Pain under the shoulder blade

24 April 2022

pain under the left shoulder blade from behind

Pain under the shoulder blade is a clinical sign of many pathological conditions, which can include gastrointestinal, cardiological, neurological diseases, as well as osteochondrosis, intervertebral hernia, bronchopulmonary pathology and others.

The pain symptom can be different in intensity and localization - under the right or left shoulder blade, and sometimes limit the motor activity of a person. Pain under the scapula is often associated with spasms of the skeletal muscles due to tension or pain reflex emanating from the internal organs located in the scapular region.

Causes of pain under the shoulder blades

Regio scapularis - this is the name of the scapular region, which is bounded by lines - in the upper part of the body between the unpaired spinous process of the most protruding VIIth cervical vertebra and the clavicles, at the bottom - a medial-vertical line along the lower edge of the shoulder blades, as well as a line from the armpits to the edge of the deltoid muscle. Diagnosis of pain under the scapula depends on the nature of the symptom, its localization and the accompanying clinical signs, since the scapular region itself can hurt only in the event of an injury - a blow, a bruise.

Causes of pain under the shoulder blades can be the following:

LSRS - scapolocostal syndrome, scapulo-costal syndrome or syndrome of the muscle that raises the shoulder blade. If the muscle that attaches to the transverse processes of the upper vertebrae of the neck is hypothermic, injured, inflamed or overloaded, it is unable to perform its function normally: tilt the neck and raise the shoulder blade. Symptomatically, PRS scapular rib syndrome manifests itself in the form of aching, sometimes intense pain in the shoulder girdle, in the upper part of the shoulder blade and below it. Often the pain sensation spreads to the shoulder, the lateral part of the breastbone. The most painful point is the attachment point of the muscle, if you press on it, the pain becomes sharp, radiating up to the neck. Also, a characteristic sign of LS is the sound of a crunch when moving the shoulders and arms. Constant dynamic loads, as well as static stress, can create a condition in which pain under the shoulder blade becomes constant, aggravated by exposure to cold, drafts.
YABZH - gastric ulcer, as the most common cause of radiating pain under the shoulder blades. The symptom begins with dull, aching pains that increase or decrease after taking medications, vomiting. Pain is directly related to food intake, seasonality and most often radiates to the left, from the epigastrium to the left shoulder blade, chest and back. The pain symptom in gastric ulcer is usually divided into hungry, late or early pain. Additionally, PU is usually accompanied by nausea at the height of pain, vomiting in 75-80% of cases, and heartburn.
Vegetative pains or as they are often called psychosomatic pains are also included among the causes of pain under the shoulder blade. Such sensations are similar to the signs of angina pectoris, cardiological pain, as they cause a squeezing, burning sensation in the chest, which intensifies and radiates to the arm, under the shoulder blade, under the collarbone, most often to the left, to the region of the heart. The pain symptom can be both intense and painful, of an indefinite nature. The main differential sign of vegetative pain is the lack of effect after taking cardio drugs: they do not relieve pain or pressure. As a rule, relaxants and sedatives help with a vegetative-vascular attack.
Osteochondrosis of the thoracic or cervical spine can cause dull, prolonged, and aching one-sided pain, most often starting in the back of the head and spreading under the shoulder blade. Pain can occur early in the morning, intensify with static load (sedentary work), with sudden movements of the body. This condition is accompanied by radiant pain in the arm, under the shoulder blade, paresthesia of the limb, dizziness, visual disturbances. The symptom is removed with warming massages, ointments, a warm bath.
Intercostal neuralgia is the most common cause of pain under the shoulder blades. The symptom develops rapidly and is expressed in one-sided paroxysmal pain, which surrounds an intense nature. The sensation of pain spreads along the intercostal muscles, sweeps and intensifies with deep breathing, coughing, sneezing, with prolonged physical exertion, walking. In a clinical sense, the intercostal syndrome is manifested by the palpation of the innervating area, which is not typical of heart pathologies, osteochondrosis. Due to constant muscle tension, the pain can spread further down, in the lower back, but most often it manifests itself with stabbing, burning sensations under the shoulder blade.
