nerve's inflammation 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 are reduced. Many non-invasive and invasive procedures can facilitate the resolution of inflammation and decompression of the nerves and depend on some factors and indications. 

If you think your shoulder pain is from baseball, please read this ARTICLE.

Treatment of Should Blade Pain

Treatment typically begins with conservative care through physical therapy interventions. Often, treatments, such as mechanical traction or manual therapy, are indicated and accompanied by therapeutic exercises to address mobility and strength deficits. 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 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. Other symptoms often accompany these conditions, and symptoms are often more difficult to reproduce with movement. It is imperative to seek proper medical advice if you are concerned about these types of symptoms. It is vital to seek proper medical advice if you are concerned about these types of symptoms.

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If you are interested in scheduling an appointment at JOI Rehab for physical therapy, or call 904-858-7045.

By: Drew Heideman, PT ATC

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