Experiencing urgent pain between your shoulder blades when you swallow can be an alarming sensation. This specific pain often points to issues with your esophagus or nearby structures. Some causes of this shoulder blade pain are minor. Other causes can be serious. Understanding these potential causes and knowing when to seek medical attention for your symptoms is crucial. This blog helps you understand this particular pain, its implications, and the necessary actions you should take. Do not ignore this type of shoulder pain. Understanding its source is key to managing your health.
Key Takeaways
Pain between your shoulder blades when swallowing often means a problem with your esophagus. This tube carries food to your stomach.
This pain can be a sign of common issues like acid reflux or esophageal spasms. It can also point to serious problems like esophageal tears or heart issues.
Seek urgent medical help if you have severe pain, trouble breathing, chest pain, dizziness, fever, chills, or cannot swallow. These are important warning signs.
Doctors use tests like endoscopies and manometry to find the cause of your pain. Treatment can include lifestyle changes, medicines, or surgery.
Do not ignore this type of pain. Getting a correct diagnosis and treatment is important for your health.
Connection: Swallowing and Shoulder Pain
You might wonder how swallowing can cause pain between your shoulder blades. The answer lies in how your body’s systems connect. Your esophagus, the tube that carries food from your mouth to your stomach, sits very close to many important nerves. These nerves also connect to other parts of your body, including your back and shoulders.
Esophagus Proximity to Nerves
Your esophagus and your back share nerve pathways. This is why irritation in your esophagus can lead to pain between your shoulder blades. For example, if acid reflux inflames your esophageal lining, it activates a pain response in these connected nerves. Your brain then interprets these pain signals. It thinks the pain comes from your back because of this nerve crossover. Understanding this helps explain why you might feel pain in your back when your esophagus has a problem.
Referred pain happens because nerves from your internal organs and nerves from your body’s outer parts meet at the same spot in your spinal cord. Your brain cannot tell exactly where the internal pain comes from. It thinks the pain comes from a body part it knows better. This body part shares the same nerve path. Your esophagus has nerves that send messages to your spinal cord. These nerves interact with other nerves there. This nerve crossover explains how irritation in your esophagus can show up as pain in areas like your shoulder blades. You might feel this as upper back pain or even specific shoulder pain.
Referred Pain Explained
Referred pain is when you feel pain in one part of your body, but the problem is actually in another part. This happens often with internal organs. For example, if you have a problem with your heart, you might feel pain in your left arm or jaw. If you have issues with your liver or gallbladder, you might feel pain at the right tip of your shoulder blade. Pain from your spleen or lung can cause pain in your left shoulder.
The main idea behind referred pain is called the convergent-projection theory. This theory says that nerves from your internal organs and nerves from your outer body parts meet at the same nerve cells in your spinal cord. Your brain gets these signals through shared paths. It then mistakes the internal organ pain for pain coming from the more common body parts. For instance, heart pain can go to your shoulder or arm. Gallbladder problems can cause pain in your right shoulder or shoulder blade. These areas share the same nerve segments.
Sometimes, especially with long-lasting pain, your central nervous system becomes more sensitive. This means your nerves become extra responsive. They amplify pain signals. This can make the area where you feel referred pain even larger. Also, some nerve fibers branch out. They connect to both internal organs and outer body tissues. This helps spread pain signals to many areas at the same time. This can result in pain at or beneath shoulder blade height, even when the issue is with your esophagus.
Common Causes of Urgent Pain
You experience urgent pain between your shoulder blades when you swallow. This symptom often points to issues within your digestive system. It is important to understand these conditions. This type of pain is different from pain from muscle strain. Swallowing difficulties suggest a problem beyond simple muscle fatigue. Digestive issues often cause pain after meals.
Esophageal Spasms
Esophageal spasms are sudden, strong contractions of your esophagus. These contractions are not coordinated. They can make swallowing difficult and cause significant pain. You might feel this pain in your chest or between your shoulder blades. Doctors use specific tests to diagnose these spasms. Manometry is the best diagnostic tool. It shows patterns like aperistalsis in over 30% of wet swallows. You might also see 20% simultaneous contractions. Amplitudes can be greater than 30 mm Hg in your distal esophagus. Sometimes, repetitive contractions or lower esophageal sphincter (LES) dysfunction appear. The classic definition involves more than two uncoordinated contractions during 10 consecutive wet swallows. At least one peristaltic contraction must be present. A barium swallow test also helps. It shows nonpropulsive contractions. Diffuse esophageal spasm often looks like a ‘corkscrew appearance’ due to many simultaneous contractions.
