Burning Between Your Shoulder Blades: What It Means and How to Fix It

Shoulder pain affects nearly 30% of adults (1). To understand why shoulder pain is so prevalent, it’s important to first understand the anatomy of the shoulder.

The shoulder moves with the help of four articulations (joints), three bones, and several muscles. The sternoclavicular, acromioclavicular, glenohumeral, and scapulothoracic joints, along with the clavicle, scapula, and humerus comprise what’s called the shoulder “girdle” (2). The rotator cuff provides support for the shoulder.

Excessive and repetitive use can wear down on the tendons that support the shoulder, which can result in pain and immobility. Physicians classify these shoulder complications in four major categories (3): 

• Tendon inflammation: Bursitis or tendonitis of the tendon
• Instability: The popping out of the upper arm bone out of the shoulder socket, either partially or completely
• Arthritis: Inflammation of the joints, the most pertinent to the shoulder is osteoarthritis
• Fracture: Broken bones

Muscle strain is the most common cause of interscapular pain. People strain their muscles through poor posture, overuse, wearing heavy backpacks, or playing sports. Any activity that requires repeated strenuous movements of the arms can create bursae (small fluid-filled sacs that hamper tendon and muscle activity) and inflame the tendons, which in turn can lead to interscapular pain (4, 5).

Another less common cause of muscle pain is cervical radiculopathy. This is commonly referred to as a “pinched nerve” because the neck compresses a nerve root at its exit point from the spinal column. Cervical radiculopathy most commonly occurs in older people, although sudden injuries can also herniate spinal discs in younger people, leading to pinched nerves (6).

While most shoulder pain is due to local issues near the shoulder itself, other life-threatening pathologies may also cause the pain, including stroke, lung cancer, tuberculosis, or even heart disease (7, 8). Severe shoulder pain may also be an indication of aortic dissection, a serious condition in which the inner layer of the aorta tears (9).

Since these can result from complications that are physically removed from the shoulder, physicians sometimes find it difficult to diagnose the true cause of interscapular pain. There have even been documented cases of shoulder pain originating from ankle issues (10). Thus, your shoulders could be suffering from possible conditions related to your lower back, middle back, or other places around your body.

If you notice that the affected area is swollen, red, or tender, make an appointment with your doctor (11). Your doctor will physically examine you and may also order blood testing, electrocardiography, electroneuromyography, or imaging scans.

Blood testing will help your doctor gauge your red blood cell count to determine if inflammatory conditions accompany your pain. A blood test can also detect erythrocyte sediment rate (ESR). A high ESR, combined with shoulder pain, could be a sign of a pathology called rheumatica (12).

For more complex cases, your doctor may use electrical activity readings from ECGs, EKGs, or EMNGs to assess your body's function. By measuring your peripheral nerve’s conduction velocity and comparing it to your muscle activity, your doctor can figure out the source and location of a neuromuscular condition responsible for shoulder pain. However, it's important to know that these tests are generally used to confirm diagnoses, not formulate them (13).

Your doctor may also order an imaging test such as a magnetic resonance imaging (MRI) scan or a computed tomography (CT) scan. MRIs use non-invasive technology to produce a detailed pictures to allow for better disease detection, diagnosis, and treatment monitoring. While MRIs don’t produce radiation like X-rays or CT scans, they do use magnetic technology to create images, so let your doctor know if you have a device or an implant inside your body (14). A CT scan uses X-rays to take cross-sectional pictures of your body to look for broken bones, cancers, blood clots, signs of heart disease, and internal bleeding (15). These imaging tests can help your doctor assess the root cause of your shoulder pain.

During your visit, your doctor may ask questions such as: 

• What symptoms are you experiencing?
• When did you first start noticing them? 
• Were you recently injured? 
• Does it hurt in just one particular area? 
• How long has it been hurting?

If you notice that your shoulder pain is accompanied by difficulty breathing or a tight chest, seek immediate medical help, as this could be a sign of a heart attack, along with sharp chest pain, nausea, and lightheadedness.

