Here's why you may feel pain between your shoulder blades—and how to find relief from the discomfort.
What Causes Pain Between the Shoulder Blades? Expert Doctors Explain
Updated on Jan. 16, 2025
Whether it’s a dull ache or sharp spasm, pain between the shoulder blades can be caused by a variety of things. It can be due to bad posture while staring at a computer screen all day, an exercise mishap, or an overuse injury.
Sometimes referred to as scapular pain—scapula is another name for your shoulder blade—it’s a common problem. According to a 2020 paper published in the Journal of the American Academy of Orthopaedic Surgeons, chronic shoulder pain affects about 8% of adults in the United States, and about 4.5 million Americans visit doctors for the condition every year.
Common causes of pain between the shoulder blades
When people experience pain between the shoulder blades, it’s “often described as tightness, muscle spasms, and sometimes a pinching pain,” explains Shane Davis, MD, a Non-Operative Sports Medicine Physician at Tufts Medical Center. “Some people can experience burning or tingling pain too at times.”
He says that, depending on what is causing the pain, it usually worsens with some degree of neck or upper back movement or shoulder movement. “A lot of time in prolonged positions, particularly sitting or carrying bags or backpacks, can be aggravating as well.”
Here’s how to recognize what’s causing the pain between your shoulder blades and when you should see a doctor.
1. Posture
Dr. Davis says that while poor posture isn’t necessarily an immediate cause of shoulder pain, it’s a major risk factor. How you sit and stand all day can develop discomfort between the shoulder blades and around the scapula, particularly if you’re in a forward-leaning position for hours.
Bad posture stems from rounded shoulders and a C-curve in the upper spine. It includes a protracted (rather than retracted) scapula, which means your shoulders round forward instead of down your back and away from your ears. The neck also flexes forward and the shoulders internally rotate. “Sitting in this posture for hours a day and weeks on end can cause muscle imbalances,” says Naimish Baxi, MD, an attending physician and physiatrist at the Hospital for Special Surgery in New York City.
For example, the muscles on the front of the body (like the pecs or chest) get tight or overworked, and the muscles on the back of the body (like the rhomboids, mid traps, or the muscles of the rotator cuff) become weak or overstretched. This leads to discomfort and potentially more serious injury.
A typical seated position, especially when you’re looking at your phone or laptop, also causes the head to come forward, stressing the neck and upper traps. Because of this, the upper traps (which sit at the base of the neck and top of the shoulder) must stabilize the head, which is not their main job. Their primary role is to elevate or shrug the shoulders, Louw explains. This can lead to aches.
Treatment
To treat pain caused by bad posture, first pay attention to how you sit. By sitting forward on your seat and staying upright, you’ll avoid relaxing into a poor posture. Sit on your two butt bones and actively use your core to sit up straight, chest tall, with shoulders rolled down and back, away from your ears. Keep your head over your shoulders, not in front of them, Louw says.
Improving your work setup to make it more ergonomic will also help adjust your posture. According to Dr. Baxi, your computer screen should be at eye level and your keyboard close enough that you don’t have to reach for it. Your elbows should flex about 120 degrees.
Dr. Baxi recommends people stretch and strengthen their back as well.
2. Nerve compression or damage
A seated, rounded posture can lead to compression of the cervical spine (the neck region), resulting in pain between the shoulder blades, says Colleen Louw, MPT, MED, CSMT, TSP, a physical therapist and program director in Iowa.
She says another possible cause of shoulder blade pain is thoracic outlet syndrome. This group of conditions results from compression on the blood vessels and nerves in the lower neck and upper chest. It can cause pain and weakness in the shoulder and tingling or pain in the fingers.
There’s debate about what exactly causes this syndrome, which can be misdiagnosed because the symptoms look similar to rotator cuff injuries and other conditions.
Another nerve-related issue that can lead to pain is scapular winging, a condition in which one or both of the shoulder blades stick out rather than lying flat against the body. But Dr. Baxi notes that it’s not very common.
Treatment
“Most of the time, nerves may be irritated but not significantly damaged—so conservative treatments such as medications, ice and heat, massage, acupuncture, physical therapy, and chiropractic care can help people improve,” Dr. Davis says. For instance, physical therapy may help treat nerve irritation by guiding you in strengthening your chest and improving your posture. “Injections can be helpful as well.”
He adds that if nerves have more severe damage, then more invasive treatments may be recommended sooner, such as surgical interventions. “Although that is rarely the case for pain between the shoulder blades.”
3. Rotator cuff injuries
The older you get, the more prone you become to rotator cuff tears, according to the Journal of the American Academy of Orthopaedic Surgeons, with people over 40 at greater risk.
