Upper Back Pain Between Shoulder Blades: What It Really Means

Upper back pain between the shoulder blades develops when the muscles, joints, or nerves in this area are irritated or strained. This irritation may develop from poor posture, repeated movements, or an underlying spine problem. Depending on the affected area, you may feel a deep ache, sharp pain with movement, or a burning discomfort that travels toward the ribs or shoulder.

At Total Orthopedics & Sports Medicine, our doctors evaluate whether your pain originates from the thoracic spine, shoulder, nearby muscles, or another area. Then, we compare your pain pattern with movement, strength, and neurological findings. This targeted evaluation helps us treat the actual source of pain rather than repeatedly treating the painful area. Call 855-321-6784 to schedule your evaluation today.

What Causes Upper Back Pain Between Your Shoulder Blades?

Upper back pain between the shoulder blades often results from strained muscles, irritated spinal joints, or pressure on nerves in the neck or upper spine. These problems can develop from prolonged posture, repetitive activity, overuse injuries, or spinal changes. In some cases, pain from the shoulder, ribs, or internal organs may also travel to the same area.

Here is how these common problems can cause pain between your shoulder blades:

1. Muscle Strain and Overuse

A muscle strain can develop when you suddenly overload the back muscles or repeatedly use them without enough recovery. This added stress can overstretch small muscle fibers and irritate the nearby soft tissues, especially during heavy lifting, pulling, throwing, or repetitive work. In such cases, you may notice a localized dull ache that worsens with arm or upper-body movement. Resuming the same activity before the muscle recovers can further worsen the discomfort.

2. Prolonged Poor Posture

Sitting for long periods with your shoulders forward can increase the workload on the muscles that stabilize your upper back. Instead of sharing the load efficiently, these muscles work continuously to hold your upper body in position. This can contribute to fatigue and discomfort between the shoulder blades, particularly during prolonged computer work. Moreover, this strain can become more noticeable with prolonged sitting. A study of 40 adults found that upper back discomfort significantly increased over four hours of continuous computer work.

3. Muscle Tension and Trigger Points

Sustained muscle tension can contribute to tight, tender areas in the muscles around your upper back and shoulder blades. These trigger points may feel tender when pressed and can also cause discomfort that spreads beyond the tight muscles. This can make reaching, turning, or holding the same position increasingly uncomfortable. A 2022 systematic review and meta-analysis also found that active trigger points in the upper trapezius were more sensitive to pressure than healthy muscle.

4. Repetitive Daily Activities

Repeated reaching, lifting, typing, or working with your arms away from your body can gradually fatigue the muscles that support your shoulder blades. Initially, these overuse injuries may cause only mild discomfort after activity. But if these muscles do not get enough time to recover, the discomfort may last longer with each activity. Over time, you may notice symptoms during everyday activities such as working, exercising, or reaching for objects.

5. Carrying Uneven or Heavy Loads

Regularly carrying heavy bags on one side can place uneven stress on your upper-back muscles. To keep your trunk and shoulder balanced, the muscles around one shoulder blade may have to work harder than those on the other side. This added workload can fatigue the muscles and cause aching discomfort around the shoulder blade. In fact, a systematic review reports that carrying external loads can contribute to discomfort in the thoracic spine, neck, and shoulders.

Which Spine Conditions Can Cause Shoulder Blade Pain?

Spine conditions such as herniated discs, pinched nerves, arthritis, and problems affecting the cervical spine or ribs can cause shoulder blade pain. These problems may irritate nearby joints or nerves, causing referred pain toward the shoulder blade. You may also notice numbness, tingling, or muscle weakness if a nerve is affected.

