Pain between the shoulder blades: causes, red flags and when to get it checked

The area between the shoulder blades is supplied by nerves from the upper thoracic spine, which also supply parts of the chest and abdomen. Pain from joints and muscles is felt there, but so can referred pain from organs sharing the same nerve pathways, which is why associated symptoms matter.

• Muscle strain and postural pain from desk work, driving, carrying or sleeping awkwardly, usually worse with movement and relieved by rest or heat.

• Stiffness or locking of thoracic spine or rib joints, with pain on twisting or deep breathing.

• Neck problems referring pain down, including a trapped nerve with arm symptoms.

• Gallbladder disease: pain after fatty meals, sometimes spreading to the right shoulder blade, with nausea.

• Gastro-oesophageal reflux and oesophageal spasm: burning pain related to meals.

• Angina or heart attack: pressure-like pain, with exertion, breathlessness or sweating.

• Pneumonia, pleurisy or a pulmonary embolism: pain that worsens on breathing in.

• Aortic dissection, spinal infection or tumours, and shingles before a rash, which are less common but important.

Sudden severe or tearing pain, pain with chest pressure, sweating, breathlessness or collapse, fever, unexplained weight loss, a history of cancer, night pain that is unrelenting, leg weakness or numbness, loss of bladder or bowel control, and pain after major injury are red flags.

• Call 999: sudden tearing or severe pain between the shoulder blades, chest pressure, collapse or breathlessness.

• Same-day GP or A&E: back pain with fever, new leg weakness or numbness, or difficulty passing urine.

• GP within days: pain with meals, yellowing of skin, or night pain with weight loss.

• Routine GP or physiotherapy: pain related to posture and movement, improving over days to weeks.

Doctors ask about onset, what triggers or eases the pain, relation to meals and breathing, chest symptoms, arm pain, fever, injury, occupation and posture. They examine the spine, ribs, neck movement and shoulder, test strength and sensation, check blood pressure in both arms, listen to the heart and lungs and examine the abdomen.

• ECG and troponin: if a cardiac cause is possible.

• Abdominal ultrasound and liver tests: for gallstones.

• Chest X-ray: for lung causes.

• MRI of the thoracic or cervical spine: for neurological signs or persistent pain.

• CT angiography: if aortic dissection is suspected.

Keep moving rather than resting, use heat packs, take simple painkillers if suitable, and adjust your desk setup and break up long periods of sitting. Gentle stretches and strengthening of the upper back help. Avoid prolonged bed rest.

The NHS route is a GP with physiotherapy referral for mechanical causes. Private physiotherapy, osteopathy and imaging are available directly, but chest or red-flag symptoms need urgent medical review.