This article is for informational purposes only and does not replace medical advice. If you have symptoms, consult a doctor.
Pain between the shoulder blades after a day at the computer, a stabbing sensation when you take a deep breath, stiffness in the middle of your back after a night on an uncomfortable pillow - thoracic spine problems are less common than lower back or neck pain, but they can be very worrying. The reason is simple: in this area, pain from the spine is easy to confuse with pain coming from the heart, lungs, aorta or digestive tract. In this article we explain the possible causes of thoracic spine pain, the symptoms that accompany it, when to call 112 immediately, how it is diagnosed and how to set up your workstation so you do not put unnecessary strain on your upper back.
How is the thoracic spine built?
The thoracic spine is the longest part of the spine - it consists of 12 vertebrae (T1-T12) located between the cervical and lumbar spine. Ribs attach to each thoracic vertebra and, together with the breastbone, form the rib cage. This makes this section more stable and less mobile than the neck or lower back, and its main role is to protect the organs of the chest and provide a stable base for shoulder and arm movements.
The thoracic region contains many structures that can be a source of pain: the joints between the vertebrae, the costovertebral joints, the paraspinal and intercostal muscles, the shoulder blade muscles (e.g. the trapezius and rhomboids), and the intercostal nerves. The heart, lungs, aorta and esophagus lie right next to it.
What causes thoracic spine pain?
For many people, pain in this area is musculoskeletal and related to strain during the day. Less often, it is caused by a specific disease of the spine or the internal organs.
The most common musculoskeletal causes
- Sitting hunched over for long periods - at a desk, laptop or phone, or behind the wheel.
- Overload - lifting, working with your arms raised overhead, a new back and shoulder workout.
- Stress and tension - raised shoulders, shallow breathing "into the upper chest".
- An uncomfortable sleeping position and an unsuitable pillow.
- Low physical activity during the week.
- Minor injuries - a sudden twist, a fall, a blow.
Spine-related causes
- Degenerative changes in the facet and costovertebral joints, more common with age.
- Osteoporotic fractures - in people with osteoporosis, a vertebra can fracture even after a minor injury, coughing or lifting something heavy.
- Spinal curvatures and increased kyphosis (a rounded back), including Scheuermann's disease in adolescents.
- A herniated disc in the thoracic spine - this is less common than in the lumbar or cervical spine.
- Inflammatory diseases of the spine, e.g. ankylosing spondylitis.
- Rarely: infections, tumors, bone metastases.
Pain "referred" from internal organs
Pain between the shoulder blades or in the middle of the back can be a symptom of conditions that have nothing to do with the spine:
| Organ | Example causes | What to pay attention to |
|---|---|---|
| Heart | Heart attack, coronary artery disease, pericarditis | Pain, pressure or burning in the chest, radiating to the arm, jaw or back; shortness of breath, sweating, nausea |
| Aorta | Aortic dissection | Sudden, tearing pain in the chest or between the shoulder blades |
| Lungs and pleura | Pulmonary embolism, pneumonia, pneumothorax, pleurisy | Pain when breathing, shortness of breath, cough, fever, coughing up blood |
| Esophagus and stomach | Reflux, peptic ulcer disease | Heartburn, pain related to meals, a burning sensation behind the breastbone |
| Gallbladder, pancreas | Gallstones, pancreatitis | Upper abdominal pain radiating to the back or right shoulder blade, nausea, vomiting |
| Nerves, skin | Shingles | Burning pain on one side, followed after a few days by blisters on the skin along the ribs |
What symptoms does thoracic spine pain cause?
Musculoskeletal pain usually:
- appears between the shoulder blades, in the middle of the back or on one side of the spine,
- can be dull and diffuse or stabbing at a single point,
- changes with movement - twisting the torso, raising the arms, taking a deep breath, changing position,
- can be reproduced by pressing on a specific spot,
- gets worse after sitting for a long time and eases after changing position or moving around.
Irritation of an intercostal nerve can cause "band-like" pain running along a rib from the back to the front of the chest. Such symptoms are always worth showing to a doctor, because pain from internal organs or shingles can look similar.
Remember: the fact that pain changes with movement does not rule out a heart or lung cause. So if you have any doubts, do not assess it yourself - contact a doctor.
When does thoracic pain require urgent care?
This is the most important part of this article.
Call 112 immediately
- pain, pressure, burning or squeezing in the chest, including when it radiates to the back, arm, neck or jaw,
- pain between the shoulder blades with shortness of breath, cold sweats, nausea, dizziness or a sense of anxiety,
- sudden, tearing pain in the chest or back, especially in someone with high blood pressure,
- sudden shortness of breath, pain when breathing, coughing up blood - especially after a long journey, surgery, immobilization or with calf swelling,
- back pain with weakness or numbness in the legs, difficulty walking, problems with urination or bowel movements,
- pain after a serious injury, e.g. a traffic accident or a fall from a height.
If you suspect a heart attack, do not drive yourself to the hospital. Call 112 and follow the dispatcher's instructions.
Urgent doctor's visit (the same or the next day)
- pain with fever, cough or a general feeling of being unwell,
- pain in someone with osteoporosis after a minor injury, coughing or lifting something heavy,
- pain in someone with a history of cancer or unexplained weight loss,
- constant pain that gets worse at night and does not depend on position,
- burning pain on one side with a rash or blisters on the skin,
- pain with heartburn, abdominal pain, nausea or a change in stool color.
