Interscapular Pain

Understanding Pain Between the Shoulder Blades

What is Interscapular Pain?

Interscapular pain means discomfort or pain felt between the shoulder blades. It is a common complaint with many possible causes, ranging from muscle strain and poor posture to serious internal medical conditions.

Common Causes of Interscapular Pain

Musculoskeletal Causes (Most Common)

• Muscle strain & poor posture: Sitting or standing with rounded shoulders for long periods, repetitive arm movements, heavy lifting, or injuries can overstretch muscles like the trapezius or rhomboids.
• Shoulder problems: Conditions such as rotator cuff tears, shoulder instability, or joint injuries may cause pain that spreads to the upper back.
• Spinal conditions: Herniated discs, arthritis, fractures, scoliosis, or spinal stenosis in the thoracic spine can compress nerves or strain muscles.
• Nerve entrapment: Compression of nerves such as the dorsal scapular nerve can cause pain and weakness.

Referred Pain from Internal Organs

• Acid reflux: Heartburn can cause burning pain radiating to the upper back.
• Gallbladder issues: Infection or stones may cause right upper abdomen pain that spreads between the shoulder blades.
• Cardiac and lung conditions: Heart attack (especially in women), aortic dissection, and pulmonary embolism can present with severe interscapular pain and require urgent medical attention.

Rare Primary Causes

• Snapping scapula syndrome: Pain and clicking noises when moving the shoulder blade.
• Levator scapulae syndrome: Pain from the shoulder blade to the neck.
• Cervico-thoraco-scapula syndromes: Conditions with poorly understood causes and persistent symptoms.
• Dorsal scapular nerve entrapment: Nerve compression leading to upper back pain.

When is Interscapular Pain an Emergency?

Seek urgent medical care if pain between your shoulder blades is severe or sudden and you have:

• Difficulty breathing or shortness of breath
• Chest pain
• Dizziness or fainting
• Excessive sweating
• Leg swelling, redness, or pain
• Coughing up blood
• Fever with severe pain
• Sudden neurological symptoms (difficulty speaking, vision loss, weakness, paralysis)
• Loss of consciousness

These may signal life-threatening conditions such as heart attack, pulmonary embolism, or aortic dissection.

Anatomy of the Interscapular Region

This region includes:

• Thoracic spine (T1-T12): Vertebrae, discs, spinal cord, and exiting nerves.
• Muscles: Trapezius, rhomboids, levator scapulae, and others supporting shoulder movement.
• Nerves: Mixed spinal nerves and specific nerves like the dorsal scapular nerve.
• Internal organs: Heart, lungs, esophagus, and large blood vessels in the chest.
• Skin and soft tissues: Conditions like shingles may cause pain here.

How Posture and Activity Affect Pain

• Poor posture (slouching, rounded shoulders) strains muscles and joints.
• Repetitive overhead movements or heavy lifting can cause muscle overuse.
• Sedentary lifestyle weakens muscles and increases risk.
• Sleeping positions and trauma can also contribute.

Diagnosis of Interscapular Pain

Your healthcare provider will:

• Take a detailed history (pain quality, duration, aggravating factors)
• Examine your neck, back, and shoulders for tenderness and movement problems
• Perform neurological and cardiac examinations if needed
• Order imaging (X-rays, MRI, CT) or tests (EMG, ECG) depending on suspected cause

Treatment Options

Non-Surgical

• Rest and activity modification
• Heat or ice therapy
• Stretching and strengthening exercises guided by a physiotherapist
• Posture correction and ergonomic advice
• Medications: NSAIDs, muscle relaxants, steroids, or nerve pain medications
• Massage and manual therapies

Surgical (Rare)

Reserved for severe cases such as fractures, severe arthritis, or nerve compression not relieved by other means.

Clinical Pearls

• Muscle strain and poor posture cause most interscapular pain.
• Persistent or severe pain with “red flag” symptoms must be evaluated urgently.
• Referred pain from heart, lungs, or digestive system can present as upper back pain.
• Physiotherapy focusing on muscle balance and posture often improves symptoms.
• Lifestyle changes and ergonomic adjustments help prevent recurrence.
• Post-operative interscapular pain after cervical spine surgery is common but usually temporary.

Patient FAQs

1. What muscles cause pain between the shoulder blades?
   Key muscles include the trapezius, rhomboids, levator scapulae, and others that stabilise the shoulder blades and spine.
2. Can heartburn cause upper back pain?
   Yes, acid reflux can cause burning pain that radiates to the upper back due to shared nerve pathways.
3. When should I worry about upper back pain?
   Seek emergency help if pain is sudden, severe, or accompanied by chest pain, breathing difficulty, dizziness, or neurological symptoms.
4. How can poor posture cause this pain?
   Slouching or rounded shoulders overstretch and weaken upper back muscles, leading to pain and stiffness.
5. What treatments help most?
   Physical therapy, posture correction, exercise, medications for pain and inflammation, and ergonomic adjustments.

Call to Action

If you experience persistent or severe pain between your shoulder blades, especially with any warning symptoms, contact your GP or visit your nearest emergency department.

For exercise advice and shoulder care resources, visit www.TheArmDoc.co.uk
Phone: 020 3384 5588
Email: Info@TheArmDoc.co.uk

Disclaimer

This information provides a general overview and should not be used as a substitute for personalized medical advice. Consult your healthcare professional for diagnosis and treatment suited to your needs.