Are you experiencing a dull ache between shoulder blades? Does it concerns you that it might be something serious? Follow along as we try to understand the causes of dull ache between shoulder blades, what are the treatments and how can we prevent it?
Dull ache between the shoulder blades is referred to as interscapular pain among the doctor community. Before analyzing the reasons of pain between the scapulas or shoulder blade, it is important we take a review of the anatomy of this area to understand the causes better.
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Anatomy
Shoulder blades or scapulas are the components of upper back along with end of cervical spines in neck, thoracic spines, their associated vertebral discs, muscles, ligaments, and a wide network of nerves which run out from the spine towards different sites.
Scapula and its muscles are important for stability and movement of shoulder joint. Scapular bone fractures are rare but the muscles surrounding it are at risk of injury.
Muscles of scapula include:
Rotator cuff muscles provide stability to shoulder joint. These include supraspinatus, infraspinatus, teresminor and subscapularis. They are important for movements of arm.
It also provides attachment to extrinsic muscles. Some of these connect the scapula to the cervical and thoracic spine such as levator scapulae, rhomboid major and minor respectively. These muscles are important for motion of scapula in respect to the central spine.
Apart from all these muscular relations, both scapula play important role in protecting the visceral organs of thoracic cavity including heart and lungs, posteriorly while ribcage covers them anteriorly.
Type of pain
Quality of pain that a person experiences between the shoulder blades and how it appeared first may also help to guess the diagnosis and act accordingly.
Pain between the shoulder blades can either be due to irritation or injury of the musculoskeletal components in this zone or it could be a referred pain from an organ located somewhere else. In this case referred pain may be from an inflamed gallbladder or pancreas or even indicative of heart attack especially in women. Heart diseases in women show atypical signs, dull ache between the shoulders being one sign of heart attack in women.
Dull ache between the shoulder blades may also be radiating from a cervical vertebra herniation and nerve impingement and in this case pain will increase with the movement of neck.
A ruptured aortic aneurysm can also cause pain between the shoulder blades. This pain is sharp, severe and stabbing and it feels like something has ruptured.
Thus, for proper interpretation of pain it is important to analyze associated symptoms too, so that we can reach a more better and specific conclusion.
Causes
Below we will list down some of the major causes of pain between the shoulder blades:
- Muscle strain
This is the most common cause of ache between the scapulas. Overusing muscles by doing strenuous jobs or exercises, sitting in bad posture for too long, lying on an uncomfortable mattress and lifting heavy objects can strain the back muscles causing pain.
Overhead jobs in which a person is supposed to lift both arms above the shoulder level for longer periods, is a risk factor for causing musculoskeletal disorder and thus backache. Overhead work includes those who work in plasterworks, install curtains or carpenters, workers carrying loads on their heads, electricians and whichever job comes to your mind with the worker’s hands above his/ her shoulder.
Poor posture is a very important preventable cause of bachache. Round shoulder and forward head position or text neck are some of the examples of poor posture which may lead to bachache and abnormal physical appearance of the body and if not treated on time, these changes may become permanent.
Round shoulder occurs as a result of any activity in which a person’s body looks forward and down for a longer duration, causing a hunch back when continued as a habit. Some of the examples of such activity include, bending forward while using a phone or tablet or computer for longer duration, driving, carrying heavy loads and sitting for too long. The same examples are associated with another abnormal body posture known as “forwad head posture” or “text neck”. In this posture the neck of the affected individual is bend forward instead of being upright with respect to his/her body. Both round shoulder and text neck and every other poor posture is bad for your body as in an attempt to adapt to this abnormal body posture, your muscles begin to undergo changes that make them weak and painful. Poor posture leads to muscle imbalance which aggravates the risk of backache. Forward head and round shoulder posture impart more pressure over the muscles of anterior chest wall and as a result muscles of te anterior chest and shoulder become stronger and shorter to hold the head and neck in this respective position while the muscles on back of the shoulder (such as rhomboid, trapezius) are stretched, become weak, strained and painful with the passage of time.
- Injured or weakened muscles of scapula
Weakened or traumatic injury to the muscles of scapula which keep this bone in place and connect it with the central spine can also result in pain between the shoulder blades.
The nerves which supply these muscles, if they are impinged or injured due to any reason, it can also weaken the muscles causing pain.
This condition may be evident on physical examination as a change in position of scapula or inability to perform all movements of arm without any difficulty.
- Diseases of vertebral bone
The area between the two shoulder blades also contains thoracic vertebrae (T3 to T7). Any abnormality in these back bones or their associated structures such as vertebral discs, can naturally cause pain in this area as well.
Abnormalities associated with thoracic vertebrae that can give dull ache sensation between the shoulder blades include:
- Disc herniation anywhere between third thoracic vertebrae (T3) and seventh thoracic vertebrae (T7). Even cervical disc herniation can cause referred pain in this zone.
- Compression fractures of vertebrae (T3 to T7) due to osteoporosis
- Arthritis of cervical or thoracic vertebrae following wear and tear of these bones due to age or overuse. Osteoarthritis of ribs can also cause pain between scapulas.
- Shingles
Varicella Zoster virus or chicken pox virus, is responsible for causing this disease. It affects nerve roots and is manifested as pain followed by an episode of blisters over a skin dermatome. If the nerve innervating a dermatome, present between the scapulas is infected, shingles will cause pain in between shoulder blades much before the onset of blisters.