An attack of angina pectoris begins with pain in the center of the chest (retrosternal space), which quickly spreads, spreads to the left, and gives way under the collarbone, in the back, under the left shoulder blade. Pain is not always relieved by taking nitroglycerin, vasodilators, which can serve as a signal of myocardial infarction. In addition, there is a distinction between the causes of angina pectoris: a sharp and intense pain in the left side of the chest, under the shoulder blade, is characteristic of angina pectoris when a person is subjected to physical or psycho-emotional stress. Pulling and aching pain can indicate an attack of angina at rest, when there are no external causes that provoke the pain symptom.
The causes of pain under the shoulder blade may be associated with a serious and life-threatening condition - the perforation of a stomach ulcer, which is accompanied by sharp, severe pain radiating under the collarbone and under one of the shoulder blades. A characteristic sign of perforation is vomiting, the patient's posture is with folded hands, knees to the stomach (fetal position). This symptom requires immediate medical attention and heart pain.
Yuert's symptom or a sign of an inflammatory process in the pericardium, accompanied by the release of exudate. The main manifestations of exudative pericarditis are retrosternal pain, shortness of breath, high body temperature and fever. The pain intensifies due to the accumulation of effusion and stretching of the pericardium when coughing, changing the posture of the body, the sensations can be aching in nature, but very often they "shoot" in the neck, under the left shoulder blade. The exacerbation of the inflammatory process often provokes the clinical picture of "acute abdomen".
Dissection of the aorta - dissection of the wall (aneurysm) of the aorta. A life-threatening condition, accompanied by intense pain in the back, between the shoulder blades or with a shift under one of them. Most often, the pain moves to the left, radiates to the arm and under the left shoulder blade, spreading along the dissecting aorta. The most dangerous consequences of this symptom can be a stroke (if the blood flow of the carotid arteries is disturbed), a heart attack (if the blood flow of the coronary arteries is disturbed), mesenteric thrombosis, paralysis of the legs (if the blood flow of the iliac arteries is disturbed), spinal cord injury (if the blood flow of the vertebral arteries is disturbed).
Herniated disc of the thoracic spine. The disease is rarely diagnosed, as the thoracic region is quite stable in this regard. Constant, aching and growing pain in the area of the violation and the pathological focus gradually become intense, often similar to the symptoms of diseases of the broncho-pulmonary or cardiovascular system. The main characteristic sign of a hernia may be muscle tension between the shoulder blades and a visible curvature of the spine. The diagnosis is confirmed by X-ray examinations, MRI.
GSD is cholelithiasis, colic can also manifest itself as paroxysmal, unbearable pain, radiating to the right, below the shoulder blade and above.
The causes of pain under the shoulder blade can be due to respiratory diseases: pneumonia or pleurisy. With inflammation of the lungs, pain is localized according to the pathological focus in the tissue, if the process develops in the posterior sections, there is pain in the back, between the shoulder blades or under them. Inflammation of the pleura is also accompanied by stitching pains between the shoulder blades, often under one of them. The pain is aggravated by the cough reflex, by breathing.
Myositis is an inflammatory process in the muscles due to hypothermia, SARS, or overexertion, less often due to bruising. Pain occurs suddenly in acute course, or develops gradually, has a pulling and aching character in chronic inflammation. The pain symptom is associated with movement, physical activity, posture change and inclinations.

Pain symptoms under the shoulder blades

The symptoms of pain under the shoulder blades are so diverse that in clinical practice there is still no single standard algorithm for differential diagnosis. Each medical specialty has its own schemes for taking anamnesis, examination, tests and examinations, however, there are often cases where the pain symptom is "masked" and does not indicate the true cause. That is why the patient is required to describe as accurately as possible the nature of the pain, all the circumstances in which it occurs. In addition, chronic pain, which a person has "got used to", often lubricates the diagnostic picture, as a result of which time is lost and the therapeutic effect is much more difficult to achieve.