The rotator cuff is a group of muscles and tendons that surround the shoulder joint. Rotator cuff tears can come from overuse—think lifting or doing an activity that requires an overhead motion, such as painting. Tennis players and baseball pitchers, who constantly repeat the hitting and throwing motion, are also at higher risk for rotator cuff injuries.
If you suspect a rotator cuff injury, see a doctor or physical therapist for a full assessment.
Treatment
A complete tear of a rotator cuff tendon is usually managed surgically, Dr. Davis explains.
“However, most rotator cuff injuries are less severe and are amenable to rest, physical therapy, and medications such as NSAIDs and Tylenol,” he says. “Injections can be performed as well, with steroid injections being the most commonly used, but Toradol injections can provide a similar benefit, and PRP (platelet-rich plasma) injections may be the best for long-term tendon health.”
4. Herniated disc
Another condition that might cause pain between the shoulder blades is a herniated disc, Louw says. That’s particularly true of herniated discs that happen at the cervical spine (neck), which can lead to pain at the scapula.
Discs are soft, rubbery pads found between your vertebrae. They help make up the spine and work as shock absorbers. A herniated disc is a condition where the softer material inside the disc slips through its tough outer layer. This can sometimes compress nerves and cause pain.
Age increases your chance of getting a herniated disc, as does repetitive and intense exercise or poor form while lifting weights.
With a herniated disc, you might also experience weakness in the arm, tingling, or burning pain.
Treatment
While occasionally herniated discs require surgery, nonsurgical treatments may help. These include:
- Rest
- Over-the-counter pain relievers and anti-inflammatories
- Muscle relaxers
- Ice
“Physical therapy can help symptoms, as can chiropractic care, but I would recommend clearance from your doctor before doing any aggressive spinal manipulations, particularly of the neck,” Dr. Davis adds. “Epidural steroid injections can be helpful as well.”
5. Scapulothoracic bursitis
Bursitis is a general term for conditions that cause swelling and pain around muscles and bones. A bursa is a small sac filled with fluid that cushions bones, muscles, tendons, and skin. Scapulothoracic bursitis refers to bursitis that affects the shoulder area.
Repetitive movements (like overhead lifts or throws) can lead to bursitis, and the older you get, the more you’re at risk.
Your doctor will need to do a full exam to look for bursitis.
Treatment
According to a 2010 research article published in the journal Sports Health, addressing shoulder bursitis comes down to strengthening the scapula, fixing posture, and building core strength and endurance. Anti-inflammatory drugs may also help.
Dr. Davis adds: “Rest, physical therapy, and NSAIDs (anti-inflammatory meds) would be the first line of treatment. Steroid injections can be done as well if needed.”
6. Gallbladder issues
Problems with your gallbladder can lead to shoulder or back pain.
A study published in 2018 in the European Journal of Translational Myology found that about 37% of patients with gallstone disease complained of shoulder or back pain.
The gallbladder is a tiny sac located under the liver that stores fat-digesting bile. Gallstones are hard pieces of material often made up of cholesterol or bilirubin, a pigment made from the breakdown of red blood cells. They can develop in the gallbladder and block the bile ducts. This leads to sudden pain and requires immediate medical attention.
Treatment
The treatment for gallstones is most often surgery.
However, “depending on the severity of the case, there are treatment options outside of surgery such as medications and other topical treatments,” explains Laura Purdy, MD, MBA, a family medicine physician licensed in all 50 states and founder of SWELL Medical.
She adds, “If you’ve been diagnosed with gallstones, it’s important to have a conversation with your provider about the signs of an attack and gallbladder disease so you can be prepared to seek care quickly in the event of onset.”
7. Acid reflux
Acid reflux occurs when your stomach acid flows upward into your esophagus and throat. This can happen after a particularly rich or spicy meal, lying down too soon after eating, drinking alcohol, or a variety of other reasons ranging from medication to stress.
The most common symptom of acid reflux is heartburn, a burning sensation in your esophagus (which makes it feel like it’s in your heart/chest). But acid reflux can also cause pain in the shoulder blade area due to proximity, Dr. Purdy explains. “The esophagus and upper intestines are generally where acid reflux occurs, and the discomfort can radiate into the back and shoulder blades.”
Treatment
“The best way to treat acid reflux is to prevent it by maintaining a healthy diet and exercise routine,” Dr. Purdy says. “There are also over-the-counter and prescription remedies that can decrease symptoms in the short term.”
8. Arthritis
Arthritis is a disease that causes pain, stiffness, inflammation, and, ultimately, damage to your joints. “Arthritis of the cervical and thoracic spine could lead to pain [between your shoulder blades],” Dr. Davis says. “Arthritis of the shoulder could cause compensatory myofascial pain in this region as well.”
