Pain in and below the shoulder blade may be related to nerve damage, spinal disease, shoulder girdle disease, or a medical condition. The etiology can be determined by clinical signs, conditions presenting with the syndrome, and medical history data.
Pain in the shoulder blade area can be felt on inhalation, and can be felt on half of the body and/or the entire arm. In some cases, these symptoms are the "first bells" of an exacerbation period and can be prevented when the precipitating factor is identified.
reason and location
Pain under the shoulder blade usually occurs during movement -- it's preceded by an awkward turn, standing for long periods of time and flexing the back. It indicates localized damage due to various reasons.
Pathology with unilateral lesions in which pain is only on the right or left side under the scapula, rarely - usually the severity of symptoms is individual. This is due to the symmetrical arrangement of nerve roots extending from the spinal cord.
If it hurts under the left and right shoulder blades, it may be the result of damage to the skeletal and muscular framework. Symptoms are not strictly localized, and severity depends on traumatic factors. Clinics are usually acute, starting abruptly and acquiring a chronic course.
The causes of traumatic pain under the left and right shoulder blades are as follows:
- Bruising - In this case, the pain is superficial and most commonly the muscle is damaged. Often there is pain, swelling, and local inflammation in the back muscles just below and below the shoulder blades. Symptoms disappear after 2-3 weeks.
- Cracks and fractures are more serious injuries, and the pain is concentrated in the shoulder blade itself. In the slightest movement, it intensifies and the patient cannot move his arms or bend over.
- Subluxation and displacement of the vertebrae - This causes pain in the shoulder blade and the joints below it, and sometimes the bone structure compresses the nerve roots.
The injury is characterized by severe pain under the right or left shoulder blade that occurs spontaneously. During exercise, tightening may occur, and swelling is often present.
If the disease affects the thoracic spine, patients may experience back pain near and below the shoulder blades. This is caused by compression of the nerve or spinal cord due to deformation of the joint disc. The pathology develops gradually, with the decrease of the intervertebral distance, the pathology clinic is aggravated.
The localization of pain depends on the affected area:
- If osteochondrosis destroys the joint discs in the thoracic region from 2 to 6, the scapula can be painful. It usually radiates to the neck and arms. When blood vessels are pinched, dizziness can occur, and intracranial pressure may increase.
- When joints 6-12 are involved, pain radiates from under the left or right scapula and down the corresponding half of the body and lower back.
The spinal roots in the thoracic region generate nerve plexuses that innervate the arms and trunk. Therefore, when they are squeezed, the pain travels along their route.
With osteochondrosis, the discomfort is one-sided -- pain can be felt on the right or left and under the shoulder blade, depending on the inclination of the spine.
This is a lateral curvature of the spine due to excessive tension in the muscles that support the posture. This can cause pinching of the roots and spinal cord, and pain under the right or left shoulder blade. Pathology is often accompanied by:
- Respiratory Failure - Unilateral deflection of the spine deforms the chest, which affects the function of the lungs, with one being compressed and the second taking over the lost function.
- Violation of the work of the heart - changes in systolic frequency and pulse, shortness of breath and pale skin appear.
- The appearance of significant deformation of the chest is the main cause of pain under the left and right shoulder blades. The vertebrae are displaced laterally along with the ribs, and as a result, on the curved side, the bony structures are displaced downward and damage the spinal cord and its branches.
If the spinal cord is compressed during scoliosis, the back is often painful between and below the shoulder blades, and focus is severely limited. If muscle spasms join in, symptoms can spread to adjacent structures.
It is characterized by backward curvature of the spine, forward displacement of the shoulder girdle, and a gradual hunchback. Pain in the shoulder blades - usually bilateral and can occur in the arms and neck. Its formation involves the following mechanisms:
- Neurogenic - The distance between the anterior vertebral bodies is reduced due to curvature, which causes pinching of the spinal cord branches. There is soreness in the left and right shoulder blades that can radiate to the collarbone, neck and shoulders.
- Muscles - The deflection of the spine causes overstraining of the muscles in the collar area, which can spasm painfully in the shoulder blades and the area below.
Due to the kyphosis, the vertebral artery is compressed and the cerebral circulation is disturbed. The work of the internal organs gradually deteriorated.
If the right or left scapula is injured, one of the causes may be spondyloarthropathy - damage to the facet joints and discs. It is accompanied by loss of mobility and stiffness, most noticeable in the morning.
The clinical situation varies with pathological progression: >
- Cartilage Destruction - Insufficient blood circulation, the integrity of connective tissue is compromised, joint discs become brittle, more damaged, and slower to recover. During this phase, intense physical exertion results in minimally invasive, pain that radiates to the scapula and the area below.
