Pain Between the Shoulder Blades and Neck: Common Mechanical and Referred Causes
- Jesse Anoraj
- Dec 17, 2022
- 5 min read
Updated: Dec 17, 2025
Pain Between the Shoulder Blades: Neck-Related and Myofascial Causes
Pain between the shoulder blades is commonly attributable to the neck and surrounding soft tissues rather than to the thoracic spine alone. Clinical guidelines and contemporary research emphasize that pain location does not always reflect the true source of symptoms. Structures in the cervical spine, including joints, discs, muscles, and neural tissues, can refer pain into the upper thoracic and periscapular region.
Educational Disclaimer: This article is for educational purposes only and is not intended to diagnose, treat, or replace medical care. Massage therapy is a supportive, non-invasive approach that may help manage symptoms related to musculoskeletal discomfort. If you have persistent, worsening, or unusual symptoms, or concerns about a medical condition, please consult a qualified healthcare professional.
Periscapular Pain Provoked by Neck Movement
Periscapular refers to the structures and muscles located around the shoulder blade (scapula). Pain felt between the scapulae (the periscapular or upper thoracic region) that is provoked by neck movement is a recognized pattern of referred pain originating from cervical spine structures. In mechanical neck pain and cervical spondylosis, symptoms may extend beyond the neck into the shoulder girdle and upper back, particularly when the neck is moved, loaded, or maintained in sustained postures. Because this pattern is often influenced by cervical dysfunction, learning more about neck pain care in Los Angeles may be helpful as part of a broader conservative approach.
Anatomical causes of referred pain
Evidence suggests that pain in the upper thoracic region, shoulder, or upper limb can originate from mechanical issues within the neck, especially structures stressed during cervical motion:
Cervical discs and facet (zygapophyseal) joints
Pain-mapping and clinical studies show that referred pain into the head, neck, shoulder, or upper thoracic region may originate from either the cervical discs or the facet joints. These structures share neural pathways that can cause pain to be perceived away from the actual source.
Mechanical neck pain and cervical spondylosis
Mechanical neck pain is a broad term describing symptoms related to acute overload or cumulative strain affecting cervical joints, discs, ligaments, and supporting tissues. Cervical spondylosis refers to age-related degenerative changes in these structures. Importantly, these changes are common and do not automatically explain pain, but they can contribute to symptoms when tissues become sensitized or inflamed.
When nerve involvement is present
In more specific cases, pain in the periscapular or upper arm region may involve cervical radiculopathy, where a nerve root is irritated or compressed. Radicular pain is often accompanied by arm symptoms such as numbness, tingling, or weakness, and tends to follow recognizable neurological patterns.
Why Neck Movement Reproduces Pain Between the Shoulder Blades
Neck pain is typically mechanically provoked by neck movements, sustained postures, repetitive activities, or daily tasks. The most common pain mechanism in mechanical neck pain is nociceptive, meaning pain arises from mechanical or inflammatory irritation of involved tissues.
Neck movement involves coordinated motion across the upper cervical (C0–2), mid-cervical (C2–7), and cervicothoracic (C7–T4) regions. When a sensitized disc, joint, or ligament is stressed during motion, symptoms can be reproduced locally in the neck or referred into the periscapular area. This helps explain why turning, side-bending, or holding the head in one position can aggravate pain felt between the shoulder blades.
Cervical Facet Joint–Related Pain
Facet joint irritation in the neck can produce pain in the neck, shoulder, and upper back, often accompanied by stiffness and restricted range of motion. People with facet-related pain frequently notice difficulty rotating or side-bending the head comfortably. Because cervical joints can refer pain downward, discomfort may be felt between the shoulder blades even when the primary source is higher in the neck.
Myofascial Trigger Points and Referred Pain
A myofascial trigger point is a sensitive area within muscle tissue that can produce pain locally or at a distance. In the neck and upper back, trigger points commonly refer pain into the area between the shoulder blade and the spine. Persistent pain can alter muscle coordination, leading to increased tone, guarding, and sensitivity even in the absence of structural injury.
Common muscles involved
Scalenes
Scalene trigger points can produce deep, aching, and sometimes shifting pain patterns. Symptoms may include pain in the upper chest, upper back, shoulder, arm, and the thumb side of the hand (including the thumb and index finger). Some people experience weakness or clumsiness in the hand. Pain may disrupt sleep and is sometimes relieved by assuming a more upright posture. Head rotation is often less restricted than side-bending.
Levator scapulae
Trigger points in the levator scapulae commonly cause pain where the neck and shoulder meet, with possible referral into the upper back between the shoulder blade and spine. A hallmark feature is neck stiffness, particularly difficulty turning the head toward the painful side.
Semispinalis capitis and cervicis
Trigger points in the semispinalis capitis may create a tight, band-like pain around the head, often focused at the temple or forehead over the eye. Semispinalis cervicis trigger points typically cause pain at the base of the skull and into the neck, making both looking down and looking up uncomfortable.
The Pain–Tension Cycle
Pain often leads to protective muscle tension. As muscles tighten, pain sensitivity increases, which in turn leads to more guarding creating a self-perpetuating pain–tension cycle. Addressing pain sensitivity and contributing mechanical factors early can help prevent the spread of symptoms to other muscles and soft tissues.
How Neuromuscular Therapy May Help
Neuromuscular Therapy can play a supportive role in managing neck-related and myofascial pain by addressing muscle tone, trigger point sensitivity, and movement tolerance. While manual therapy does not treat nerve compression directly, conservative, noninvasive approaches are widely recommended as first-line care for mechanical neck pain. Specialized, targeted massage therapy may help reduce discomfort, improve movement confidence, and support daily function as part of a broader care plan.
When to Seek Medical Evaluation
Most pain between the shoulder blades is musculoskeletal in origin. However, you should seek medical evaluation if pain is severe, unusual, progressively worsening, or persistent, or if it is accompanied by symptoms such as numbness, tingling, weakness in the arm or hand, changes in coordination, unexplained weight loss, fever, or unrelenting pain. Appropriate screening helps ensure safe and effective care.
About the Author
Jesse Anoraj is a Certified Massage Therapist and Neuromuscular Therapist, and a Certified Member in good standing of the Associated Bodywork & Massage Professionals (ABMP) since 2018. He owns and operates Artisan Neuromuscular & Sports Massage Therapy, a local Los Angeles massage studio specializing in therapeutic and sports massage for pain and stress management. His work emphasizes evidence-informed soft-tissue techniques, assisted stretch therapy, and collaboration with other healthcare providers when appropriate.
References
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Kjaer P, Kongsted A, Hartvigsen J, et al.National clinical guidelines for non-surgical treatment of patients with recent onset neck pain or cervical radiculopathy.The Spine Journal. 2017;17(9):1347–1362.https://www.thespinejournalonline.com/article/S1529-9430(17)30918-X/abstract
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