Pain under the shoulder blade

24 April 2022

pain under the left shoulder blade from the back

Pain under the scapula is a clinical sign of many pathological conditions, which may 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 most often associated with spasms of skeletal muscles due to tension or with a reflection of pain 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 limited by lines - in the upper part of the body between the unpaired spinous process of the most protruding VIIth cervical vertebra and the collarbones, below - 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 accompanying clinical signs, since the scapular region itself can only hurt in case of injury - a blow, a bruise.

Causes of pain under the shoulder blades can be as follows:

LSRS - scapulocostal, scapular-costal syndrome or syndrome of the muscle that lifts the scapula. If the muscle that attaches to the transverse processes of the upper vertebrae of the neck is hypothermic, injured, inflamed or overstressed, it is not able to perform its function normally - to tilt the neck and raise the scapula. Symptomatically, PRS - scapular-rib syndrome manifests itself in the form of aching, sometimes intense pain in the shoulder girdle, at the top of the shoulder blade and under it. Often the pain sensation spreads to the shoulder, the lateral part of the sternum. The most painful point is the attachment point of the muscle, if you press on it, the pain becomes acute, radiating up to the neck. In addition, a characteristic sign of LS is the sound of a crunch when moving the shoulders and arms. Dynamic constant loads, as well as static stress, can create a condition in which pain under the shoulder blade becomes constant, aggravated by exposure to cold, draft.
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. The pain is directly related to food intake, seasonality and most often radiates to the left - from the epigastrium to the left shoulder blade, to the chest and back. The pain symptom in gastric ulcer is usually divided into hungry, late or early pain. In addition, PU is usually accompanied by nausea at the peak of pain, vomiting in 75-80% of cases, and heartburn.
Vegetative or as they are often called psychosomatic pains are also included in the causes of pain under the scapula. Such sensations are similar to signs of angina pectoris, cardiological pain, as they cause a feeling of squeezing, burning in the chest, which intensifies and radiates to the arm, under the shoulder blade, under the collarbone, more often to the left, to the region of the heart. The pain symptom can be both intense and aching, indefinite in 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 unilateral dull, prolonged, aching pain, which most often begins at the back of the head and spreads down under the shoulder blade. Pain can occur in the early morning hours, intensify with static load (sedentary work), with sudden movements of the body. This condition is accompanied by radiating 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 paroxysmal, one-sided pain, encircling intense nature. The pain sensation spreads along the intercostal muscles, spaces and intensifies with deep breathing, coughing, sneezing, with prolonged physical exertion, walking. In the clinical sense, intercostal syndrome is manifested by palpation of the innervating area, which is not typical for cardiac pathologies, osteochondrosis. Due to constant muscle tension, the pain can spread lower - to the lower back, but most often manifested by stabbing sensations, burning under the shoulder blade.
An attack of angina pectoris begins with pain in the middle of the chest (retrosternal space), which quickly spread, spread to the left and give 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 pain: Severe, acute 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, aching pain may indicate an attack of angina at rest, when there are no external, provoking causes for the pain symptom.
The causes of pain under the shoulder blade can be associated with a severe, life-threatening condition - perforation of a stomach ulcer, which is accompanied by strong, sharp pains radiating under the collarbone and under one of the shoulder blades. A characteristic sign of perforation is vomiting, the patient's posture is clasped hands, knees to the stomach (fetal position). This symptom requires immediate medical attention, as well as cardialgia.
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 most often they "shoot" into the neck, under the left shoulder blade. Exacerbation of the inflammatory process often causes 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 shifts 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, since the thoracic region is quite stable in this sense. Constant, aching and growing pain in the area of infringement and the pathological focus gradually becomes intense, often similar to the symptoms of diseases of the broncho-pulmonary or cardiovascular systems. The main characteristic sign of a hernia can be muscle tension between the shoulder blades and a visible curvature of the spinal column. The diagnosis is confirmed by X-ray examinations, MRI.
GSD is a cholelithiasis, colic can also manifest itself as paroxysmal, unbearable pain, radiating to the right, under 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, the pain is localized in accordance with 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. Pain is aggravated by cough reflex, breathing.
Myositis is an inflammatory process in the muscles as a result of hypothermia, SARS, or overexertion, less often due to bruises. Pain occurs suddenly in acute course, or develops gradually, has a pulling, aching character in chronic inflammation. The pain symptom is associated with movements, physical activity, a change in posture, and inclinations.