- Cancers
Lung cancer especially pancoast tumor at the apex of lungs by compressing adjacent nerves, can give rise to referred pain between the shoulder blades. Lymphoma, mesothelioma and esophageal cancer can also cause this pain.
Mesothelioma is defined as cancerous growth of mesothelial cells. Mesothelium is a thin layer which covers the organs inside the body. Its occurs due to prolonged exposure to asbestos. Mesothelial lining of lungs and chest wall is most commonly affected area and thus this may also present as interscapular pain.
Also cancers which metastasize to bones such as breast cancer, Hodgkin’s lymphoma, can cause pain along the medial borders of scapula, felt as pain between the shoulder blades.
- Diseases of gastrointestinal tract
Cholilithiasis or gall stones
Gallstones are cholesterol stones made in the gallbladder. They’re usually asymptomatic but can create problem is large enough to obstruct the outlets of duct. Gallstones when symptomatic present with nausea and pain in the upper right quadrant of abdomen that usually begins after a fatty meal. This pain also radiates to either the right shoulder or between the two scapulas. Hence, gallstones are also suspected if someone complains of pain between the shoulder bones and nausea.
Acute pancreatitis
It is defined as the sudden inflammation of pancreas caused mostly due the obstruction of bile duct by gallstones, leading to accumulation of pancreatic enzymes and thus self destruction of pancreatic tissue by its own enzymes that trigger the inflammatory process.
Symptoms of acute pancreatitis include nausea, vomiting, diarrhea, bloating, fever and abdominal pain which radiates to either left scapula or interscapular space.
Gastro esophageal reflux disease (GERD)
Even though it is an abnormality involving malfunctioning lower esophageal sphincter that sets ground for backflow of gastric acidic contents into the esophagus causing irritation and pain in the epigastric zone of abdomen, GERD may be a causative agent of pain between scapulas as well. Pain due to reflux disease can also radiate to back due to the close association if adjacent visceral neurons.
- Scoliosis
It is a condition in which the spine of a person is curved abnormally. This abnormal curvature puts extra pressure over the back muscles making them weak and strained. Scoliosis of thoracic vertebrae can cause pain between the shoulder blades.
- Complication of epidural anesthesia
Epidural anesthesia usually used to relieve the labor pain and birth process, is sometimes associated with an unexplained pain between the shoulder blades or anywhere in the back. It is a transient complication and heals itself.
Causes that need immediate treatment
As we discussed until now the most common cause of dull ache between the shoulder blades is muscle strain, which either heals spontaneously or by some home remedies and rest.
Other causes also do not put a person at an immediate risk and thus provide the suffering person with enough time to seek medical help.
Some conditions however, if not recognized and treated on time can cause serious complications, more importantly death!
Causes of interscapular pain that need immediate treatment are as follows:
- Heart attack
Yes, you read right! Heart attack presenting as pain between the shoulder blades is a very atypical sign and often missed. Around 3 percent women experiencing heart attack complain about pain between their shoulder blades. Since it is an uncommon sign of heart attack and difficult to suspect, mortality rate due to heart diseases is high in women compared to men who present with typical signs and thus receive on time treatment.
So if someone has pain between shoulder blades, look for these clues so that we don’t miss this important cause:
- Female sex
- Chest pain
- Shortness of breath
- Pulmonary embolism
When a deep vein thrombosis walls off from its original site, it is known as emboli that travels towards different sites in the body via the blood vessels and has the potential to occlude any blood vessel if large enough. Pulmonary artery occlusion due to emboli is common. Symptoms include sudden shortness of breath, wheezing, coughing, dull chest pain and even pain between the shoulder blades.
Whenever pain between the shoulder blades is accompanied by sudden shortness of breath, coughing, wheezing or chest pain, call an ambulance and do not delay seeking help.
- Aortic aneurysm rupture or aortic dissection
The walls of aorta rupture in this disorder causing a sharp and severe, tearing pain in the upper back (involving interscapular area) along with rapid loss of blood internally and its associated symptoms such as tachycardia, palpitations, pale skin, low blood pressure and loss of consciousness.
It is a medical emergency and any unnecessary delay can prove fatal.
When to call emergency?
By now it must be clear that in any case if you suspect a heart attack, pulmonary embolism or aortic dissection, make sure you are quick enough to seek medical help as these are all emergencies and delay can take away a precious life.
Considering the importance of this issue lets revise the associated symptoms in presence of interscapular pain, which if positive, emergency treatment will be needed:
- Chest pain, cold sweats and feeling of impeding death
- Shortness of breath
- Wheezing
- Loss of consciousness
- Severe progressive pain
Treatment
Treatment is based on the cause of pain. Since, muscle strain is the most common cause home remedies can be utilized to relieve the pain. Cold or hot compressions can be placed on the strained muscle. Topical muscle relaxants can also relieve the pain.
Preventive measures include doing stretches to strengthen the back muscles, sitting in an appropriate posture, sleeping on comfortable mattresses suitable for back and proper rest if already in pain.
We saw that a simple dull ache between shoulder blades may not be this simple at all and may point towards a huge number of problems ranging from transient, self recovering mild issues to serious and fatal conditions.
We may not like the pain that our body goes through but it is a blessing in disguise. Nature has blessed us with the ability to experience pain, because of which we understand that something is wrong. We can say that pain is a way our body communicates with us, by which it tells us that it may need proper care or sometimes even proper treatment and medications to function properly.
So, listen to your body when it tries to speak to you and take care of it.