Pain Between Your Shoulder Blades: Not a “Poking” Matter

In Neck Pain, Physical Therapy, Shoulder Pain by Seth Peterson, Physical Therapist Oro ValleyLeave a Comment

It can feel like squeezing, a dull ache, or like a hot poker getting driven into the area next to your shoulder blades.  It can make it hard to breathe, hard to back the car up in the driveway, or make sitting almost unbearable.  It’s effects are clear—but the cause isn’t so easy to determine. 

As a physical therapist, I often see patients who have struggled with this for months thinking it was a pulled muscle.  Doctor Google, massage therapists, or a well-meaning spouse pushing on the area was often cited as evidence.  If you reference anatomy charts, you’ll see that this area of the spine has several layers of muscle.  There are deep spinal muscles, muscles along the spinal column called the erector spinae, and groups of muscles that pull the shoulder blades together (rhomboids, trapezius, etc.).  However, similar to other areas in our body, you can’t always tell what’s causing the pain by pushing.  It’s true that this type of pain really isn’t a “poking” matter.  

True muscle strains in this area are probably pretty rare.  A 2010 study entitled, “What does local tenderness say about the origin of pain?” Found that, at least in patients with neck pain, tenderness was not very helpful in determining the source of the pain.Relying on tenderness is not full-proof probably because of what’s called “referred tenderness.” You may have experienced this before, with a tingling or burning sensation in your hand that is actually sensitive if you touch it.  However, you probably figured out that the tingling and burning was not actually the skin in your hand – it was another area making your hand sensitive.  This is an action of your nervous system. Generally, when an area stimulates nerve endings in your body, your brain may get the message and then react by mobilizing the defense system so that you begin to protect that area.  It can both generate the feeling of pain AND make areas more sensitive. In a perfect world, you protect the area and Mother Nature does her work.

So what DOES cause pain in the shoulder blade area?  Above is an infographic of the referral patterns of some of the joints and discs in the neck and thoracic spine.  As you can see, all of the above structures can cause referred pain and tenderness between the shoulder blades.  While touching an area in pain can be part of coming to a diagnosis, it clearly shouldn’t be the only thing you rely on. 

There are other simple things you can do to determine if your shoulder blade pain is coming from your neck, for example.  A 2003 study found that the following two things were helpful in diagnosing a similar neck condition:

1.) the shoulder blade area is the most painful, and

2.) movements of your neck increase your shoulder blade pain.5

Remember: these tests are not enough on their own to lead you to a diagnosis.  Multiple positive tests, however, can begin to point you in the right direction. 

The best way to tell may simply be to have a thorough physical examination by a qualified healthcare provider.  If you have any questions or concerns, reach me directly below.  Let me know if this blog was helpful to you at all!

  1. Siegenthaler A, Eichenberger U, Schmidlin K, Arendt-Nielsen L, Curatolo M. What does local tenderness say about the origin of pain? An investigation of cervical zygapophysial joint pain. Anesth Analg. 2010;110(3):923-927. doi:10.1213/ANE.0b013e3181cbd8f4.
  2. Aprill C, Dwyer A, Bogduk N. Cervical zygapophyseal joint pain patterns. II: A clinical evaluation. Spine. 1990;15(6):458-461.
  3. Dreyfuss P, Tibiletti C, Dreyer SJ. Thoracic zygapophyseal joint pain patterns. A study in normal volunteers. Spine. 1994;19(7):807-811. doi:10.1097/00007632-199404000-00014.
  4. Cloward RB. Cervical diskography. A contribution to the etiology and mechanism of neck, shoulder and arm pain. Ann Surg. 1959;150:1052-1064.
  5. Wainner RS, Fritz JM, Irrgang JJ, Boninger ML, Delitto A, Allison S. Reliability and diagnostic accuracy of the clinical examination and patient self-report measures for cervical radiculopathy. Spine. 2003;28(1):52-62. doi:10.1097/01.BRS.0000038873.01855.50.

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