Symptoms of pain 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 specialization has its own schemes for collecting anamnesis, examination, testing and examinations, however, there are often cases when 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 under which it occurs. In addition, chronic pain, to 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 scapula 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 scapula with static stress (sedentary work) in people over 50 years of age.
Pain that radiates under the shoulder blades, increasing at night or in a horizontal position.
Pain with fever.
Pain accompanied by numbness of the arm, shoulder.
Pain causing pressure, burning, beginning in the middle of the chest.
Pain that is not relieved by heart medications, sedatives.
Girdle pain radiating under the shoulder blade.
Sharp, severe pain with vomiting.

Symptoms of pain under the shoulder blades are most 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 aggravated by movement.
Sharp, severe pain under the shoulder blades.
Dull pain below the shoulder blades, aggravated by raising the arms.
Drawing, aching pain under the scapula, spreading down to the waist.
Pain under the left scapula 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 on.
Pain under the shoulder blade is replaced by a burning sensation, numbness of the arm.
Intense pain that goes away after vomiting.

Despite the variety of causes that provoke a pain symptom under the shoulder blades, there are differential signs - danger signals that allow an experienced doctor to exclude relatively benign diseases associated with dorsalgia. Alarming symptoms that may accompany pain in the shoulder blades are the following signs:

Hyperthermia - 38-40 degrees.
Spontaneous pain, growing 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.
Vomit.
Drop in blood pressure. pulse.
Fainting.

Back pain under shoulder blades

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

In addition, 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 - exertion or rest.
Protrusion (degeneration) of the disc of the thoracic spine without rupture.
YABZH - peptic ulcer of the stomach.
Cholecystitis.
Hepatic colic with concomitant dyskinesia of the gallbladder.
Dry pleurisy.
Pneumonia.
Inflammation of the interscapular muscles, tendons, supraspinous ligaments.

Pain under the shoulder blade on the left

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

Periodic pain under the left shoulder blade may 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 sideways - 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 pains, massaging under cardiopathy. Pain under the shoulder blade on the left, pulling, aching, often causing a feeling of fear, not stopping with nitroglycerin and other heart drugs - this is a typical sign of psychogenic conditions.
Myocardial infarction most often has clinically pronounced symptoms - burning in the middle of the chest, pain radiating to the left side of the jaw, to the arm, under the left shoulder blade, numbness of the limb, nausea.
Angina pectoris - attacks of pain can develop with tension, stress (angina pectoris) or as an exacerbation of a chronic form (rest angina pectoris).
Intercostal neuralgia is accompanied by acute pain, often girdle, radiating to the right or left under the shoulder blade. The symptom may intensify with a change in body posture, physical activity. The pain is relieved by warming up, relaxing the muscles.
Osteochondrosis, both cervical and thoracic, is also one of the reasons that provokes 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 very severe pain radiating to the collarbone area, under the shoulder blade. In addition to intense pain, the patient is characterized by a posture with 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 pain symptom that manifests itself under the right shoulder blade is associated with such diseases:

Biliary colic with spasm of the bladder, ducts due to blockage with stones. The pain is sharp, cutting, localized under the right rib and radiating 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, radiates most often to the right.
Pyelonephritis in acute form begins with pain in the lumbar region, which subsequently spreads higher and is given under the right shoulder blade. The purulent process in the right kidney is accompanied by painful urination, elevated body temperature.
Myofascial syndrome is also the cause that provokes pain under the scapula on the right. These are chronic muscle pains associated with irritation of certain trigger points.
Among the factors that provoke a pain symptom under the right shoulder blade, sometimes herpes is also found - shingles. This is a viral disease that is not considered life-threatening, but it causes very severe, excruciating pain, 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 provokes radiating pain under the shoulder blades, including the right one.
Right sided pneumonia. Pain with inflammation of the lungs most often manifests itself in the acute stage, there may be fever, a feverish state.

