Pain Between My Shoulder Blades: What Is Causing It?

It sits between your shoulder blades, usually a little off to one side of the spine. People describe it three ways: a burning band, a knot they can press but never quite reach, or a sharp catch that bites on a deep breath. It builds through a day at a laptop and it is still there the next morning.

Start with the causes that are not muscular

Nearly all pain in this spot is mechanical: muscle, the joints of the mid back, the ribs, or the neck. But this is one of the few places in the body where organs refer pain, so a small number of non-musculoskeletal causes have to be excluded before anyone puts hands on your back. That is not a reason to be frightened of a sore mid back. It is the reason a good first visit asks about your chest, your breathing and your stomach before it asks where the knot is.

Two of them belong here rather than at the bottom. Chest pain or pressure with pain spreading into the back, jaw, neck or arm, especially with shortness of breath, sweating or nausea, means calling 911, not waiting to see if it settles. In women, heart attack symptoms more often include back pain, nausea and breathlessness than the crushing chest pain people picture, so "this does not feel like a heart attack" is not a safe reason to wait. Sudden severe pain between the shoulder blades that feels like tearing or ripping is also an emergency and needs 911 immediately.

What the mechanical version feels like

• A burning or aching band just inside one shoulder blade, worse late in the workday, better once you move.
• A knot you keep pressing. It softens under a thumb and returns within the hour.
• A sharp, small, localized catch that bites on a deep breath, a sneeze or a twist.
• No fever, no weight loss, and no stomach symptoms.

Where it actually comes from

Three sources cover most cases. The first is muscular. The rhomboids and mid trapezius hold your shoulder blades back against a day of reaching forward, so they sit long and tired and develop tender points that ache and burn.

The second is joint restriction. Each rib meets the spine at two small joints. When one stops moving, the rib cannot rise properly with a breath, and you get that sharp localized catch.

The third is the one most people get wrong. The lower neck refers pain straight into the area between the shoulder blades, and it does this regularly even when the neck itself barely hurts. An irritated joint or nerve root at the base of the neck can produce a deep ache under the shoulder blade as its only complaint. If you have chased this knot for months with massage and stretching, the neck is the first place worth examining. Our neck pain page covers what happens when the neck is the painful part too.

Why the knot keeps coming back

Because the knot is usually the messenger. A muscle guarding a stiff joint, or firing in response to an irritated nerve upstream, grips again as soon as the pressure comes off it. Sustained load keeps that running: a laptop screen below eye level, a phone held low, a bag on the same shoulder, long drives. Raising the screen and adding a separate keyboard changes more than any stretch does.

How we treat it at Tradewinds

At Tradewinds Chiropractic & Wellness in Charlotte Amalie, St. Thomas, the first visit is a history and a hands-on exam that screens the non-mechanical causes first, then tests the neck, the thoracic segments, the rib joints and the muscles between the shoulder blades. Dr. Keys is the Chair of the Virgin Islands Board of Chiropractic Examiners, a member of the Virgin Islands Chiropractic Society, and the International Chiropractors Association representative for the U.S. Virgin Islands. When the source is the mid back and ribs themselves, upper back pain describes the care in full. Our services page lists the methods used.

When you should see someone else

Call 911 or go to the nearest emergency room for any of these:

• Chest pain or pressure, or pain spreading to the back, jaw, neck or arm, particularly with shortness of breath, sweating or nausea. That is a cardiac concern, and in women it often presents as back pain, nausea and breathlessness without classic chest pain.
• Sudden severe tearing or ripping pain between the shoulder blades, which can signal a problem with the aorta.
• Pain that started after a serious fall or crash.

See a physician before hands-on care if you have:

• Pain under the right ribs traveling to the right shoulder blade, often after a fatty meal and sometimes with nausea. That points toward the gallbladder and needs medical assessment rather than manual therapy.
• Back pain with fever, unexplained weight loss, or a history of cancer.
• Pain with a cough or shortness of breath, or new numbness or weakness in an arm or hand.

Visitors, crew and cruise passengers

Charter crew, divers hauling tanks, and visitors who slept on a plane and then in a narrow berth all land in this spot. Tell us your departure date when you call.

Getting seen

We are in the VI Medical Foundation Building, Suite 202, 9150 Estate Thomas, St. Thomas, USVI 00802, just east of Charlotte Amalie and a short drive from the Havensight cruise port. Call (340) 690-4994. We take walk-ins and same-day appointments. Hours are Mon, Wed, Thu: 10:00 am to 1:00 pm and 3:00 pm to 7:00 pm. Tue, Fri: 7:00 am to 2:00 pm. Closed Sat and Sun. New patient forms are at forms. Tradewinds has more than 180 five-star Google reviews.

Questions patients ask

What causes pain between my shoulder blades?

Most often one of three things: strain and tender points in the rhomboid and mid trapezius muscles, a rib or mid back joint that has stopped moving, or pain referred from the lower neck. The neck is the one people miss, because it can send a deep ache under the shoulder blade while the neck itself feels fine. A small number of cases are not musculoskeletal at all, which is why a first visit screens the heart, lungs and gallbladder before treating the back.

What does burning between the shoulder blades mean?

Burning usually comes from muscle that has been held long and loaded for hours, or from an irritated nerve in the lower neck referring into that area. It is typically worse late in the day and eases with movement. Burning that comes with chest pressure, shortness of breath, sweating or nausea is different and needs 911 rather than an appointment.

I have a knot between my shoulder blades that won't go away. Why does it keep coming back?

Because the knot is usually the response, not the cause. A muscle guarding a stiff rib or thoracic joint, or reacting to an irritated nerve in the neck, tightens again as soon as the pressure comes off it. Massage feels good and helps briefly. Lasting change usually needs the joint or the neck addressed and the daily load changed.

Can pain between my shoulder blades be my heart?

It can. Pain radiating to the back, jaw, neck or arm along with chest pain or pressure, shortness of breath, sweating or nausea is a reason to call 911 immediately. In women, heart attack symptoms more often include back pain, nausea and breathlessness than classic chest pain, so it may not feel the way people expect. Do not wait to see if it settles.

When is pain between the shoulder blades an emergency?

Call 911 for chest pain or pressure with radiation to the back, jaw, neck or arm, especially with shortness of breath, sweating or nausea, and for sudden severe tearing or ripping pain between the shoulder blades. See a physician first for pain under the right ribs going to the right shoulder blade after fatty meals, or for back pain with fever, unexplained weight loss, or a history of cancer.