- Deformation of the articular disc - presence of seals that impede movement. This triggers new damage, which slows down the regeneration process, and patients experience back and shoulder blade pain.
- The appearance of skeletal growth is characteristic of advanced stages of the disease. Tumors can damage joints, muscles, blood vessels, and nerves.
With spondyloarthropathies, the back may be injured between or below the shoulder blades -- usually with physical activity before the attack. With rest, symptoms subside because bone growth does not harm surrounding tissue.
Protrusions and Hernias
In these cases, acute pain under the left and right shoulder blades due to compression of the spinal cord or its roots is worrying. Due to the pinching, the sensitivity of the nerve fibers is disturbed.
Symptoms are located as follows:
- Pain in the scapula and above - herniation or hernia in the cervicothoracic region or when 1-3 thoracic segments are affected. Symptoms worsen when you try to tilt your head, turning it to one side.
- Pain in the interscapular region - in this case, the middle part may be affected, from 3 to 6. The discomfort increases when you move your hands to the side, take a deep breath, or turn around.
- Severe pain under left and right scapula - articular discs affected from 6 to 12, pathology may be involved in the lower back. In this case, there is a risk of developing a hernia because this part of the spine is loaded more than before.
Unlike spondyloarthropathy, hernia and protrusion pain does not go away long with rest. This is due to the constant pressure on the nerves, which is exacerbated by muscle spasms.
This is a squeeze on the lumbar roots, which gather in the powerful sciatic nerve. If its upper part is involved, the patient experiences pain under and below the scapula, which is bilateral and aggravated by flexion and sudden movement.
Additional symptoms may develop as the condition progresses: >
- There is back pain radiating to the lower extremities - a sharp tingling that feels like an electric shock as it runs along the nerve.
- Burning pain in the back, lumbar region, or under the shoulder blades indicates that the vertebral roots in the lumbar region have been compressed for a long time.
- Spasticity and loss of sensation usually occur in the lower back, buttocks, and sometimes numbness along nerve fibers in the thighs, calves, and feet.
periarticular disease of the scapula
This condition is understood as inflammation of the shoulder joint and surrounding tissues, with stiffness that disappears only after warming up.
Depending on the development of motor skills in the cerebral hemisphere (right or left hand), pain is concentrated on the right or left shoulder blade and the area below it. First, it appears after exercise, then at rest. During this process, other symptoms develop:
- numbness of hands;
- Violation of the mobility of the spine.
With periarticular disease of the scapula, the clinical manifestations increase when the arm is raised - it is pain in the right or left shoulder, scapula area. Gradually, the range of motion decreases and stiffness increases.
The next cause of pain under the right or left shoulder blade is inflammation of the nerves in this area. The disease is caused by hypothermia, drinking water. Most commonly affected:
- Suprascapular and Supraspinous Nerves - Pain from the right or left scapula of the back, mainly in the collarbone. Sometimes the discomfort spreads to the shoulder, which indicates a failure of branching of the skin in this area.
- Subscapular nerve and infraspinatus nerve - In this case, it is injured on the right or left side under the scapula, depending on the side of the lesion. If the muscle of the same name is involved, the clinical manifestations are aggravated when the arm is moved down and abducted.
- Intercostal nerves - usually 1-4 pairs. These branches run along the lower edge of the ribs, and pain occurs not only on the shoulder blades and the area below, but also on the sides of the chest and sometimes in the front.
Symmetry is not typical for neuralgia—if the left half of the body is exposed to airflow, pain in the neck, chest, and shoulder blade will be noted from that side.
Branches of the parasympathetic trunk, which are connected to the spinal cord and its roots, reach the heart. This is why heart disease can cause pain in and below the shoulder blade. Usually mild myocardial infarction is latent. It may be accompanied by the following symptoms:
- A dull pain or burning pain behind the breastbone or under the left shoulder blade - can last for hours, get worse with walking, but go away a little with rest.
- Shortness of breath - accompanied by soreness, which can manifest over several days.
- Tachycardia - an increased heart rate and sometimes a rhythm disorder.
- Other symptoms include increased stress, dizziness, nausea and vomiting.
Similar to the previous mechanism, pain travels along nerve fibers. Clinical symptoms can be bilateral, but in most cases there is a pattern of symptoms based on the location of the internal organs.
Left shoulder blade pain from behind occurs in the following disorders:
- Stomach ulcer.