If the pain gives under the shoulder blade

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

Increased pressure in the intestines with inflammation, ulcerative process. The postbulbar part of the duodenum with an ulcer radiates to the right under the scapula.
Biliary colic (gall bladder, 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 radiating to the neck, left side, shoulder, under the shoulder blade.
Pneumothorax (spontaneous) - acute pain in the chest with a reflection under the scapula, in the region of the scapula.
Exacerbation of pancreatitis.
Renal colic.
Acute musculoskeletal dorsalgia.
Myocardial infarction.
Osteochondrosis of the cervical spine.

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

Pain under the shoulder blades when inhaling

A pain symptom under the scapula, aggravated by inhalation, is a signal characteristic of the following pathologies:

Dry pleurisy is an inflammatory process in the pleura, the lining of the lungs. The pain may increase with bending, movements, subside in a horizontal position or on its side. Accumulating fluid in the pleural cavity provokes swelling and pain under the scapula when inhaling.
Pericarditis is an inflammatory process in the pericardial sac, the disease is manifested by weakness, retrosternal pain, which become more intense when inhaled.
Pain under the shoulder blades with a deep breath may indicate intercostal neuralgia, which manifests itself in the form of girdle pains that seem to tighten the chest.
Diseases of the gallbladder, spasm, colic, can also be accompanied by a pain symptom associated with inhalation.
Renal colic (pyelonephritis, kidney abscess) can also be accompanied by pain in the hypochondrium, so intense that it spreads throughout the epigastric region, gives under the scapula and increases with inspiration.

Severe pain under the shoulder blade

Intense severe pain under the scapula - left or right - is a reason to seek medical help, often such a pain symptom cannot be stopped on its own, and it may also indicate life-threatening conditions. Severe pain under the shoulder blade can be triggered by such diseases:

Dagger, sharp, shooting pain, which increases during inspiration, reflected in the shoulder, may be a sign of spontaneous pneumothorax. Additional clinical symptoms of pneumothorax are rapidly developing shortness of breath, tachycardia, a drop in blood pressure, a slow pulse, an increase (compensatory) in the veins in the neck.
Severe pain, which radiates under the scapula and is accompanied by arterial hypertension, indicates an exacerbation of osteochondrosis of the thoracic spine. Simultaneous back pain under the scapula, headache and a jump 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, shoot when bending or moving, and is not stopped by heart drugs, 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 drawn up to the chest.
Hepatic (biliary) colic is also manifested by severe pain, radiating up 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, fatty foods.
A purulent process in the area between the diaphragm and the organs located below, the 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 shoulder blade. Also typical hyperthermia up to 40 degrees, fever, nausea.

A strong radiating pain symptom is not recommended to endure for more than an hour, if it cannot be stopped by available means, you need to call emergency help.

Pain behind the shoulder blades

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. Untimely determination of the cause, the factor that provokes such pain, can lead to the development of chronic, difficult-to-treat diseases.

Persistent, persistent pain between the shoulder blades, under them, is most often caused by muscle tension, which in turn is explained by professional specifics - sedentary work in the office, at a sewing machine, driving a car, and so on. Usually, back pain under the shoulder blades is not associated with life-threatening pathologies and even with dystrophic changes in the spinal column, since the thoracic region is not mobile, it is quite stable and stable. Most often, violations, changes, less often inflammation, relate to the muscular system of the interscapular region, 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 pass with active movements (exercises), massage or warming up.

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

Periodically change the position of the body, preferably every half hour. If the work is sedentary, you need to get up, walk around, make circular movements with your hands, shoulders, bring together and spread your shoulder blades.
It is advisable to spend 20-30 minutes daily for stretching exercises for the muscles of the interscapular zone, 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 zone, the collar zone.
Periodically, you can perform the following exercise: put a small (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 pain symptom from the back under the shoulder blades is accompanied by a cough, subfebrile temperature, pain increases with breathing, cough reflex, you should consult a doctor, be examined to exclude diseases of the broncho-pulmonary system.