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Why does my back hurt between my shoulder blades?


Back pain between the shoulder blades, also known as interscapular pain, is a common complaint. The medical term for this area is the thoracic spine. There are several potential causes of middle back pain, ranging from muscle strain to more serious medical conditions. Understanding the possible reasons for interscapular pain can help determine when to seek treatment.

Causes of Middle Back Pain Between the Shoulder Blades

Here are some of the most common causes of back pain between the shoulder blades:

Muscle Strain

Muscle strain is a very common source of back pain, including in the mid back between the shoulder blades. Activities that involve repetitive motions of the arms and shoulders can lead to muscle fatigue and spasms in the rhomboid and trapezius muscles. Poor posture adds extra stress on these muscles as well. Muscle strain responds well to rest, ice, heat, massage, and over-the-counter pain medication.

Injury

Sudden injuries to the thoracic spine area from sports, falls, or accidents can result in middle back pain between the shoulders. Fractures, dislocations, sprains, and damage to the disks or ligaments all can occur. Seeking prompt medical treatment is important for proper diagnosis. Rest, immobilization, physical therapy, or surgery may be necessary depending on the type and extent of injury.

Arthritis

Osteoarthritis and rheumatoid arthritis commonly affect the middle to upper back. Degenerative disk disease and spinal stenosis also cause arthritis symptoms. The facet joints between vertebrae can become inflamed and enlarged, causing localized back pain. Anti-inflammatory medications, steroid injections, physical therapy, or surgery may help relieve arthritis pain.

Pinched Nerve

A herniated or bulging disk in the thoracic spine can put pressure on a nerve, resulting in a pinched nerve. This can cause sharp, shooting pain in the back between the shoulders as well as numbness or tingling in the arms. Physical therapy, epidural steroid injections, nerve pain medications, or surgery may be used for treatment.

Muscle Knots

Myofascial pain due to trigger points and muscle knots can occur in the rhomboids and trapezius, causing localized middle back pain. Muscle knots feel like a tense, tender nodule or band within the muscle tissue. Massage therapy, trigger point injections, dry needling, and muscle relaxants help ease this type of muscular back pain between the shoulder blades.

Poor Posture

Slouching, hunching over a computer, carrying heavy bags only on one shoulder, and habits like these contribute to poor posture. The exaggerated curvature of the thoracic spine strains the muscles and other soft tissues. Improving posture and performing stretching and strengthening exercises usually helps relieve postural mid back pain between the shoulder blades.

Kidney Infection

A kidney infection, also called pyelonephritis, causes unilateral pain under the ribs that may spread around to the upper back. Associated urinary symptoms include burning with urination, fever, chills, nausea, and vomiting. Seeking prompt medical treatment is necessary for a kidney infection, which is treated with antibiotics.

Pneumonia

Pneumonia involving the lower lobes of the lungs can sometimes cause sharp mid back pain near the bottom of the shoulder blades. Other symptoms of pneumonia are cough with phlegm, fever, chills, breathing difficulties, and chest pain with inspiration. Pneumonia requires treatment with antibiotics.

Pancreatitis

Inflammation of the pancreas, often due to gallstones or excessive alcohol use, causes severe upper abdominal pain that radiates to the back. The mid back pain is usually located between the bottom of the shoulder blades. Associated symptoms include nausea, vomiting, fever, rapid heart rate, and tenderness of the abdomen. Hospitalization for hydration, pain control, and treatment is often needed for pancreatitis.

Gallbladder Disease

Disorders of the gallbladder, such as gallstones, cholecystitis, and biliary colic can also result in right upper quadrant abdominal pain that radiates to the right shoulder blade area. The middle back pain is exacerbated after eating a fatty meal. Treatment depends on the underlying gallbladder disease but may involve medications, gallbladder removal surgery, or lithotripsy to break up stones.

Lung Conditions

Certain lung diseases, such as lung cancer, pleurisy, pulmonary embolism, and pleural effusion can cause a stabbing chest and upper back pain between the shoulder blades that worsens with coughing or deep breathing. Shortness of breath also often occurs with these conditions. Seeking prompt medical attention for evaluation is crucial.

Heart Attack

Although chest pain is the classic symptom associated with a heart attack, many people may also experience mild to severe middle back pain between the shoulder blades during a heart attack. This referred pain occurs because the nerves supplying the heart also enervate the thoracic spine. A heart attack is a medical emergency requiring immediate emergency care.

Shingles

The shingles virus can affect the nerves of the thoracic spine, leading to a painful shingles rash as well as possible mid back pain between the shoulder blades. Other shingles symptoms include tingling, burning pain, and extreme sensitivity to light touch in the area of the rash. Antiviral medications can treat the shingles infection, while pain medications, topical creams, and nerve blocks help ease the pain.

When to See a Doctor

Mild to moderate back pain between shoulder blades from muscle strain or poor posture often resolves with home treatment. However, you should make an appointment with your doctor if the middle back pain:

  • Is severe or worsens
  • Radiates down one arm or both arms
  • Is accompanied by worrisome symptoms like chest pain, shortness of breath, abdominal pain, fever, or neurological changes
  • Persists longer than 1-2 weeks despite rest and medication
  • Is caused by an injury

Seeking prompt medical care is crucial if mid back pain occurs with signs of a medical emergency, such as difficulty breathing, chest pain, weakness or coordination problems, loss of bladder control, or rectal bleeding.