In addition, the following spine conditions may cause pain between or around the shoulder blades:

• Thoracic Disc Herniation: A damaged disc in the mid-back can irritate nearby nerve roots, causing pain that may spread around the ribs or toward the shoulder blade.
• Thoracic Spondylosis: Age-related changes in the discs and joints of the mid-back can cause stiffness and localized pain that may be felt between the shoulder blades.
• Scoliosis: A sideways spinal curve can unevenly distribute pressure across the upper back, causing discomfort around the shoulder blades.
• Thoracic Kyphosis: An excessive forward curve of the upper spine can place additional strain on the muscles and joints between the shoulder blades.
• Vertebral Compression Fracture: A weakened vertebra can collapse, causing sudden or persistent upper or middle back pain.

Can Shoulder Problems Cause Pain Between the Blades?

Yes, shoulder problems can cause pain between the blades by affecting the muscles and joints that support normal shoulder movement. When the shoulder does not move normally, nearby shoulder muscles may work harder to maintain stability. This added strain can cause muscle pain around or between the shoulder blades, especially during reaching or lifting.

Here are some common shoulder problems that can cause pain around the shoulder blades:

• Rotator Cuff Injury: Irritated or torn rotator cuff tendons can affect shoulder movement and cause pain that extends toward the shoulder blade.
• Shoulder Impingement: Pinching of tissues during arm movement can cause pain with reaching or lifting, sometimes extending toward the upper back.
• Shoulder Arthritis: Joint damage can cause pain and stiffness that may be felt around the shoulder and the nearby shoulder blade.
• Frozen Shoulder: Limited shoulder movement can place extra strain on nearby muscles, causing discomfort around the shoulder blade.
• Scapular Dyskinesis: Abnormal shoulder blade movement can strain the surrounding muscles and cause pain along the inner border of the shoulder blade.

Other than that, research shows that shoulder conditions can affect the mechanics of the shoulder blade itself. For example, in a systematic review of 16 studies, researchers evaluated 335 patients with rotator cuff tears. They found that larger tears were generally linked to significant changes in shoulder blade movement. This altered shoulder blade movement can contribute to pain along the shoulder blade during reaching, lifting, and overhead activities.

How Does Pain Between Your Shoulder Blades Feel?

Pain between your shoulder blades (interscapular pain) may feel like a deep ache, a burning sensation, or tightness across the upper back. Some people feel pain only with movement, while others notice discomfort even at rest. If the irritation continues, the discomfort may also spread to the neck, shoulders, or ribs.

Depending on the cause of pain, you may notice other symptoms that affect movement, strength, or sensation, such as:

• Stiffness: Tightness between the shoulder blades may make it uncomfortable to twist or move your upper body.
• Tenderness: The area between or around the shoulder blades may feel sore when touched or pressed.
• Numbness or Tingling: Nerve irritation may cause unusual sensations that travel toward the shoulder, arm, or hand.
• Weakness: You may notice muscle weakness when lifting, reaching, or using the affected arm.
• Muscle Spasms: Sudden tightening of the upper back muscles may occur during movement or after prolonged activity.
• Limited Movement: Pain or muscle tightness may limit your ability to twist, reach, or move your shoulders normally.

Does the Type of Pain Help Identify the Underlying Problem?

Yes, the type of pain can help identify the underlying problem. For example, muscle pain may feel like a deep ache or soreness, while nerve irritation can cause sharp, burning, or shooting sensations. In contrast, sudden, severe pain accompanied by other symptoms may indicate a problem that requires medical evaluation.

Which Movements Worsen Shoulder Blade Pain?

Shoulder blade pain often worsens during overhead reaching, lifting, pulling, or twisting movements. These activities can increase stress on irritated muscles, joints, or nerves. You may also notice worsening upper or mid-back pain when turning your upper body or holding your arms in the same position for extended periods.

Furthermore, a study of 181 elite athletes evaluated back pain in sports involving repetitive overhead movements, including volleyball, tennis, badminton, beach volleyball, and handball. Researchers found that upper back pain was more common among volleyball players. These athletes repeatedly raise and swing their arms overhead during serving, hitting, and blocking, increasing strain on the upper-back muscles.

Why Does Your Upper Back Hurt After Sitting All Day?

