Thoracic back pain is pain in the mid-back, between the shoulder blades and around the rib cage. Once organ causes are ruled out, it usually comes from one of three places. These are the joints where the ribs meet the spine, the thoracic facet joints (small joints at the back of the mid-spine), or pain sent down from the neck.
Mid-back pain is less common than neck or low back pain. That is exactly why it is so often handled badly.
What it is
The rib cage braces the thoracic spine, so it moves less and degenerates (breaks down) less. When it hurts, the usual sources are the costovertebral joints where ribs meet the spine, the thoracic facet joints, or pain sent from the neck.
It is also where pain from internal organs shows up. So a proper exam rules that out first.
How it usually presents
- Aching between the shoulder blades.
- Pain on deep breathing or twisting.
- A band of pain wrapping around the rib cage.
- Worse after long hours at a desk.
How we treat it
- Rule out causes outside the spine first.
- Thoracic facet injection or costovertebral joint injection.
- Trigger point injection for the muscle part.
- Physical therapy to help the mid-back move.
To get checked, call us or request an appointment.
What usually gets missed
The key step is ruling out causes outside the spine first. The thoracic spine sends pain to, and gets pain from, the heart, lungs, aorta, gallbladder and pancreas. New mid-back pain in an older patient calls for that check before any muscle or joint diagnosis.
Once that is done, the costovertebral joints (where each rib meets the spine) are the most often missed muscle and joint source. They are rarely examined.
What to expect over time
Mechanical thoracic pain (pain from how the parts move) usually responds well to mobility work, because the region stiffens more than it degenerates, and stiffness can be undone.
Thoracic compression fractures act differently and need to be spotted. Look for sudden pain in one spot, much worse standing and better lying flat, in someone with thin bones.
When this becomes urgent
New mid-back pain in an older adult, or in anyone with a past cancer, needs investigation (testing). Tearing chest or back pain that starts suddenly is a vascular emergency. Mid-back pain with fever, weight loss, or any leg weakness or bladder change needs urgent assessment.
Why it happens
The mid-back moves the least of any part of the spine, because the ribs brace it. That makes mechanical pain there less common than in the neck or low back. Most of what does happen comes from the costovertebral and facet joints, from myofascial (muscle) sources across the shoulder blades, or from long hours at a desk.
What it gets confused with
Because it is less common, thoracic pain deserves investigation a bit sooner than low back pain. Some pain does not change with position, comes at night, or comes with whole-body symptoms. That pain needs a check for vertebral compression fracture, infection, cancer and pain sent from visceral organs (the organs inside the chest and belly). Only then should it be treated as mechanical.
What we measure
What you can do, not a number: distance walked, hours slept, tasks taken back up, medication needed. We record those at the start and compare them after. The reason is that a treatment that moves a pain score for a while but changes nothing you can do has not done much. It is also how we decide whether to continue, change or stop.
Common questions
Why is mid-back pain less common?
The rib cage splints the thoracic spine. So it takes less load than the more mobile parts above and below.
Why is mid-back pain taken more seriously?
Because mechanical causes are less common there. So other causes make up a larger share, and they are worth ruling out early.
Can this come from my desk setup?
Often, yes. Steady strain across the shoulder blades is one of the most common causes. Screen height is usually the thing that matters.
Sources
- Johansson MS et al. Incidence and prognosis of mid-back pain in the general population: A systematic review. European journal of pain (London, England), 2017. PubMed 27146481
- Reffat N et al. Advances in radiofrequency ablation for thoracic spine pain. Annals of palliative medicine, 2024. PubMed 39308163
- Expert Panel on Thoracic Imaging et al. ACR Appropriateness Criteria® Nontraumatic Chest Wall Pain. Journal of the American College of Radiology : JACR, 2021. PubMed 34794596
Hurt in an accident? Start here.
You do not need a lawyer, a police report or a referral to be seen. Bring your symptoms and we will work out the rest.
Monday–Friday, 8:00 a.m. – 4:00 p.m. Same-day appointments are often available for new accident and injury patients.