Modern medicine offers many treatment options for interscapular pain. As long as your condition is not a medical emergency, you may even want to try some home remedies before seeking out professional care.

While some studies claim that exercise can be beneficial for musculoskeletal pain, it may be wise to begin the treatment of shoulder pain with rest, especially as shoulder pain often results from strenuous or repetitive movements. Consider following the RICE method to start off – Rest, Ice, Compression, and Elevation (16).

As part of the RICE method, you may want to incorporate temperature therapy. Temperature therapy includes hot and cold compresses, both of which show results for treating musculoskeletal injuries (17). Though cold therapy is traditionally better suited for treating inflammation, muscle spasms, and pain, personal preference can factor in as to which temperature therapy you choose to apply for your interscapular pain.

If rest and temperature therapy don’t resolve your pain, you may want to seek out physical therapy. A physical therapist can help you learn how to move your body in beneficial ways. You can also practice self-massages that could target potential trigger points of your pain. Good posture and daily activities can go a long way when it comes to treating shoulder pain.

Along with these methods, you may be interested in using pain relievers, particularly over-the-counter (OTC) non-steroidal anti-inflammatory drugs (NSAIDs) such as aspirin, ibuprofen, or ketoprofen. These will be especially effective in controlling interscapular inflammation. Keep in mind that these shouldn’t be used long-term, as continual use can damage parts of your body like your stomach lining. NSAIDs should be used in conjunction with the more conservative pain management techniques like physical therapy.

Persistent Pain

If your pain persists or gets worse, talk to your physician about other treatment options.

One additional treatment method is therapeutic ultrasound. Therapeutic ultrasound uses sound waves to treat conditions such as tendinitis or bursitis. While there are risks of burns or vascular injuries, a skilled ultrasound operator can help mitigate the likelihood of these effects (18). Unfortunately, if your interscapular pain continues to worsen, especially if it’s caused by irritated spinal nerves, you may want to consider more aggressive methods.

For particularly intense pain, your doctor may prescribe corticosteroid injections, especially in cases of bursitis or tendonitis. These shots are not meant to be a long-term solution – they’re generally used for symptom control, not treatment. Steroids will calm the inflamed joints and tissues but will not promote healing or prevent future problems. And even so, the injections may not necessarily help. Studies show that the efficacy of steroid injections for pain control varies from person to person. Continual steroid shots in the same area can cause bones or cartilage to break down, so physicians recommend only three to four per year (19).

Your doctor may also suggest benzodiazepine (BZD) injections. Physicians use BZD for treating anxiety, insomnia, epilepsy, and pain relief. While powerful, BZDs come with a variety of heavy side effects that warrant caution. BZDs can cause aggression, drowsiness, amnesia, and dependence (20). They should not be used long-term, particularly if the patient is older. Chronic pain patients also exhibit to dependency issues (21).

As a last resort, your doctor may propose surgery. A majority of patients respond to non-surgical treatments, but even if not, over 90% of patients can find relief with surgery (22).

Choosing a Treatment

When it comes to choosing a treatment to relieve your interscapular pain, start with the most conservative treatment first. Try rest, temperature therapy, physical therapy, OTC pain relievers before looking at more involved treatments.

Interscapular pain result from any one of several underlying conditions. While muscle strain is often the main culprit of interscapular pain, it’s important to make sure that the pain is not a symptom of something more serious, like a heart attack or cancer.

If your shoulder pain isn’t swollen, red, or tender, consider home therapies such as rest, temperature therapy, OTC pain relievers, or physical therapy. If your pain persists or worsens, consult a doctor. They may order a series of tests and scans, including blood testing, EKGs, CT scans, or EMNGs. Depending on your diagnosis, they may prescribe steroid injections, muscle relaxants, or, in severe cases, surgery. Be sure to ask questions about anything you’re unsure about!