Additionally, the thoracic spine supports the rib cage and protects vital organs. Nerves branching from this region supply sensation and motor function to the arms, chest, and upper back. Any irritation or compression in these structures can lead to referred pain between the shoulder blades.

Common Causes of Constant Pain Between Shoulder Blades

While occasional discomfort between the shoulder blades may result from poor posture or muscle strain, constant pain often points to deeper causes. Here are the most common culprits:

1. Poor Posture and Muscle Strain

One of the leading reasons for chronic upper back pain is prolonged poor posture—commonly seen in people who sit for long periods at desks, hunch over smartphones, or drive frequently. This can lead to muscle imbalances, particularly in the trapezius and rhomboids.

Over time, weakened or overworked muscles compensate by tightening or spasming, leading to persistent aching. Sitting with rounded shoulders, for example, stretches the rhomboids and overloads the trapezius, resulting in pain between the shoulder blades.

2. Herniated or Bulging Discs

The intervertebral discs act as cushions between the vertebrae. When a disc in the upper or mid-thoracic spine herniates or bulges, it can press on nearby nerves, causing radiating pain between the shoulder blades. While less common than cervical or lumbar disc issues, thoracic disc problems can still lead to significant discomfort and require medical evaluation.

3. Spinal Conditions

Conditions such as kyphosis (excessive outward curvature of the spine), scoliosis (lateral curvature), and degenerative disc disease can all contribute to chronic upper back pain. These structural changes alter the mechanics of the spine and surrounding muscles, leading to strain and discomfort.

4. Myofascial Pain Syndrome

This chronic condition involves sensitive trigger points in the muscles—tight knots that can cause referred pain. Trigger points in the trapezius or rhomboids often refer pain directly between the shoulder blades. The pain may worsen with stress, poor sleep, or overuse.

5. Arthritis

Osteoarthritis or inflammatory arthritis (e.g., ankylosing spondylitis or rheumatoid arthritis) affecting the facet joints of the spine can cause persistent pain and stiffness. Arthritis in the thoracic spine may result in dull, aching pain that radiates to the interscapular region.

Serious Medical Conditions That Cause Interscapular Pain

While musculoskeletal issues are common, constant pain between the shoulder blades can also be a red flag for serious health conditions. Never ignore pain that is severe, sudden, or accompanied by other symptoms.

1. Heart-Related Issues

Although chest pain is a well-known symptom of heart problems, pain between the shoulder blades—especially on the left side—can also indicate cardiac issues. Conditions such as:

• Angina: Chest discomfort due to reduced blood flow to the heart, often radiating to the back, neck, and arms.
• Heart attack (myocardial infarction): Pain may present atypically in women or older adults, with back pain being a primary symptom.
• Aortic dissection: A life-threatening tear in the aorta that often causes sudden, severe upper back pain.

If pain is crushing, radiates to the jaw or arm, is accompanied by shortness of breath, sweating, or nausea, seek emergency medical attention immediately.

2. Gallbladder Disease

Pain from gallstones or cholecystitis (inflammation of the gallbladder) often radiates to the right shoulder blade. This is known as referred pain and occurs due to shared nerve pathways. The pain typically follows meals, especially fatty ones, and may be accompanied by nausea, bloating, or jaundice.

3. Lung Conditions

Issues such as pleurisy (inflammation of lung lining), pneumonia, or even lung cancer can cause upper back pain. Pain from lung problems may worsen with breathing or coughing and may be associated with respiratory symptoms like shortness of breath or persistent cough.

4. Gastroesophageal Reflux Disease (GERD) and Hiatal Hernia

GERD, or chronic acid reflux, can cause a burning sensation behind the breastbone that sometimes radiates to the back. A hiatal hernia—where part of the stomach pushes into the chest—can also lead to discomfort between the shoulder blades, often mistaken for musculoskeletal pain.

5. Spinal Infections or Tumors

Although rare, infections (e.g., discitis, osteomyelitis) or tumors in the spine can cause constant, progressive back pain that worsens at night. Unexplained weight loss, fever, or neurological symptoms (numbness, weakness) warrant immediate investigation.

