Upper Back Pain and Pain Between the Shoulder Blades

What counts as upper back pain?

The upper back is the area from the base of the neck to the bottom of the ribcage, which is called the thoracic spine. Pain here is less common than lower back or neck pain, but it still affects many people, especially those who spend long hours sitting, working at screens or doing repeated overhead or lifting work.

Common causes

• Muscle strain and tension. The muscles around the shoulder blades and upper back can become sore from sustained postures, heavy lifting or a new activity.
• Joint pain. Small joints between the vertebrae, and where the ribs join the spine, can become irritated and cause sharp, localised pain, sometimes worse with breathing or twisting.
• Pain from the neck. Problems in the neck, including a pinched nerve, often cause pain between or around the shoulder blades. See pinched nerve in the neck.
• Posture and deconditioning. Posture alone rarely causes damage, but staying in one position for a long time can lead to aching that improves with movement.

Pain between the shoulder blades

This is one of the most common places for upper back pain. Usually it’s muscular or comes from the neck. But organs in the chest and upper abdomen can also refer pain here:

• The heart. A heart attack can cause pain between the shoulder blades, sometimes without much chest pain, particularly in women.
• The lungs. A blood clot in the lung, pneumonia or inflammation of the lung lining can cause sharp pain that’s worse with breathing.
• The aorta. A tear in the main artery causes sudden, severe, tearing pain through to the back. This is an emergency.
• The gallbladder. Gallbladder pain can spread to the right shoulder blade, often after fatty meals.
• Shingles. Burning pain on one side, followed by a band-like rash.

When it’s an emergency

Call 000 if upper back pain comes with chest pain or pressure, breathlessness, sweating, nausea or dizziness, or if it is sudden and severe.

What helps

• Keep moving, and change position often if you sit for long periods.
• Gentle mobility exercises, such as shoulder rolls and upper back rotations.
• Heat can ease muscle tension.
• Strengthening the upper back and shoulders, often with a physiotherapist’s help, can reduce recurring pain.
• Look at work set-up, sleep and stress, which all play a part.

When to see a GP

See a GP if your pain isn’t improving after a few weeks, is constant and worse at night, comes with fever or weight loss, follows a fall, or if you have a history of cancer or osteoporosis. A GP can work out whether it’s coming from the spine or somewhere else, and arrange tests if needed.

References

1. Briggs AM, Smith AJ, Straker LM, et al. Thoracic spine pain in the general population: prevalence, incidence and associated factors in children, adolescents and adults. A systematic review. BMC Musculoskelet Disord. 2009;10:77.
2. Cohen SP, Hooten WM. Advances in the diagnosis and management of neck pain. BMJ. 2017;358:j3221.
3. Iyer S, Kim HJ. Cervical radiculopathy. Curr Rev Musculoskelet Med. 2016;9(3):272-80.
4. Finucane LM, Downie A, Mercer C, et al. International Framework for Red Flags for Potential Serious Spinal Pathologies. J Orthop Sports Phys Ther. 2020;50(7):350-372.
5. healthdirect. Back pain.