Pain in your middle back (thoracic spine) is quite common. It is not quite well reported in journals and unfortunately so doesn’t get the attention like neck and back pain do. The area of the upper back (spine) between the two shoulder blades is called the thoracic spine. The shoulder blades are called scapula and pain between the shoulder blades is called interscapular pain.

Symptoms
There are many times a person will come into see a chiropractor for treatment because of this pain in-between the shoulder blades and spine that they cannot get rid of. These are some of the symptoms of what I might hear people complain about:

• It’s sore to take a deep breath,
• I need to push my shoulder into the corner of the wall to get some relief,
• It feels like stabbing with a knife,
• The pain is a deep ache,
• It’s sore to put my chin to my chest,
• It hurts to try stretch the muscles between my shoulder blades,
• I want to twist my shoulders to try get a click in my back for some relief,
• I have a right or left shoulder blade pain just on the inside of the shoulder blade,
• It feels like I have a muscle knot stuck underneath my shoulder blade.

Rib Dysfunction
Does it feel like you got a rib out? You have twelve ribs on the left and right side of your thoracic spine. The ribs move like a bucket handle, going up and down with breathing in and out. There are times movement of the rib head on the vertebral body can cause pain. The 3rd and 4th ribs are the most tender to touch.
Muscle Trigger Point
A trigger point is basically a muscle knot. A common problem in these thoracic muscle trigger points is one of the upper back muscles, especially the levator scapulae. This is the time when you want people to rub your shoulders or you try to get something hard like a golf ball or tennis ball to push into your back. Trigger points can cause referred pain away from where the muscleknot is found.
Thoracic Dysfunction
The spinal joints (facets) can, like the ribs, move abnormally causing a pain in the middle of the spine. Maybe you have heard your chiropractor mention a condition called, T4 syndrome. I find that a lot of people have tenderness over the T4-5-6 vertebrae region. I think this is because of our seated posture when we tend to slump our shoulders through this area. This in turn over time will cause stiffness to move and tenderness to touch.
Nerve Pain
Got a trapped nerve in neck pain? Mechanical neck pain can also be a cause of pain near the shoulder blade and top of the shoulders. A cervical spinal nerve refers pain away from the neck commonly down the inside of the shoulder blade and outer arm. So your pain could be coming from your neck where there is a pinched nerve condition.