GERD and Acid Reflux
Acid reflux happens when stomach acid flows back into your esophagus. This irritates the lining. When this happens often, it becomes Gastroesophageal Reflux Disease (GERD). GERD is a very common cause of discomfort. The acid can cause a burning sensation, known as heartburn. This sensation can spread to your back. You might feel this as upper back pain or even shoulder pain. Eating certain foods or lying down after a meal can make this worse.
Esophagitis
Esophagitis means your esophagus is inflamed. Many things can cause this inflammation. Common types include acid reflux, infectious causes, or even certain medications. You might also get it from caustic ingestion, eosinophilic conditions, or chemotherapy and radiation therapy. Systemic illnesses can also lead to esophagitis. When your esophagus is inflamed, you will likely feel pain when you swallow. Other common symptoms include heartburn, difficulty swallowing (dysphagia), and nausea. You might also experience vomiting, abdominal pain, a cough, or hoarseness. Some people have anorexia and weight loss.
Hiatal Hernia
A hiatal hernia occurs when part of your stomach pushes up through your diaphragm. Your diaphragm is the muscle separating your chest and abdomen. This condition can allow stomach acid to reflux more easily into your esophagus. This causes symptoms similar to GERD. You might feel chest pain or discomfort. This discomfort can radiate to your shoulder or back. Swallowing can aggravate this sensation.
Achalasia
Achalasia is a rare disorder. It affects your esophagus’s ability to move food into your stomach. The lower esophageal sphincter (LES) does not relax properly. This makes it hard for food and liquids to pass through. You will experience trouble swallowing. You might also have chronic heartburn. This heartburn is often mistaken for GERD. It happens because food stays in your esophagus. Chest pain is another common symptom. You might also have frequent hiccupping or difficulty belching. As the condition gets worse, you might regurgitate undigested food. Doctors diagnose achalasia through a physical exam and symptom history. An esophagram test, also called a barium swallow, helps. Esophageal manometry is the gold standard diagnostic method. An upper endoscopy can also visualize your esophagus.
Foreign Body Obstruction
Sometimes, something gets stuck in your esophagus. This is a foreign body obstruction. It can cause sudden and severe pain when you swallow. In adults, the most common foreign body is a food bolus. This often consists of chicken, steak, or pork. Food stuck in your esophagus is more common in adults. In children, coins and button batteries are more frequent culprits. This obstruction can cause immediate discomfort and make swallowing impossible.
Serious Causes of Pain
Sometimes, the urgent pain you feel between your shoulder blades when swallowing points to more serious health problems. You must recognize these conditions. They require immediate medical attention.
Esophageal Tears or Tumors
An esophageal tear is a serious injury. It causes sudden, noticeable pain. This pain often appears in your chest, neck, or upper abdomen. It can feel sharp, tearing, burning, or penetrating. This pain may also refer to your shoulder. Other signs include air bubbles under your skin, difficulty swallowing, a fast heart rate, fever, low blood pressure, nausea, shortness of breath, or vomiting blood. If you suspect a rupture, seek immediate medical attention at the emergency room. Severe pain, difficulty breathing, or difficulty swallowing are emergency symptoms. Tumors in your esophagus can also cause significant pain and swallowing difficulties.
Esophageal Cancer
Esophageal cancer is another serious cause of pain. This cancer grows in your esophagus. Early diagnosis improves your outlook.
Stage | 5-Year Relative Survival Rate |
|---|---|
Localized | 49% |
Localized means the cancer grows only in your esophagus. This represents an early stage diagnosis. You should not ignore persistent swallowing pain.
Pericarditis
Pericarditis is inflammation of the sac around your heart. This sac is called the pericardium. This condition can cause sharp chest pain. You might feel this pain in your shoulder or upper back. The pain can worsen when you swallow or breathe deeply. This type of pain can sometimes be mistaken for other issues.