What symptoms of pain under the shoulder blade require immediate medical attention?

Drawing, constant pain in the back with irradiation under the shoulder blade, which does not subside within 2-3 days.
Pain under the shoulder blade with static stress (sedentary work) in people over the age of 50.
Pain that radiates under the shoulder blades, increasing at night or in a horizontal position.
Pain with fever.
Pain accompanied by numbness in the arm, shoulder.
Pain that causes pressure, burning, starting in the middle of the chest.
Pain that is not relieved by heart medications, sedatives.
Pain in the girdle that radiates under the shoulder blade.
Sharp and intense pain with vomiting.

Symptoms of pain under the shoulder blades are often described as follows:

Sharp pain in the middle of the back, extending under the left shoulder blade. The pain started in the morning and is made worse by movement.
Sharp and intense pain under the shoulder blades.
Dull pain under the shoulder blades, aggravated by raising the arms.
Drawing, aching pain under the shoulder blade, extending to the waist.
Pain under the left shoulder blade and a feeling of constriction in the chest.
Pain under the shoulder blades in the form of a localized area, burning.
The pain gets worse when the cough comes.
Pain under the shoulder blade is replaced by a burning sensation, numbness in the arm.
Intense pain that disappears after vomiting.

Despite the variety of causes that provoke a painful symptom under the shoulder blades, there are differential signs - warning signs that allow an experienced doctor to rule out relatively benign diseases associated with back pain. The alarming symptoms that may accompany shoulder blade pain are the following signs:

Hyperthermia - 38-40 degrees.
Spontaneous pain, increasing and provoking the state of "acute abdomen".
Shortness of breath, cyanosis of the skin.
Swelling of the hands.
Pain that does not subside at rest.
He retched.
Drop in blood pressure. wrist.
Fainting.

Back pain under the shoulder blades

Back pain in the scapular region can be associated with many diseases, but most often it is due to a deformation of the spine, especially if accompanied by a feeling of numbness in the extremities, tingling in the fingers.

Also, back pain under the shoulder blades is provoked by such diseases, conditions:

Curvature of the spine - kyphosis.
Herniated disc in the thoracic region.
Lateral curvature of the spine - kyphoscoliosis.
Coronary artery disease.
Shoulder periarthritis.
Intercostal neuralgia.
Frontal curvature of the spine - scoliosis.
Angina: effort or rest.
Protrusion (degeneration) of the thoracic spine disc without rupture.
YABZH - peptic ulcer of the stomach.
Cholecystitis.
Hepatic colic with concomitant gallbladder dyskinesia.
Dry pleurisy.
Pneumonia.
Inflammation of the interscapular muscles, tendons, supraspinal ligaments.

Pain under the shoulder blade on the left

Pain symptom under the left shoulder blade can be associated with such diseases:

Periodic pain under the left shoulder blade can signal a developing stomach ulcer. The pain increases rapidly, is accompanied by nausea and then vomiting, the symptom is associated with food intake or its absence - hungry pains. The pain begins in the epigastrium and spreads laterally - to the right or left, most often radiating under the left breast and under the left shoulder blade.
Vegetative crises are also characterized by left-sided pain, massage under heart disease. Pain under the shoulder blade on the left, traction, pain, often causing a feeling of fear, do not stop with nitroglycerin and other heart drugs - this is a typical sign of psychogenic conditions.
Myocardial infarction often has clinically pronounced symptoms: burning in the center of the chest, pain radiating to the left side of the jaw, arm, under the left shoulder blade, numbness in the limb, nausea.
Angina pectoris - Pain attacks can develop with tension, stress (angina pectoris) or as an exacerbation of a chronic form (rest angina pectoris).
Intercostal neuralgia is accompanied by acute, often cingulate pain that radiates to the right or left under the shoulder blade. The symptom can intensify with a change in body posture, physical activity. Pain is relieved by warming up, relaxing the muscles.
Osteochondrosis, both cervical and thoracic, is also one of the reasons that causes pain under the left shoulder blade. The pain symptom is accompanied by dizziness, nausea, numbness of the hands or one hand.
Ulcer perforation is an acute condition, which is expressed in a very intense pain that radiates to the area of the collarbone, under the shoulder blade. In addition to intense pain, the patient is characterized by a posture with the knees pressed to the stomach, cold sweat, cyanosis, a drop in blood pressure and a pulse.