It is also worth seeing your primary care doctor when the pain is not a red flag but lasts longer than a few weeks, keeps coming back, wakes you up at night or limits your daily activities.
How does a doctor diagnose thoracic spine pain?
Because the internal organs are so close, diagnosing pain in this area often starts with ruling out non-spinal causes.
- Medical history - the nature and location of the pain, its relationship to exertion, breathing, meals and position; chronic conditions, medications, heart disease risk factors.
- Examination - listening to the heart and lungs, measuring blood pressure, assessing posture, mobility of the spine and rib cage and tenderness to pressure, and a neurological examination if needed.
- ECG and blood tests - often at the start of diagnosing pain in the chest or between the shoulder blades.
- Chest or spine X-ray - to assess the lungs, bones, vertebral alignment and fractures.
- MRI or CT - with neurological symptoms, when a more serious cause is suspected or when there is no improvement.
- Bone densitometry - when osteoporosis is suspected.
- Depending on symptoms: abdominal ultrasound, gastroscopy, echocardiogram.
Treatment depends on the cause and is always determined by a doctor. For musculoskeletal problems, it often includes recommendations on activity and ergonomics, as well as physical therapy.
How should you set up your workstation to put less strain on your upper back?
Ergonomics is not a form of treatment, but a well set-up desk reduces the number of hours you spend hunched over. Check your workstation:
| Element | How to set it up |
|---|---|
| Monitor | Straight ahead, top edge roughly at eye level, at arm's length |
| Laptop | On a stand, with a separate keyboard and mouse |
| Chair | Back resting against the backrest, feet flat on the floor, knees roughly at hip level |
| Keyboard and mouse | Close to the edge of the desk, at elbow height, forearms supported |
| Documents | On a holder next to the monitor, not flat on the desk |
| Phone | Headphones for longer calls, phone held higher when browsing |
| Breaks | A short movement break every 30-60 minutes |
Everyday habits
- Change position - even the best chair cannot replace standing up and walking.
- Move regularly - walking, swimming, general fitness exercises within a pain-free range.
- Breathe calmly - at a desk it is easy to fall into shallow breathing with raised shoulders; short breaks for a few calm breaths are a good habit.
- Carry loads symmetrically - a backpack on both shoulders, groceries split between both hands.
- Choose your pillow so that your head is roughly in line with your spine.
- Take care of your bones - if you have risk factors for osteoporosis, talk to your doctor about testing.
Many people do gentle stretching exercises for the upper back as general activity, e.g. slow shoulder circles, "cat-cow" on all fours or gentle seated torso twists. Do every exercise without pain, and if you have symptoms, consult a doctor or physical therapist first. We write more about tension in the shoulder area in our articles on the trapezius muscle and tight neck muscles, and general principles regarding back pain in the article back pain - when to see a doctor.
Frequently asked questions
What can pain between the shoulder blades mean?
It is often related to overloaded muscles and joints, e.g. from sitting hunched over for long periods. However, it can be a symptom of heart, aortic, lung or digestive conditions. Pain with shortness of breath, sweating or pressure in the chest requires calling for help immediately - 112.
How can you tell spine pain from heart pain?
You should not try to do this on your own. Pain that changes with movement is more often musculoskeletal, but that does not rule out a heart cause. With chest pain, shortness of breath, sweating or nausea, call 112.
When should you see a doctor about thoracic spine pain?
Immediately with red-flag symptoms, urgently with fever, osteoporosis, night pain or a rash, and with a regular appointment when the pain lasts longer than a few weeks, keeps coming back or limits your daily activities.
Can thoracic spine pain radiate to the chest?
Yes, irritation of an intercostal nerve can cause pain running along a rib to the front of the chest. Such pain is always worth showing to a doctor, because conditions of the internal organs and shingles can look similar.
What tests are done for thoracic spine pain?
Often an ECG and blood tests, a chest or spine X-ray, and depending on symptoms an MRI, CT, bone densitometry, abdominal ultrasound or echocardiogram. The scope is determined by a doctor.
Can sitting at a computer cause pain between the shoulder blades?
Sitting hunched over for long periods is one of the common factors contributing to problems in this area. Movement breaks and a well set-up workstation help, but new or unusual pain is always worth discussing with a doctor.
Is pain in the middle of the back when breathing dangerous?
It may be musculoskeletal, but it can also be a symptom of lung and pleural conditions, such as an embolism or pneumonia. Shortness of breath, fever, coughing up blood or a sudden onset require urgent help.
Teeter equipment for movement and self-massage
The products below are not a form of treatment. They are equipment for everyday movement and accessories for self-massage, which are worth using after consulting a doctor or physical therapist if you have symptoms.
- Teeter FreeStep LT1 - a recumbent cross trainer (seated stepper) for training your arms and legs in a seated position.
- Teeter FreeStep LT3 - the same mechanism as the LT1, with a ComfortSelect seat, SoftStep pedals and SureGrip handles.
- Massage ball and self-massage stick - Teeter accessories for self-massage at home.