Heart-Related Issues (Angina)
Heart-related issues, such as angina, can also cause pain that radiates to your shoulder blades. Angina is chest pain from reduced blood flow to your heart. This pain often feels like pressure or squeezing in your chest. It can spread to your arms, neck, jaw, or back. A heart attack is a medical emergency. You must seek help immediately if you suspect a heart attack.
You can differentiate angina pain from esophageal pain. Angina often shows an atypical response to exercise. The pain might continue as a background ache. It is retrosternal pain without lateral radiation. This pain can disturb your sleep. You might also have certain esophageal symptoms. These differences help doctors diagnose the source of your pain. Do not ignore any chest pain, especially if you think it relates to your heart. These cardiac issues need prompt evaluation.
When to Seek Urgent Help
Recognizing when your symptoms require immediate medical attention is crucial. While some causes of pain between your shoulder blades when swallowing are manageable at home, others signal a medical emergency. You must know the red flag symptoms. These symptoms tell you to seek urgent care.
Red Flag Symptoms: Breathing, Chest Pain, Dizziness
Pay close attention to any breathing difficulties. These can indicate a serious problem. You need immediate medical help if you experience:
Severe, sudden breathing difficulty.
Breathing difficulty along with chest discomfort, pain, or pressure. This could be a sign of a heart issue.
Fever alongside breathing difficulty.
Shortness of breath after only slight exertion or while you are at rest.
Shortness of breath that wakes you up at night.
Tightness in your throat.
Wheezing.
Any of these breathing symptoms, especially when combined with pain, demand an urgent medical evaluation. Dizziness can also be a sign of a serious underlying condition. If you feel dizzy, especially with chest pain and shortness of breath, do not delay seeking help. These are critical symptoms.
Sudden, Severe Pain
Sudden and severe pain is always a warning sign. You should not ignore it. Medical professionals define severe pain as levels 7-10 on a pain scale.
At level 7, pain prevents sleep and makes social interactions difficult.
At level 8, pain severely impairs physical activity. It makes conversation extremely difficult.
At level 9, pain is excruciating. It prevents speaking. It may cause moaning or crying out.
At level 10, pain is unbearable. It leads to bedridden states and potential delirium.
Any sudden and severe pain anywhere in your body, especially if it is new or unexplained, needs immediate attention. This includes sudden, crushing chest pain with shortness of breath and sweating. These are classic heart attack symptoms. If you experience sudden, severe abdominal pain or pain starting halfway down your back, head to the emergency room. This type of urgent pain can indicate serious conditions like a ruptured abdominal aortic aneurysm. Do not wait if you have sudden, severe pain.
Fever or Chills
A fever, especially when combined with swallowing pain, can indicate an infection or inflammation. You need to seek immediate medical attention if your fever reaches certain temperatures.
For adults, a fever of 105°F (40.5°C) or higher warrants an emergency room visit. This is especially true if you also have difficulty swallowing. You should also seek immediate care if your fever reaches or surpasses 103°F (39.4°C) and is accompanied by severe pain, including difficulty swallowing. For children, an emergency room visit is recommended if they have a fever of 100.4°F (38°C) or higher along with difficulty swallowing. Chills often accompany a fever. They are another sign your body is fighting an infection.
Inability to Swallow
An inability to swallow liquids or solids is a serious symptom. It can lead to several immediate risks.
Aspiration pneumonia/respiratory infection: Food or liquid can enter your lungs. This causes infection. Even with texture-modified foods, the risk remains. Thickened liquids might even be more likely to be silently aspirated.
Dehydration: Not being able to drink enough leads to dehydration. This can cause kidney failure, constipation, urinary tract infections, confusion, and poor recovery from illness.
Weight loss and malnutrition: You cannot get enough food. This leads to weight loss and malnutrition.
Other signs of swallowing problems include coughing or choking during or immediately after eating or drinking. You might also have frequent respiratory infections. A color change during feeding, such as becoming blue or pale, is also a critical sign. If you cannot swallow, or if you notice these symptoms, seek urgent medical help. Your health depends on it.