Your upper back may hurt after sitting all day because prolonged sitting can increase strain on the muscles that support your spine and shoulders. Slouching or leaning forward further increases this workload and can lead to muscle tightness. Over time, this strain may lead to aching or stiffness between the shoulder blades.

Certain sitting habits can gradually worsen this discomfort throughout the day. For instance, repeatedly leaning toward your screen, sitting hunched over a desk, or reaching for your keyboard can place added strain on your upper back muscles. To reduce this ongoing workload, change your sitting position regularly and use a supportive chair that provides adequate back support.

How to Tell if Upper Back Pain Is Serious?

You should consult a doctor if your upper back pain continues to worsen or interferes with your normal movement and daily activities. Progressive numbness or weakness, difficulty walking or maintaining balance, or pain accompanied by fever also needs medical attention. Beyond these symptoms, the following pain patterns may require medical evaluation:

• Discomfort that persists despite rest or position changes.
• Pain that regularly interrupts your sleep.
• Upper-back discomfort that begins after a fall or direct impact.
• Aching that spreads toward your ribs, shoulder, or arm.

Over time, you may start adjusting how you sit, sleep, lift, or reach to avoid positions and movements that worsen your discomfort. Instead of planning your daily activities around the discomfort, visit our doctors for a thorough evaluation. We can identify the underlying cause of your discomfort and develop an appropriate treatment plan based on the source of your symptoms.

Which Symptoms Need Urgent Care?

You should seek immediate medical attention if your upper back pain is severe, suddenly worsens, or occurs with chest pain, breathing difficulty, weakness, or numbness. Upper back pain after a significant injury, or accompanied by new movement or sensory changes, also needs prompt medical attention.

If your symptoms need same-day orthopedic care, you can visit Total Ortho Express without an appointment. Our team can assess your condition and provide treatment based on your symptoms and examination. However, if your condition requires specialized orthopedic care, we can refer you to our specialists at Total Orthopedics & Sports Medicine.

How Do Doctors Find the Source of the Pain?

During a physical examination, doctors compare the location of your pain with the movements, positions, and activities that trigger it to find the source of symptoms. For example, they may assess shoulder and spinal movement, test nerve function, and check whether pressure on certain areas reproduces your pain.

They may also assess whether you have rib back pain or symptoms spreading into your arm, which can help distinguish muscular pain from nerve-related symptoms. But if the examination does not clearly identify the source of pain, doctors may use the following tests:

• X-rays: Show fractures, spinal alignment changes, arthritis, and other problems involving the bones and joints.
• MRI Scans: Provide detailed images of discs, nerves, the spinal cord, and surrounding soft tissues.
• CT Scans: Show detailed images of the spinal bones and help doctors examine areas that may not be clearly visible on X-rays.
• Electromyography (EMG): Checks the electrical activity of muscles and nerves to help identify problems affecting nerve function.
• Blood Tests: May be ordered when symptoms suggest an infection, inflammation, or another medical condition.

How Can You Relieve Mild Pain at Home?

You can relieve upper back pain at home with gentle stretching exercises, a warm compress, and cold therapy. These approaches may help loosen tight muscles and provide temporary pain relief after mild strain. As your symptoms improve, gradually resume normal movement to maintain upper-back mobility and prevent stiffness.

In addition, temporarily limit lifting, repetitive reaching, or other activities that worsen your symptoms. Similarly, adjust your sitting and working position to maintain good posture and reduce unnecessary strain on the upper back. A study of 24 women also reported that regular exercise and posture education helped reduce upper-back, neck, and shoulder stiffness.

What Treatments Help With Shoulder Blade Pain?

Shoulder blade pain can be treated with medications, therapeutic exercises, injections, or targeted procedures. Doctors may adjust treatment based on the underlying cause, duration of chronic pain, and the presence of associated nerve or shoulder symptoms. The goal is to reduce pain while addressing the muscle, joint, nerve, or shoulder problem responsible for your symptoms.

