Pain between the shoulder blades: causes and when to get help

The area between the shoulder blades is the upper part of the back, at the level of the thoracic spine and the ribs. Pain here is sometimes called interscapular pain. It can feel like an ache, a tight band, a burning sensation or a sharp catch with movement or breathing.

It is rarely a diagnosis on its own. The NHS explains that back pain can have many causes, that it is not always obvious what causes it and that it often gets better on its own. A common cause is an injury such as a pulled muscle, and sometimes medical conditions such as a slipped disc, sciatica or ankylosing spondylitis can cause back pain. Very rarely it is a sign of a serious problem such as a broken bone, cancer or an infection.

The sources reviewed here describe back and shoulder pain in general rather than this exact site, so the following should be read as the usual explanations rather than a way to identify your own cause.

• Muscle strain or tension from lifting, awkward positions or sustained postures such as desk work, which the NHS includes among the causes of back pain and shoulder pain.

• Poor posture: the NHS advice for shoulder pain includes standing up straight with shoulders down and gently back and not slouching when sitting.

• Referred pain from the neck, which Patient.info says is the most common source of pain felt in the shoulder, usually with neck pain or stiffness as well.

• Shoulder problems such as tendonitis, bursitis, impingement or frozen shoulder, which the NHS lists as causes of shoulder pain.

• Less commonly, a problem in the chest or abdomen: Patient.info says occasionally pain may be felt in the shoulder when the source is the heart or the diaphragm, with a problem in the abdomen irritating the diaphragm.

The NHS pages on heart attack, back pain and shoulder pain set out when pain needs urgent attention.

• Call 999 for chest pain that feels tight or like squeezing, or that spreads to the arms, neck or jaw, breathlessness, or feeling pale, sweaty or sick, which can be signs of a heart attack.

• Call 999 or go to A&E if back pain comes with pain, tingling, weakness or numbness in both legs, loss of feeling around the genitals or anus, changes in bladder or bowel control, chest pain, or follows a serious accident.

• Ask for an urgent GP appointment or call NHS 111 if the pain is severe and starts suddenly or is getting worse quickly, or you feel hot, cold, shivery or generally unwell.

• Seek urgent advice for shoulder pain that is sudden or very bad, follows an injury, comes with a hot or badly swollen shoulder, pins and needles that do not go away, or severe pain in both shoulders.

The NHS says to see a GP if your back pain does not improve after treating it at home for a few weeks, stops you doing day-to-day activities, you are worried or struggling to cope, you have lost weight without trying to, there is a lump or swelling or your back has changed shape, it does not improve after resting or is worse at night, it is worse when sneezing, coughing or pooing, or it is coming from the top of your back, between your shoulders, rather than your lower back.

Patient.info adds that medical attention should be sought soon if the pain affects both shoulders and is worse in the mornings or overnight, is not improving with simple painkillers for a couple of weeks, is affecting daily activities, or comes with other symptoms such as tummy pain, a persisting cough, night sweats or weight loss.

The NHS advice for back pain is to stay active and continue daily activities, take anti-inflammatory medicine such as ibuprofen if suitable (checking with a pharmacist or GP), use an ice pack or heat pack wrapped in a tea towel, and try exercises and stretches, while avoiding staying in bed for long periods. Paracetamol on its own is not recommended for back pain but may be used with another painkiller.

For shoulder pain it suggests gently moving the shoulder, doing shoulder exercises for 6 to 8 weeks to stop pain returning, sitting with a cushion behind the lower back, resting the arm on a cushion in the lap, and using heat or cold packs for up to 20 minutes. Activities such as walking, swimming, yoga and pilates may also help ease back pain. Stop any exercise if the pain gets worse and see a GP for advice.

A clinician will ask when the pain started, what makes it better or worse, and whether there are other symptoms such as chest pain, breathlessness, fever or weight loss, and will examine the back, neck and shoulders. The NHS says that for shoulder pain, a health professional will examine you to work out the cause and might arrange tests such as an X-ray.

If a heart cause is suspected, tests such as an ECG and blood tests are used, as the NHS describes for heart attack. Pain that clearly changes with neck or shoulder movement points more towards a musculoskeletal cause.

The NHS says that for back pain that is severe or not getting better, other treatments may be recommended after a few weeks, including group exercise sessions and physiotherapy, manual therapy, cognitive behavioural therapy to help cope with pain, and, for long-term lower back pain only, a procedure on the nerves. If a medical condition such as a slipped disc is the cause and other treatments have not helped, surgery may be an option.

For shoulder pain, treatment depends on the cause and may include stronger medicine or injections, physiotherapy or exercises at home, or seeing a specialist. In many areas you can refer yourself to NHS community musculoskeletal (MSK) services for physiotherapy without a GP referral, according to the NHS.

NHS physiotherapy is available, but the NHS says waiting times can be long, and you can also pay to get physiotherapy privately. Private physiotherapists, osteopaths and chiropractors can offer faster appointments for musculoskeletal pain. Whoever you see, anyone with chest symptoms, breathlessness, fever, unexplained weight loss or neurological symptoms should have these assessed medically rather than treated as a muscle problem.