Pain in the upper right back is usually caused by a muscle or bone problem. However, pain in this location is sometimes caused by a condition affecting an internal organ. The body's pain network sends impulses from the source of the discomfort through nerves to the brain. Pain from an internal organ can be experienced at the source of pain or another location due to shared nerve pathways. This type of pain, known as referred pain, explains how a problem with an internal organ can lead to pain in the upper right back. Other symptoms, a physical examination, and laboratory and imaging tests can assist your doctor in determining the cause of right upper back pain.
Muscle Strain and Injury
The muscles of the neck, shoulders and back support the upper body and head, but also carry stress from worry and poor posture. These muscles can cause pain in the right upper back after injuries, such as a muscle strain or bruise from a car accident or fall. Overuse from work or recreational activities, such as painting or playing racket sports, might also be to blame -- especially for people who are right handed. Even long stretches of computer work using a mouse or track pad with the right hand can stress the muscles of the right upper back. Upper back trigger points -- irritable areas in muscles that can be felt as small knots -- can also cause pain in this area, as well as in the shoulder.
The bones of the neck and shoulders include: the vertebrae, or back bones; the clavicle, or collar bone; the scapula, or shoulder blade; the ribs; and the humerus, or upper arm. Injuries to these bones that cause bruising or fracture can lead to upper right back pain, as can arthritis in the joints between these bones. Fractures from osteoporosis and cancers that have started in or spread to these bones -- most commonly breast, lung, prostate, thyroid and kidney cancers -- can also cause pain in this area.
Right upper back pain can be due to problems affecting the lungs, particularly if the right lung is involved. Common causes include pneumonia and pleurisy, which refers to infection or inflammation of the thin layer of tissue that surrounds the lung and lines the chest cavity. Buildup of fluid around the lung, known as a pleural effusion, can also sometime provoke right upper back pain. Cancer in the lung, whether arising there or spreading from another organ, is another possibility. Sudden pain accompanied by shortness of breath might signal a blood clot in the lung, known as a pulmonary embolism.
Problems related to the gallbladder, liver, intestines, stomach, esophagus, appendix, kidney, right fallopian tube and right ovary can sometimes cause referred pain in the right upper back. Particularly with respect to diseases of the liver and gallbladder and stomach or intestinal ulcers, the referred pain to the upper back and shoulder typically results from irritation of the diaphragm -- the muscle that separates the chest and abdominal cavities. Other specific conditions affecting internal organs that can sometimes cause right upper back pain, with or without pain near the involved organ, include:
-- kidney infection and kidney stone
-- tear or constriction of the esophagus
-- ovarian cyst or twisting of the ovary
-- infection of the ovarian tubes
-- pregnancy in the ovarian tubes, known as a tubal or ectopic pregnancy
Warnings and Precautions
See your doctor as soon as possible if you experience persistent, severe or worsening right upper back pain. Seek urgent medical care if your pain is related to an injury or accident, or if it is accompanied by warning signs and symptoms, such as:
-- difficulty breathing or shortness of breath
-- sudden cough or coughing up blood
-- vomiting blood
-- difficulty swallowing or a choking sensation
Reviewed and revised by: Tina M. St. John, M.D.