Medical Evaluation

To diagnose the cause of middle back pain between the shoulder blades, the doctor performs a physical examination, medical history review, and asks questions about symptoms, lifestyle, risk factors, and when the pain occurs.

Imaging tests may include:

  • X-ray to visualize bones and joints
  • MRI scan to assess disks, muscles, nerves, ligaments
  • CT scan if infection, cancer, or fracture is suspected

Blood tests help reveal issues like arthritis, infection, or kidney problems.

Other diagnostic procedures that may be appropriate include nerve conduction studies, electromyogram, diskography, bone scan, thoracentesis, or lung function tests.

The examination findings, test results, and any pertinent risk factors allow the doctor to make an accurate differential diagnosis to determine the cause.

Treatment Options for Mid Back Pain Between Shoulder Blades

Treatment depends on the underlying cause of the middle back pain between the shoulder blades. Options may include:

Rest

Rest helps ease sore, strained back muscles. Avoid activities that aggravate the pain. Ice packs can relieve muscle spasm and inflammation.

Medications

Over-the-counter non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or naproxen, alleviate muscle aches and arthritic pain. Acetaminophen and topical creams containing menthol or capsaicin also help reduce back pain between shoulder blades.

Physical Therapy

Physical therapy uses stretch techniques, posture correction, massage, ultrasound therapy, and specialized exercises to strengthen the thoracic back muscles. This improves mobility of the spine and healing.

Epidural Steroid Injections

For middle back pain between the shoulder blades caused by disk herniation, spinal stenosis, or pinched nerves, epidural steroid injections deliver anti-inflammatory corticosteroid medication near irritated nerve roots.

Chiropractic Adjustments

Spinal manipulation and mobilization performed by a chiropractor can improve spinal joint motion and relieve muscle tension, spasm, and middle back pain between the shoulder blades.

Trigger Point Injections

Trigger point injections into tense, knotted muscles in the thoracic spine area help ease localized myofascial pain between the shoulder blades.

Surgery

For severe back injuries, spinal abnormalities, or nerve compression causing intractable mid back pain between the shoulders, surgery may be needed. Procedures can include disk repair, spinal fusion, laminectomy, or foraminotomy.

Antibiotics

If an infection causes the middle back pain between the shoulder blades, such as pneumonia or kidney infection, antibiotics are used to treat the underlying infection and relieve the back pain.

Home Remedies and Lifestyle Changes

Several self-care remedies and techniques may help alleviate non-specific back pain between the shoulder blades:

  • Apply a heating pad or ice pack to ease muscle spasms and pain
  • Use an over-the-counter pain cream containing menthol, camphor, methyl salicylate, or capsaicin
  • Massage the upper back muscles gently
  • Perform stretching exercises to improve thoracic spine flexibility
  • Apply a pain-relieving adhesive patch to the sore area between the shoulder blades
  • Sleep on your side with a pillow between the knees to help align the spine
  • Fix posture problems like slouching or slumping over
  • Quit smoking and lose excess weight to reduce back pain causes
  • Control chronic coughing to avoid strain on the thoracic back
  • Use relaxation techniques to ease muscle tension in the back

While recovering from bouts of mid back pain between the shoulders:

  • Avoid activities that strain the back like heavy lifting
  • Modify strenuous exercise routines temporarily
  • Wear low-heeled, supportive shoes
  • Sit in chairs with good back support
  • Sleep on a medium-firm mattress for cushioning and alignment

Seeking chiropractic or massage therapy treatments can facilitate healing of muscular mid back pain between the shoulder blades.

Prevention

Some tips to possibly prevent middle back pain between the shoulder blades include:

  • Improve posture, especially when sitting at a desk or computer
  • Strengthen the thoracic back muscles with exercise
  • Lose excess weight to avoid strain on the back
  • Stretch the chest, shoulders, upper back, and torso
  • Avoid or modify activities that cause back strain
  • Use good body mechanics and proper lifting techniques
  • Wear supportive footwear
  • Quit smoking
  • Get chiropractic spinal manipulation if needed for alignment
  • Use ergonomic cushions and furniture to reduce slumping
  • Learn and practice stress management techniques

Seeking treatment at the first sign of muscle tightness or strain in the mid back may help prevent the problem from worsening.

Pain Between Shoulder Blades – When to Worry

In most cases, back pain between the shoulder blades results from muscle tension and resolves readily with rest and conservative treatment. However, if the middle back pain worsens or persists longer than one to two weeks, consult your doctor for proper diagnosis and care.

Seek prompt medical attention for mid back pain between the shoulder blades accompanied by:

  • Difficulty breathing or chest pain
  • Wheezing or coughing up blood
  • Abdominal pain, nausea, vomiting
  • Fever, chills
  • Leg weakness
  • Bowel or bladder incontinence

These signs and symptoms can indicate a medical emergency requiring immediate treatment. Better safe than sorry!

Conclusion

Back pain between the shoulder blades has many possible muscular and neurological causes. The source of mid back pain determines appropriate treatment options, which might include physical therapy, steroid injections, pain medications, surgery, or alternative therapies.

Mild interscapular pain often responds well to rest, heat or ice packs, OTC pain relievers, and gentle stretches. However, worsening middle back pain between the shoulder blades warrants medical evaluation to identify any serious underlying conditions requiring proper diagnosis and management.