Pain under the shoulder blade on the right

The symptom of pain occurring under the right shoulder blade is associated with such diseases:

Biliary colic with bladder spasm, ducts due to blockage with stones. The pain is sharp, cutting, localized under the right rib and radiates to the back under the shoulder blade.
Pain under the shoulder blade on the right can be triggered by a diaphragmatic abscess. The symptom is very acute, aggravated by inhalation, even not deep, more often radiates to the right.
Acute pyelonephritis begins with pain in the lower back, which subsequently spreads higher and is administered under the right shoulder blade. The purulent process in the right kidney is accompanied by painful urination, high body temperature.
Myofascial syndrome is also the cause of pain under the right shoulder blade. These are chronic muscle pains associated with the irritation of certain trigger points.
Among the factors that provoke a painful symptom under the right shoulder blade, herpes is sometimes also found - herpes zoster. This is a viral disease that is not considered to be life-threatening, but it causes very severe and excruciating pain, a burning sensation and numbness. Herpes is typical of a rash, itching, and muscle pain that radiates under the shoulder blade.
Osteochondrosis is one of the reasons that often causes radiating pain under the shoulder blades, including the right one.
Right-sided pneumonia. Pain with inflammation of the lungs is most often manifested in the acute stage, there may be fever, a febrile state.

If the pain subsides under the shoulder blade

Any pain symptom that it "transmits" is called irradiation. The impulse of visceral pain can be so intense that the irritation of the primary nerve branch is rapidly transmitted along the chain to the final branch, that is, away from the original source. Pain gives under the shoulder blade more often from the organ affected by inflammation and can be triggered by such reasons:

Increased pressure in the intestine with inflammation, ulcerative process. The postbulbar part of the duodenum with an ulcer radiates to the right under the scapula.
Biliary colic (gallbladder, liver).
Acute pain gives under the left shoulder blade and during an attack of angina pectoris, when there are sensations of pressure, compression.
Pericarditis can also present with referred pain under the shoulder blades.
Aortic dissection (aneurysm) is manifested by severe chest pain that radiates to the neck, left side, shoulder, under the shoulder blade.
Pneumothorax (spontaneous) - sharp pain in the chest with reflex under the shoulder blade, in the region of the shoulder blade.
Exacerbation of pancreatitis.
Renal colic.
Acute musculoskeletal back pain.
Heart attack.
Osteochondrosis of the cervical spine.

Referred pain can be transient, but it can also signal that an acute condition is developing that requires immediate medical attention. If the pain occurs under the shoulder blade and is not stopped by antispasmodics, heart drugs, it is necessary to consult a doctor who will conduct an examination, differential diagnosis and prescribe adequate treatment.

Pain under the shoulder blades when inhaling

A painful symptom under the shoulder blade, aggravated by inhalation, is a characteristic sign of the following pathologies:

Dry pleurisy is an inflammatory process in the pleura, the lining of the lungs. The pain can increase with bending, movement, subside in a horizontal or lateral position. The accumulation of fluid in the pleural cavity causes swelling and pain under the shoulder blade during inhalation.
Pericarditis is an inflammatory process in the pericardial sac, the disease is manifested by weakness, retrosternal pain, which becomes more intense when inhaled.
Pain under the shoulder blades with a deep breath may indicate intercostal neuralgia, which manifests itself in the form of pains in the girdle that seem to tighten the chest.
Diseases of the gallbladder, spasms, colic, can also be accompanied by a painful symptom associated with inhalation.
Renal colic (pyelonephritis, renal abscess) can also be accompanied by pain in the hypochondrium, so intense that it spreads throughout the epigastric region, gives way under the shoulder blade and increases with inspiration.

