Pain between the shoulder blades most often comes from the muscles, joints and discs of the upper back, or is referred from the neck. Long hours at a desk, a sudden twist or lift, and poor sleep positions are common triggers. Most of this kind of pain eases within 2 to 6 weeks with gentle movement and fewer long, static positions. Less often, the cause is the heart, the main artery (aorta), the lungs or the gallbladder, and those need urgent care.
Pain that changes when you move, press on a spot, turn your neck or take a deep stretch usually points to a muscle or joint source. Pain that does not change with movement, or comes with chest pain, breathlessness, sweating, sudden tearing pain or pain after meals, needs a different kind of check.
If your pain came on suddenly and severely, or with any of those other symptoms, go to the emergency section near the end of this page first.
Key takeaways
- Common causes: strained upper back or shoulder blade muscles, stiff joints between the spine and ribs, and pain referred from the neck.
- Typical course: most muscle and joint pain here eases within 2 to 6 weeks.
- Movement clue: pain that changes with movement or position is more likely to come from muscles or joints.
- Urgent causes: the heart, a tear in the aorta, a blood clot in the lung and gallbladder problems can all cause pain between the shoulder blades.
- Emergency signs: sudden severe or tearing pain, chest pain, breathlessness, sweating or fainting need emergency care.
Where are you right now?
- It has just started: read the emergency section first, then “Where else this could be coming from” and the week-by-week section.
- Weeks in and not settling: go to “If it isn’t going to plan”. Pain referred from the neck is a common reason this area stays sore.
- After an injection or surgery: follow your doctor’s plan. Neck surgery can leave aching between the shoulder blades for some weeks.
- Getting back to work or sport: the “When can I…” table gives typical ranges, including desk work.
Where else this could be coming from
This area sits where the neck, upper back, ribs and shoulder blades meet, and in front of it lie the heart, the aorta, the lungs and the upper abdomen. That is why the same spot can hurt for very different reasons.
Muscles, joints and the neck
- Muscle strain or overuse (rhomboids, middle trapezius): an ache or burning along the inner edge of the shoulder blade, tender to press, worse after long sitting or carrying.
- Rib joint irritation: a sharp, catching pain beside the spine, often worse with a deep breath, twisting or reaching, and tender over one spot.
- Referred from the neck: a deep ache near the inner shoulder blade that changes when you move or tilt your neck, sometimes with arm pain or tingling.
- Stiff upper back: a dull ache across the middle of the back with long sitting, easing when you move around.
- Spinal compression fracture: sudden pain after a minor fall, lift or even a cough in someone with thin bones (osteoporosis), often in older adults or after long-term steroid use.
Organs that can refer pain here
- Heart (heart attack or angina): pressure, tightness or aching that may spread to the chest, jaw or arms, often with breathlessness, sweating or nausea. It does not change with back movement. Women and people with diabetes more often have back or upper body pain without classic chest pain.
- Aorta (aortic dissection): sudden, severe, tearing or ripping pain between the shoulder blades or through to the chest. It is rare and a medical emergency.
- Lungs (blood clot or collapsed lung): sharp pain on breathing in, with sudden breathlessness, a fast heartbeat, or coughing blood. A recent flight, surgery or leg swelling raises the concern for a clot.
- Gallbladder: pain under the right ribs that can spread to the right shoulder blade, often after fatty meals, sometimes with nausea, fever or yellowing of the skin or eyes.
- Other abdominal causes: stomach ulcers and pancreatitis can cause pain that goes through to the back, often linked to eating, with nausea.
Week by week
This timeline is for pain from muscles, joints or the neck, once more serious causes have been ruled out.
- Days 1 to 3: pain is often sharpest, especially with twisting, deep breaths or turning in bed. Keep moving gently. Short walks and changing position every 20 to 30 minutes usually help.
- Week 1 to 2: sharp pain usually eases to an ache that comes on with long sitting or carrying.
- Weeks 2 to 6: most people notice the ache fading. Gentle mobility for the upper back and strengthening for the shoulder blade muscles can be built up.