When to See a Doctor

While many cases of interscapular pain resolve with self-care, certain red flags indicate the need for prompt medical evaluation:

• Pain that is sudden, severe, or worsening over time
• Pain accompanied by chest pain, shortness of breath, or dizziness
• Unexplained weight loss or fever
• Numbness, tingling, or weakness in the arms or legs
• Pain that persists despite rest and home remedies
• Pain following an injury or trauma

Immediate emergency care is crucial if you suspect a heart attack, aortic dissection, or pulmonary embolism.

Diagnosis: How Doctors Identify the Cause

A healthcare provider will begin with a thorough medical history and physical examination. They may ask about:

• The onset, location, and nature of the pain (dull, sharp, burning)
• Triggers or relieving factors (movement, breathing, posture)
• Associated symptoms (fever, cough, digestive issues)
• Occupational habits, physical activity, and mental stress levels

Diagnostic tests may include:

1. Imaging Studies

• X-rays: To assess spinal alignment, fractures, or degenerative changes.
• MRI (Magnetic Resonance Imaging): Provides detailed images of soft tissues, discs, nerves, and spinal cord. Ideal for detecting herniated discs, tumors, or infections.
• CT Scan: Offers cross-sectional views of bones and soft tissues, useful in trauma or suspected aortic issues.
• Ultrasound: If gallbladder disease is suspected, an abdominal ultrasound can visualize gallstones or inflammation.

2. Blood Tests

These can detect signs of infection, inflammation (e.g., elevated ESR or CRP), or markers of autoimmune diseases like rheumatoid arthritis.

3. Electrocardiogram (ECG or EKG)

If cardiac issues are suspected, an ECG measures heart rhythm and can reveal signs of ischemia or previous heart attacks.

4. Endoscopy or pH Monitoring

For suspected GERD or hiatal hernia, these tests evaluate esophageal function and acid exposure.

Treatment Options for Constant Pain Between Shoulder Blades

Treatment depends on the underlying cause. A multidisciplinary approach often yields the best results. Here’s a breakdown of common strategies:

1. Conservative and Home-Based Treatments

Posture Correction

Improving posture is one of the most effective ways to relieve and prevent interscapular pain. Tips include:

• Use ergonomic chairs with lumbar support
• Keep computer screens at eye level
• Avoid prolonged sitting—take breaks every 30–60 minutes
• Practice 'ear-over-shoulder-over-hip' alignment when standing

Stretching and Strengthening Exercises

Targeted exercises can alleviate muscle tension and strengthen weak areas:

• Chin tucks: Improve forward head posture.
• Doorway stretches: Open up tight chest muscles contributing to rounded shoulders.
• Scapular squeezes: Strengthen the rhomboids and mid-back muscles.
• Thoracic spine mobility drills: Use foam rollers to improve upper back flexibility.

Heat and Cold Therapy

Apply ice packs for the first 48 hours after acute pain to reduce inflammation. Afterward, use heat (heating pads or warm showers) to relax tight muscles and improve blood flow.

Over-the-Counter Pain Relievers

Medications like ibuprofen (NSAIDs) or acetaminophen can help manage pain and inflammation. Always follow dosage instructions and consult a doctor if used long-term.

2. Physical Therapy

A licensed physical therapist can design a personalized program to correct movement patterns, improve posture, and strengthen stabilizing muscles. Manual therapy techniques such as massage, joint mobilization, and trigger point release are often included.

3. Medications Prescribed by a Doctor

• Muscle relaxants: For severe muscle spasms.
• Neuropathic pain medications: Such as gabapentin or pregabalin for nerve-related pain.
• Antidepressants: Low-dose tricyclics (e.g., amitriptyline) may help with chronic pain and sleep.
• Proton pump inhibitors (PPIs): For GERD-related pain.

4. Injections and Procedures

For persistent pain, doctors may recommend:

• Corticosteroid injections: Into facet joints or trigger points to reduce inflammation.
• Nerve blocks: Temporarily interrupt pain signals from affected nerves.
• Radiofrequency ablation: For chronic facet joint pain, uses heat to disable nerve conduction.

5. Surgical Interventions

Surgery is rare but may be necessary for:

• Severe spinal deformities
• Herniated discs compressing nerves
• Spinal tumors or infections
• Cardiac or vascular emergencies (e.g., aortic dissection repair)

Lifestyle Changes to Prevent and Manage Pain

Long-term relief from interscapular pain often requires sustainable lifestyle changes:

1. Maintain a Healthy Weight

Excess weight, especially around the abdomen, can pull the