Severe pain under the shoulder blade

Intense and intense pain under the shoulder blade - left or right - is a reason for seeking medical attention, often such a painful symptom cannot be stopped on its own, and can even indicate life-threatening conditions. Severe pain under the shoulder blade can be triggered by such diseases:

Dagger, sharp, stabbing pain, which increases during inspiration, reflected in the shoulder, may be a sign of spontaneous pneumothorax. Additional clinical symptoms of pneumothorax are rapid development of shortness of breath, tachycardia, drop in blood pressure, slow pulse, (compensatory) increase in neck veins.
Severe pain, radiating under the shoulder blade and accompanied by arterial hypertension, indicates an exacerbation of osteochondrosis of the thoracic spine. Simultaneous back pain under the shoulder blade, headache and an increase in blood pressure are a clear symptom of pinched nerve endings in the cervical or thoracic region. The pain can increase when turning the body, shooting when bending or moving, and is not stopped by heart medications, sedatives.
Severe pain under the shoulder blade may be associated with perforation of the ulcer of the upper stomach. If the perforation progresses rapidly, the pain increases literally every minute, the general clinical picture of the ulcer is typical - acute pain with irradiation, vomiting, cold sweat, cyanosis of the face, characteristic posture - knees pulled to the chest.
Hepatic (biliary) colic is also manifested by severe pain, which radiates to the right, under the shoulder blade, in the neck and even in the region of the right eye. The pain symptom is associated with blockage of the bile ducts after eating fried and fatty foods.
A purulent process in the area between the diaphragm and the organs located below, subdiaphragmatic abscess is an acute condition that requires immediate medical attention. A developing bacterial infection in this form can provoke general intoxication, sepsis. In fact, this is purulent peritonitis, limited by the diaphragm, manifested by severe pain in the hypochondrium, radiating to the right - the shoulder, under the scapula. Also typical is hyperthermia up to 40 degrees, fever, nausea.

A strong symptom of radiant pain is not recommended to last for more than an hour, if it cannot be stopped by available means, it is necessary to call for help.

Pain behind the shoulder blades

The pain behind the shoulder blades, between them, as a rule, is not intense, so the person does not pay attention to the symptom, considering it temporary, transient. Premature determination of the cause, the factor that causes such pain, can lead to the development of chronic and difficult-to-treat diseases.

Persistent and persistent pain between the shoulder blades, under them, is often caused by muscle tension, which in turn is explained by professional specifics: sedentary work in the office, at the sewing machine, driving a car, and so on. Usually, back pain under the shoulder blades is not associated with life-threatening pathologies or even with dystrophic changes in the spine, since the thoracic region is not mobile, it is quite stable and stable. Most often, violations, changes, less often inflammation, refer to the muscular system of the interscapular region, the ligaments and tendons can also be stretched.

Pain of this type, associated with the muscles, is characterized by a feeling of heaviness, tension, which quickly passes with active movements (exercises), massage or warm-up.

Pain, which is caused by damage, stretching of the tendons, feels differently, causes a feeling of pain under the shoulder blades, often the pain symptom is reflected in the region of the heart. Also, a person complains of numbness in the hands, tingling sensation, "crawling goosebumps". It is not possible to neutralize such pain with heart medications, but you can get rid of it and simply do it:

Periodically change the position of the body, preferably every half hour. If the work is sedentary, you need to get up, walk, make circular movements with your hands, shoulders, join and spread your shoulder blades.
It is recommended to spend 20-30 minutes a day for stretching exercises for the muscles of the interscapular area and for the general muscle tone of the body. Regular exercise will help prevent muscle spasms and pain behind the shoulder blades.
It is necessary to periodically massage the shoulder-scapular area, the collar area.
Periodically, you can perform the following exercise: put a (tennis) ball on the floor, lie on it with your upper back and "roll" on the ball, passing it vertically and between the shoulder blades.

If a symptom of back pain under the shoulder blades is accompanied by cough, subfebrile temperature, pain increases with breathing, cough reflex, you should consult a doctor, be examined for diseases of the broncho-pulmonary system.