Often, patients with these conditions complain of indigestion, nausea, and vomiting. If internal bleeding occurs, symptoms such as pale skin, darkened stools, decreased pressure, and weakness can occur.
Pain from behind from behind under right scapula accompanied by:
- cirrhosis of the liver;
- Duodenal ulcerative lesions.
In addition to these factors, pain under the shoulder blade can also cause:
- Uncomfortable mattress - If it fails and you sleep on your right side, you may feel pain from behind under your left shoulder blade in the morning as the curved spine squeezes the base of the spine.
- Pleurisy - Pain in the shoulder blade area due to sheets rubbing against each other when breathing, peaking with deep breathing.
- Polio - pathology with neurological symptoms, often back pain.
- Poisoning - Severe poisoning or a cold can manifest as muscle aches, chills, and fever.
- VVD - Phytovascular dystonia is accompanied by changes in pressure, interruption of the work of the heart and shortness of breath, sometimes with back discomfort.
- Kidney disease - This type of disease is characterized by pain or tingling under the right shoulder blade, changes in diuresis and urine color, and general symptoms.
- Subphrenic abscess - If suppuration is found in the upper abdominal cavity, pain under the shoulder blade, fever and symptoms of poisoning may be felt when inhaled.
- Mental disorders - In some cases, pain in and below the shoulder blade can be a result of this disorder. The exact mechanism of occurrence has not been studied.
nature of pain
Soreness in the scapula and the area below can vary, and by its nature, a specific set of pathologies can be assumed and a provocative factor can sometimes be established:
- For compressed nerves, low back pain is characteristic - a sharp stabbing pain that occurs with a sharp turn of the body, raising the arm. This is the main difference from cholelithiasis, the symptoms of which are not curling with exercise.
- Pain, throbbing, or burning pain indicates a disease in an internal organ. The latter option occurs when squeezing the root of the spinal cord, but it increases with movement and may become a suture.
- Severe constricting pain in the shoulder blade and the area below is characteristic of a hernia. Sometimes there is low back pain and numbness in the limbs.
- Cutting pain of varying intensity is characteristic of neuralgia, and drilling is often accompanied by joint inflammation.
Which doctor treats shoulder blade pain?
If you experience pain in and below your shoulder blade, you will need to make an appointment with a neurologist. If there is no nerve compression, the specialist will refer you to the consultation of an orthopedist, cardiologist, gastroenterologist or urologist depending on the suspected condition
Laboratory and instrumental tests were performed to determine the cause of discomfort in the scapula and the area below:
- X-ray or CT - Using these methods, you can detect osteochondrosis, spinal curvature and the aftermath of injury.
- NMR >- Examination of spine, shoulder joints or internal organs based on suspected pathology.
- Electrocardiogram - Helps identify heart disease.
- Blood and urine tests can provide some information on somatic pathology, muscle and joint inflammation.
- Ultrasound - for medical conditions if MRI is not available.
Usually, pain under the shoulder blade is caused by the nervous system. Therefore, CT and MRI are considered the "gold standard" in diagnostic protocols.
General principles of treatment
The main task is to eliminate symptoms and predisposing factors. First, stabilize the patient's health and then treat the underlying pathology.
The treatment plan includes:
- Medications - Pain relievers are often used to relieve pain and inflammation. Funds are then prescribed based on the underlying disease - antibiotics, gastroprotectives, diuretics.
- Physiotherapy - Strengthens the spine, treats physical ailments. Medicinal electrophoresis is used in the field of scapula, warming procedures, SWT.
- Massage - The warm-up is performed with spinal damage. With this procedure, the muscles above and below the scapula relax and posture improves. In this case, you need professional help from a chiropractor or osteopath.
- Gymnastics - performed after pain relief, programmed according to the ailments suffered by physiotherapists, rehabilitation specialists.
Following successful treatment, patients are advised to follow a prophylactic regimen to prevent recurrence of the pathology:
- pay attention to your posture;
- Choose mattresses and orthopedic pillows with moderate firmness;
- Twice a week, massage the shoulder blades and the area below;
- Follow a low-calorie diet to treat obesity;
- Get rid of bad habits;
- Prophylaxis of somatic pathology (if it is present in past medical history);
- See your doctor every six months.
Pain in and below the shoulder blade may be neuropathic or somatic in nature. When nerves are damaged, symptoms are acute and sudden, appearing spontaneously.
Visceral and joint lesions are characterized by gradual and prolonged pain, always clinically accompanied by additional symptoms. In the initial phase, analgesics are prescribed, and after diagnosis, the regimen is supplemented with etiological treatment and intensive procedures.