Treatment
Arthritis in the spine or shoulder is usually first treated with rest, ice and heat, massage, physical therapy, acupuncture, chiropractic care, and/or oral and topical medications, explains Dr. Davis.
“If pain persists, some people will try injections, which usually consist of an epidural steroid injection or radiofrequency ablation, depending on the exact issue,” he says. “Surgery would be a last resort.”
9. Heart attack
“Pain between the shoulder blades may be related to a heart attack due to how deprivation of oxygen in the heart is perceived by the brain,” explains Mary Branch, MD, a board-certified cardiologist at Cone Health in North Carolina.
When the heart is not receiving enough blood flow—and therefore, oxygen—chest pain often occurs. However, “nerve signals from the heart use the same nerve pathways as the back, shoulder, and jaw,” says Rohit Vuppuluri, DO, FACC, RPVI, an interventional and vascular cardiologist at Chicago Heart & Vascular Specialists. “When the nerve signal reaches the brain, the brain is unable to distinguish where the pain is coming from—and the pain from the heart can be referred to other body areas such as the back, shoulder, or jaw.”
Treatment
Pain between the shoulder blades isn’t necessarily a sign of a heart attack. But if it’s accompanied by symptoms such as shortness of breath, chest pain, fatigue, nausea, sweating, and/or lightheadedness, you should get immediate medical attention, says Dr. Vuppuluri.
“These are all symptoms associated with having a heart attack and should be treated emergently by calling 911, as quick treatment can be life-saving,” he states.
10. Cancer
While uncommon, shoulder pain can be a symptom of some forms of cancer—particularly a type of rare lung cancer called a Pancoast tumor. The Cleveland Clinic explains that this tumor doesn’t cause typical lung cancer symptoms such as coughing or chest pain but tends to cause shoulder pain and arm weakness.
Other forms of cancer could cause shoulder pain if a tumor puts pressure on a nerve or if cancer spreads into your bones or tissue around your shoulder. Cancer treatments can also affect shoulder mechanics and cause pain, according to 2024 research published in Current Medicine and Rehabilitation Reports.
Treatment
While pain between the shoulders is not generally a solitary symptom of cancer, if you have any persistent pain—in any area of your body—seek out a medical provider who can help you to properly diagnose your unique situation, Dr. Purdy explains.
Other possible causes of pain between your shoulder blades
When not caused by an injury, shoulder pain can be referred pain stemming from stress on internal organs, Dr. Purdy says. But it can also be something much more benign, such as muscle tension or stress, she adds.
Muscle tension is usually temporary. But myofascial pain—pain related to the muscles and connecting fascia—is a more chronic condition that can cause pain between the shoulder blades, Dr. Davis explains. “Other than that, possible things to consider would be heart, aorta, and lung issues, which would be much more rare but also more dangerous.”
For instance, aortic dissection (tear), pericarditis, and congestive heart failure can all cause back pain, Dr. Vuppuluri says.
When to see a doctor for pain between your shoulder blades
If you have tried improving your posture and you regularly strengthen and stretch the muscles of the upper body, yet you still have pain, it’s probably time to seek medical attention.
“Pain is meant to protect—it’s an output from the brain, based on the perception of threat,” Louw says. If the brain senses something is off, it will alert you via pain to make a change. When that change doesn’t work, it’s time to get medical help.
A few other factors signal it’s time to talk to someone, like pain at night that wakes you up or unexplained weight loss, says Louw.
“You want to see someone sooner rather than later if pain persists between the shoulder blades. A medical professional can help you avoid long-term problems,” Dr. Baxi says. “If the issue is musculoskeletal, they can give you a program for strengthening and stretching, too.
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Sources
- Journal of the American Academy of Orthopaedic Surgeons: “Management of Rotator Cuff Injuries”
- Sports Health: “Clinical Management of Scapulothoracic Bursitis and the Snapping Scapula”
- Cleveland Clinic: “Pancoast Tumor”
- National Institute of Diabetes and Digestive and Kidney Diseases: "Gallstones"
- European Journal of Translational Myology: "Frequency of symptoms associated with gallstone disease: a hospital-based cross sectional study"
- National Institute of Arthritis and Musculoskeletal and Skin Diseases: "Bursitis"
- National Institute of Neurological Disorders and Stroke: "Thoracic Outlet Syndrome Information Page."
- American Academy of Orthopaedic Surgeons: "Diseases & Conditions: Herniated Disk"
- Current Physical Medicine and Rehabilitation Reports: "Evaluation and Management of Shoulder Dysfunction in Cancer Survivors"
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