Pain Between Shoulder Blades

Pain between shoulder blades is a relatively common complaint in patients with back pain, but it may also occur in many diseases of digestive tract and cardiovascular system. Some of these conditions may be often very serious or even fatal.


Neuromuscular pain

This is probably the most common cause of pain between shoulder blades. In this complex issue many factors play their roles such as degenerative processes of the spine, narrowing of intervertebral discs and spinal muscular system disorders. The pain worsens when changing position, it is not dependent on exertion (meaning it doesn’t stop shortly after exertion ending) and it is not usually associated with shortness of breath. It should be noted that some patients describe their difficulties so convincingly that they can be easily confused with pulmonary embolism (see below). The diagnosis of neuromuscular etiology should be thus made by excluding the others and more serious conditions.

Pulmonary embolism

It is often accompanied by chest pain and pain between the shoulder blades. The pain occurs suddenly, and typically it is accompanied by a sudden shortness of breath. This condition is potentially fatal and belongs to feared situations in internal medicine. Correct diagnosis and treatment is a challenging issue. For more information read related article about pulmonary embolism.

Angina pectoris and myocardial infarction

Pain resulting from heart muscle ischemia may radiate to the back. For both states, however, classic chest pain is more typical.

Gallbladder inflammation (cholecystitis)

Gallbladder pain is typically situated into the right upper quadrant of abdomen, but it may radiate towards the back and between the shoulder blades. In addition to pain between the shoulder blades there is virtually always a tactile pain in right subcostal area of the abdomen, nausea or vomiting.

Lung diseases

Pain between shoulder blades combined with cough and elevated temperature is often present by respiratory tract infections, typically by pneumonias. Even less serious respiratory infections that are associated with intense coughing may irritate respiratory muscles and cause annoying chest pain or backache.

Esophageal diseases

Pain between shoulder blades occurs by jamming of digested food in esophagus. Pain also accompanies later forms of esophageal cancer. In both cases the patient will complain of painful swallowing.

Diagnostic approach

If the pain is chronic or unusually strong, it is certainly appropriate to undergo a medical examination. The examination should begin with a thorough medical history. Important information should be gathered about patient's previous illnesses, family history, the circumstances of pain, the nature of pain, etc. It is necessary to mention any other warning symptoms, particularly shortness of breath and chest pain presence. Blood test can be performed to check cardiac enzymes to rule out heart muscle disorders and to examine D-dimers to exclude pulmonary embolism. ECG and X-ray of thoracic spine should also be a part of internal medical examination. When we suspect the digestive system to be the real cause of problems, we can perform an esophagogastroduodenoscopy to directly visualize esophagus and stomach. Gallbladder can be visualized by an abdominal ultrasound.


Other diagnostic technique can follow according to outcome or previously mentioned methods. If possible diagnosis head towards neuromuscular problems, it is appropriate to perform a neurologic examination, or examination and therapy by chiropractic.

Jiri Stefanek, MD  Author of texts: Jiri Stefanek, MD
 Sources: basic text sources