What’s Causing My Upper Back Pain?

That uncomfortable tightness and ache between your shoulder blades just won’t seem to go away. While occasional upper back pain often resolves on its own, chronic or worsening discomfort can signal a more serious problem. If you’re wondering what your upper back pain may be a symptom of, read on to learn about some possible causes.

Muscle Strain

One of the most common sources of upper back pain is muscular strain, especially involving the trapezius muscles. These large, triangular muscles running from the base of your neck out to your shoulders can grow tight and painful from poor posture, overuse, repetitive motions, and tension. Prolonged hunching over devices, stressful work conditions, and sedentary lifestyles make muscle strain a frequent culprit.

Degenerative Disc Disease

The discs that cushion the vertebrae in your spine naturally lose elasticity and wear down over time, resulting in degenerative disc disease. As discs deteriorate, inflammation and mechanical stress on the spinal nerves can occur, causing localized back pain. Degenerative changes are most common in the neck and upper back.


Osteoarthritis of the upper spine can pinch nerves and cause inflammatory pain between the shoulder blades. Rheumatoid arthritis, an autoimmune disorder affecting joints throughout the body, may also prompt upper back discomfort. Middle aged and older adults are more prone to arthritic back pain.

Spine Curvature Disorders

Excessive curvature of the upper spine due to conditions like scoliosis, kyphosis (hunchback), or lordosis (sway back) alters normal posture and mechanics, leading to backache. The abnormal pressure and rotation can irritate joint, discs, nerves, and muscles.

Myofascial Pain Syndrome

Myofascial pain syndrome occurs when knotted trigger points form in the fascia, the connective tissue surrounding muscles. These trigger points commonly affect the upper back area, causing localized pain that may spread or radiate. Poor posture and injury often contribute.

Bone Fractures

Traumatic fractures of the vertebrae or ribs due to accidents, falls, or even severe coughing can produce acute upper back pain. Compression fractures of the spine are also common in those with osteoporosis.

Spinal Stenosis

Narrowing of the spinal canal in the neck and upper back, termed cervical or thoracic spinal stenosis, puts pressure on the spinal cord and nerves. This can cause painful cramping, numbness, or tingling through the shoulders, arms, and hands.

Heart Disorders

Cardiac conditions like pericarditis, angina, and even heart attacks sometimes produce referred pain that localizes between the shoulder blades. Upper back pain that occurs with exertion or spreads to the arms and neck warrants prompt medical attention.


Inflammation of the pancreas, often due to gallstones or excessive alcohol use, may create pain that radiates to the upper back. The pain may worsen after eating and be associated with nausea and fever.

Lung Conditions

Certain lung diseases, including pneumonia, pleurisy, and lung cancer, can sometimes manifest as shoulder blade pain. This occurs as inflammation spreads to the tissues and nerves of the upper back. Shortness of breath accompanies the pain.


The viral infection shingles often affects the nerves of the upper back and presents with a painful rash. The rash usually localizes to one side and may itch or tingle before becoming sore. Upper back pain precedes the rash by a few days.

Stress and Tension

Chronic stress commonly manifests with neck, shoulder, and upper back tightness and discomfort. The muscles tense up in response to mental strain and anxiety. Poor posture from sitting hunched over while stressed can worsen pain.

Kidney Issues

Kidney infections, kidney stones, and even kidney cancer sometimes cause upper back pain as inflammation spreads. The pain typically occurs on one side and may radiate into the abdomen or groin.

Gallbladder Disease

Biliary colic, or gallbladder pain from gallstones or inflammation, may radiate through the upper right back. The pain occurs in episodes and is often positional, worsening when lying down.

While many conditions can cause upper back pain, the majority of cases have a benign, muscular source. Simple stretching, posture correction, and OTC pain medication can usually provide relief. However, seek medical guidance for pain that worsens, spreads, or is accompanied by other concerning symptoms. Getting to the root cause is key to finding the right treatment.