Diagnosis and Treatment Options
When you experience urgent pain between your shoulder blades when swallowing, finding the right diagnosis and treatment is crucial. Doctors use several steps to understand your symptoms and help you feel better.
Medical History and Exam
Your doctor starts by asking you many questions. They want to know about your pain. They will ask, “Is swallowing painful?” You will discuss when your problem began and how it started. Your doctor will ask if your symptoms are always the same or if they come and go. They want to know if the symptom has been constant for a long time. You will also talk about triggers for your symptoms.
Did the problem start with solid food or liquids? Does the problem affect solids or liquids now? You might avoid certain foods. Your doctor will ask which foods are best or worst for you. They want to know if you can swallow solid food, like bread crust or meat. They will also ask if the problem depends on the food’s consistency. What food consistency is most difficult for you to swallow? They might ask if carbonated liquids or sorbets ease your symptoms. This detailed history helps your doctor understand your unique situation.
Diagnostic Tests
Doctors use specific tests to check your esophageal function. An upper endoscopy (EGD) is often the first step. It helps identify inflammation or blockages. A barium esophagram, also called a barium swallow, uses X-rays. It shows how liquid barium moves through your esophagus. This test checks for blockages and muscle function. Esophageal manometry is the best test for checking esophageal muscle movement. Doctors use it for suspected muscle disorders. These tests help pinpoint the cause of your pain.
Lifestyle Changes
You can make changes to your daily life to help manage your pain. If you have GERD, avoid certain foods. These include alcohol, chocolate, coffee, high-fat foods, and mint. Carbonated drinks and large meals can also cause problems. Eating late at night can make symptoms worse. Instead, eat fruits, vegetables, and whole grains. Alkaline foods like cottage cheese or yogurt can also help. Do not drink a lot of water during meals. Chew gum to make more saliva. Eat slowly and have small meals every few hours. If you smoke, quitting can reduce acid reflux risk.
Medications
Doctors often prescribe medicines to treat esophageal disorders. Antacids neutralize stomach acid. H2 blockers, like Zantac, reduce acid production. Proton pump inhibitors (PPIs), such as Prilosec, are very strong acid blockers. They stop acid release from stomach cells. Prokinetic agents help your esophagus muscles contract better. These medications can reduce your pain.
Procedures or Surgery
For severe conditions, you might need a procedure or surgery. For achalasia, a Heller myotomy cuts muscle fibers in your esophagus. This allows food to reach your stomach. Laparoscopic Heller myotomy uses small cuts for this procedure. Peroral Endoscopic Myotomy (POEM) is a newer, less invasive option. It uses an endoscope through your mouth to cut the muscle. In very rare cases, doctors might perform an esophagectomy. This removes part of your esophagus. These treatments offer relief for persistent pain.
You should never ignore urgent pain between your shoulder blades when you swallow. This pain can signal many issues, from common problems to serious conditions. Understanding the cause of your pain requires an accurate diagnosis of your symptoms. Always seek timely medical help, especially when you experience severe pain or other red flag symptoms. With proper diagnosis and treatment, you can manage many causes of this pain. This helps improve your overall well-being and relieve your pain.
FAQ
What causes pain between your shoulder blades when you swallow?
Many things can cause this pain. It often comes from your esophagus. Conditions like esophageal spasms, acid reflux, or inflammation (esophagitis) are common culprits. Sometimes, a hiatal hernia or achalasia can also cause it.
When should you seek urgent medical help for this pain?
Seek urgent help if you have severe, sudden pain. Also, look for breathing difficulty, chest pain, or dizziness. A fever, chills, or an inability to swallow anything are also red flags. Do not delay getting medical attention for these symptoms.
Can stress cause pain between your shoulder blades when you swallow?
Stress does not directly cause this pain. However, stress can worsen symptoms of existing conditions. For example, stress can make acid reflux or esophageal spasms more noticeable. Manage your stress to help reduce symptom severity.
What foods should you avoid if you have this pain?
If acid reflux is the cause, avoid trigger foods. These include alcohol, chocolate, coffee, and high-fat meals. Spicy foods, citrus, and carbonated drinks can also irritate your esophagus. Eat smaller meals and avoid eating close to bedtime.