- After 6 weeks: pain that is still there often has a contributing cause, such as the neck, long static hours, or sleep. This is a good time to be assessed.
Pain that changes with movement usually comes from the back. Pain that ignores movement deserves a closer look.
Is this normal?
- “It hurts when I take a deep breath.” A stiff or irritated rib joint commonly does this, especially if one spot is tender and twisting hurts too. Breathing pain with breathlessness, fever or coughing is different and needs a doctor.
- “It is worse at the end of the workday.” Long periods in one position commonly build up this ache. Breaks every 30 to 45 minutes often help.
- “There is a knot I can feel.” Tender, tight spots in these muscles are common and usually ease as you move more and sit less.
- “It moves around.” Muscle and joint pain in this area often shifts from one side to the other or up and down over days.
If it isn’t going to plan
It is week four. By mid-afternoon the burning between your shoulder blades is back, and you have tried pressing it against the edge of the door frame more times than you can count. The thought in your head is that if you sit up straighter and hold your shoulders back, it will finally go.
Holding any position for hours, even a good one, keeps the same muscles working without a break. They fatigue and stay sore. Pulling the shoulders back hard often adds to the load instead of easing it.
What this area usually needs is variety: changing position often, moving the upper back through its range a few times a day, and building endurance in the muscles around the shoulder blade so they cope with the day. If the neck is part of the picture, treating only the spot that hurts tends to bring it back.
If you are 4 to 6 weeks in and not clearly easing, get assessed by a physical therapist or your doctor. Useful questions to ask:
- Source: is this coming from my upper back, my ribs or my neck?
- Other causes: have other causes, such as my heart or gallbladder, been considered?
- Daily habits: what should I change in how I sit, sleep or carry things?
- Exercise: which movements should I do each day, and how should they progress?
When can I…
| Activity | Typical range |
|---|---|
| Sleep on that side | Usually within days to 2 weeks for muscle or joint pain |
| Drive | Once you can turn to check blind spots comfortably, often within days to 1 week |
| Reach overhead | Usually within 1 to 3 weeks |
| Lift | Light loads close to the body within days; heavier lifting often 2 to 6 weeks |
| Desk work | Usually within days, with a position change every 30 to 45 minutes |
| Manual work or sport | Often 2 to 6 weeks, longer for rowing, climbing or heavy lifting |
If you have had surgery, your surgeon’s protocol comes first.
Call your local emergency number or go to the emergency department if
- Heart: pain between the shoulder blades comes with chest pain, pressure or tightness, pain spreading to the jaw or arm, sweating, nausea or breathlessness.
- Aorta: sudden, severe, tearing or ripping pain in the upper back or chest, especially with high blood pressure, fainting or a difference in pulse or blood pressure between the arms.
- Lungs: sudden breathlessness, sharp pain on breathing in, a racing heart, or coughing up blood.
- Collapse: you feel faint, collapse, or become confused.
- Spinal cord: new weakness or numbness in both legs, or loss of bladder or bowel control.
See a doctor today if
- Gallbladder: pain under the right ribs or in the right shoulder blade comes with fever, vomiting, or yellowing of the skin or eyes.
- Fever: you have back pain with a fever or chills.
- Possible fracture: sudden pain after a minor fall, lift or cough, and you have osteoporosis, are older, or take long-term steroids.
- Constant pain: the pain is severe and does not change at all with movement, position or rest.
Get it checked soon if
- No clear easing: the pain is not clearly better after 4 to 6 weeks.
- Meals: the pain is linked to eating, or comes with indigestion or nausea.
- Night pain: the pain wakes you at night and is not eased by changing position.
- Other illness: you have unexplained weight loss, a history of cancer, or feel generally unwell.
More on this area: upper and mid back conditions.
Most pain between the shoulder blades comes from the back and neck, and the few causes that do not are the ones to rule out first.
Written by Louise Yow, Neck & Shoulder Physio.