Since different structures can produce similar symptoms, doctors select treatment options based on the specific source of your symptoms, such as:

1. Muscle-Related Pain

Muscle-related pain often improves with activity modification, targeted stretching, ice pack, heat therapy, and gradual strengthening exercises. These methods can help restore movement and improve support around the shoulder blades. Improving posture and correcting repetitive movements can also reduce ongoing strain on the upper back muscles.

2. Joint-Related Pain

Doctors may recommend activity modification, mobility exercises, and anti-inflammatory medications to manage pain from irritated spinal joints. If pain continues despite these treatments, doctors may recommend targeted injections, such as medial branch blocks, to address the affected joints. In fact, a randomized trial of 100 patients with thoracic facet-joint pain found that 80% to 84% improved in pain and function after medial branch blocks.

3. Nerve-Related Pain

Treatment for nerve-related shoulder blade pain depends on the location and cause of nerve compression. For cervical nerve compression, doctors may recommend over-the-counter medications like ibuprofen, nerve-gliding exercises, or cervical traction. But if symptoms continue despite initial care, an epidural steroid injection may help reduce inflammation around the affected nerve.

When Does Upper Back Pain Need Surgery?

Spine specialists may recommend surgery when imaging shows a structural spine problem that causes significant nerve compression, instability, or neurological symptoms. They may also advise surgery when nonsurgical treatment does not provide enough upper back pain relief or neurological function continues to worsen.

However, the type of surgery depends on the problem causing your symptoms. For a thoracic disc herniation, surgeons may remove the disc material that is pressing on the nerves or spinal cord. In some cases, spinal fusion may be performed to stabilize the affected part of the spine. The goal of surgery is to relieve pressure on the affected nerves and alleviate pain while maintaining spinal stability.

What if Pain Returns After Treatment?

If upper back pain returns after treatment, doctors may perform another evaluation to identify the current source of your symptoms. They may assess changes in the location, intensity, and pattern of your pain, along with any new movement or nerve-related symptoms. Based on these findings, they can adjust your treatment to address the current source of symptoms.

You may start tracking your recovery progress by counting the pain-free days between each flare-up. Treatment may temporarily control your symptoms, but recurring symptoms may indicate that the underlying problem requires further evaluation.

In such cases, our doctors compare how long your previous treatment provided relief with the timing and pattern of your current symptoms. This helps us identify whether the original condition has progressed or a new problem is contributing to your pain. Book an appointment today to address pain that continues to return after treatment.

Can Untreated Shoulder Blade Pain Get Worse?

Yes, untreated shoulder blade pain can worsen when the underlying muscle, joint, or nerve problem continues to progress. Ongoing irritation may lead to more frequent pain, reduced movement, or increasing weakness. If pressure on a nerve persists, symptoms such as numbness, tingling, and weakness may also intensify.

Here are some other problems that may develop when shoulder blade pain is left untreated:

• Muscle Compensation: Nearby muscles may work harder to support the painful area.
• Altered Mechanics: Changed shoulder blade movement may strain nearby tissues.
• Reduced Endurance: Upper-back muscles may fatigue more quickly.
• Structural Progression: Certain cervical spine or joint problems may worsen.

Visit Total Orthopedics & Sports Medicine for Persistent Upper Back Pain!

Persistent upper back pain can be difficult to manage when symptoms return despite rest, medication, or other conservative treatments. At that point, repeatedly treating each flare-up may provide short-term relief without resolving the problem that continues to trigger it.

At Total Orthopedics & Sports Medicine, our spine specialists treat recurring upper back pain based on the underlying structure responsible for the symptoms. We focus on restoring movement in stiff thoracic joints, strengthening muscles that support the upper spine, or reducing irritation around painful joints and nerves. Moreover, we accept major insurance plans and offer flexible payment options, helping you focus on your recovery without financial stress. Call 855-321-6784 or visit us in New York or New Jersey to schedule an evaluation.

FAQs