There are a host of different things that can cause pain between your shoulder blades (or scapulae) or between your shoulder blades and your neck. Often these pains come and go, and are due to nothing more than tired muscles or mild strains that will quickly heal. If you know that to be the case, your soreness or pain should not be a cause for concern. There are causes of pain however that stem from disorders that may require prompt attention. These are often referred pains, pains that result from a disorder or an injury to a body part that would seem to have nothing to do with the back.
One reason back pain can be common, whether it is in the lower, middle, or upper back, is because the central nervous system runs along the spine, and there are a variety of things that can trigger a reaction, at times causing pain to be experienced in strange places. Insofar as back pain is concerned, lower back pain is much more common than upper back pain or discomfort between the two scapulae.
Nevertheless, if you do experience pain in the shoulder blade area it can be helpful to understand what some of the more common causes are. Some rare, but serious causes include lung cancer, liver cancer, torticollis (a twisting of the neck), esophageal cancer, and various other diseases and syndromes.
Trauma can be an obvious source of discomfort. A broken collarbone, a rotator cuff injury, or a shoulder separation can be the source, as can an injury to the spinal column. A muscle strain or a sprained ligament would be another source of pain. As for the scapulae themselves, they are rarely injured.
Below are nine of the more common causes of pain between the scapulae. They may give you a clue as to whether you should see your doctor, get a massage, or simply take a pain reliever.
1) Poor posture is one of the more common causes of discomfort between the scapulae. Hunching forward, whether you are standing or sitting, places an abnormal amount of pressure on your neck muscles, due in part to the weight of your head if it is not being held in its proper, upright position. When your head is held upright the muscles provide stability, which requires far less effort. The pain between your shoulder blades is therefore due to muscles that have become tired, irritated, or inflamed. Proper posture combined with exercise, including exercises designed to strengthen the neck muscles, is usually an effective cure.
2) Herniated discs tend to be a more common occurrence in the lower back and are often referred to as ‘slipped discs’, which is somewhat of a misnomer. A herniated disc occurs when the disc, a pad-like structure between the vertebrae, breaks down or ruptures. Each of these discs consists of a tough, ring-like structure that encases a gel-like substance enabling the disc to act as a spinal column shock absorber. Either disease or an injury can cause one of these discs to become damaged, to the point that it eventually breaks down. If the disc happens to be one of the cervical discs, you will experience discomfort between the scapulae, and motion in the arms and upper back can become painful, and hence more difficult.
3) Gallbladder disease is a well-known cause of discomfort in the upper abdomen. The pain is usually felt on your right side, and it will at times radiate to your upper back where it can sometimes be felt in the region between your scapulae. There are two types of gallbladder disease that can cause this discomfort. One type causes the formation of gallstones and the other type causes an inflammation of the gallbladder, neither of which is serious. The truly serious gallbladder diseases, such as gallbladder cancer, tend to be quite rare. Whether gallstones are present or not, a gallbladder disease can sometimes cause a good deal of pain, often described as a gripping or gnawing pain that is referred to as biliary colic. The pain is not continuous, but tends to flare up during the same time of the day or after a heavy meal. It may last for several hours.
4) A Heart attack, or an impending heart attack, can be a cause of pain between your scapulae. This is more common in women than it is in men. During a heart attack, discomfort will initially be felt in the chest and then radiate to the shoulder, down one arm, or to the upper portion of the back, where it may center between the scapulae. In short, a pain in the upper back is not the most reliable of indicators that a serious heart condition may exist, as a heart attack may have many symptoms. Nevertheless, any pain that seems unusual, or difficult to explain, should be given careful attention.
5) Inflammation under the diaphragm can sometimes be a referred pain, a pain that is felt in a different body part from where the problem actually exists. There may not, at first glance, appear to be a logical connection between your diaphragm, which separates the chest cavity from the lower abdominal area, and the area between your shoulder blades. The diaphragm is a large, dish-shaped muscle that helps you to breathe. It moves up and down as the lungs contract and expand. As we breathe, muscles in the upper back also come into play. If one of these back muscles suffers a strain, breathing can sometimes become painful. Conversely, if an inflammation below the diaphragm affects the action of the diaphragm, it can indirectly affect the actions of the back muscles as well. If those muscles are being forced to function in a somewhat abnormal manner they can become sore and painful when they are in motion.
6) Spinal stenosis is an abnormal narrowing of the spinal canal. This narrowing can occur anywhere along the length of the backbone, but the two most common forms occur in the lower (lumbar) spinal region or in the cervical part of the spine at the neck or at shoulder level. The symptoms are similar to sciatica and include tickling, numbness, and even pain down into the legs. If the narrowing becomes too great, spinal stenosis can become a dangerous condition, as it can compress the spinal cord, often leading to quite serious complications. When the condition occurs in the cervical part of the spine, pain may be felt beneath the neck, and below the scapulae. While the pain may be felt on one side of the spine or the other, which is often the case with lumbar spinal stenosis, when the condition occurs in the region just below the neck, it may simply be felt as a pain between the scapulae. The symptoms of milder cases of this disorder can often be treated with a combination of medication and exercise. A more severe case may require surgical intervention to correct the problem and relieve the pain.
7) Cervical spondylosis is a condition in which neck vertebrae, or the disks between them, have begun to degenerate. Spondylosis is more common in the lumbar part of the spine, but this disease can affect any spinal part, including the cervical spine. When the vertebrae degenerate up to a point, the nerves feeding out from that part of the spinal column can become pinched, and pain can be experienced in the neck or the upper back, including between the shoulder blades. The conditions of cervical spondylosis and spinal stenosis sometimes go hand in hand, since degeneration of the vertebrae or the spinal discs can also result in a narrowing of the spinal canal.
8) Osteoarthritis of the cervical spine can easily be confused with spinal spondylosis, as the symptoms are similar. In fact, the two disorders sometimes occur concurrently. When osteoarthritis is the cause of pain in the center of the upper back, the pain tends to be worse first thing in the morning and late evening, while often tapering off during the more active hours of the day. Pain will often be localized in the area of the spine at first, but can then radiate to the shoulder area and beyond. Osteoarthritis often affects only the joint, and unlike rheumatoid arthritis it is not a systemic disease. One of the differentiating factors between osteoarthritis and cervical spondylosis is that stiffness in the affected spinal area is likely to be experienced with the former condition and not with the latter.
9) Facet joint syndrome is yet another source of discomfort. Facet joints are stabilizing joints that are found between adjacent vertebrae, with the exception of the top vertebra. These joints serve to enable a certain amount of twisting, while at the same time, limiting excessive motion that could result in a displacement of one or more of the discs between the vertebrae. There are other facet joint disorders than can cause one to feel discomfort in the area of the scapulae, one being the formation of bone spurs in one or more of the facet joints. These bone spurs are usually caused by wear and tear on the facet joints and may be accompanied by an enlargement of the joints. When bone spurs are present, one or more of these joints becomes enlarged, and osteoarthritis enters the picture – the overall condition is often referred to as ‘facet joint syndrome’.
Of the possible causes mentioned above, poor posture is most common cause, with a herniated disk next. Spinal stenosis, osteoarthritis, facet joint issues and spondylosis are more common among older adults. It’s probably worth mentioning that obesity can be a contributing factor, in the sense that it can affect both posture and the back muscles involved in breathing. The overwhelming number of back problems that people experience and report involve more the lumbar (lower) spinal area than the cervical (upper) area or the thoracic (middle) area.