Pain under the shoulder blade

24 April 2022

Pain under the scapula 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 location - under the right or left shoulder blade and sometimes it limits a person's motor activity. Pain under the scapula is most often associated with spasms of the skeletal muscles due to tension or a reflex of pain coming 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 cervical vertebra of the VII and the clavicles, below - a mid-vertical line along the edge underside of the shoulder blades, as well as a line from the armpits to the edge of the deltoid muscle. The diagnosis of pain under the scapula depends on the nature of the symptom, its location and the 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 syndrome, scapulocostal syndrome or muscle that lifts the scapula syndrome. If the muscle that attaches to the transverse processes of the upper vertebrae of the neck is hypothermic, injured, inflamed, or overworked, it will not be able to perform its normal function - tilt the neck and elevate the scapula. Symptomatically, PRS - scapular rib syndrome manifests itself in the form of pain, sometimes intense, in the shoulder girdle, in the upper part of the shoulder blade and under it. Often the sensation of pain spreads to the shoulder, the side of the sternum. The most painful point is the muscle attachment point, if you press, the pain becomes sharp, radiating to the neck. In addition, a characteristic sign of the LS is the crunching sound when moving the shoulders and arms. Dynamic constant loads as well as static stress can create a condition in which the pain under the shoulder blade becomes constant, exacerbated by exposure to cold.
YABZH - gastric ulcer, as the most common cause of radiating pain under the shoulder blades. The symptom starts with dull, aching pains that increase or decrease after taking medication, vomiting. 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 symptom of pain in gastric ulcer is usually divided into hunger, 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 pains or as they are often called psychosomatic are also included in the causes of pain under the scapula. Such sensations are similar to the signs of angina pectoris, cardiac pain, as they cause a sensation of tightness, 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 intense and painful, of an undefined nature. The main distinguishing sign of vegetative pain is the lack of effect after taking cardio medications - 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 painful one-sided pain that usually starts at the back of the head and spreads under the shoulder blade. Pain can occur in the early hours of the morning, intensify with static load (sedentary work), with sudden body movements. 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 heating massages, ointments, hot bath.
Intercostal neuralgia is the most common cause of pain under the shoulder blades. The symptom develops rapidly and is expressed as paroxysmal, unilateral pain involving an intense nature. The sensation of pain spreads along the intercostal muscles, spaces and intensifies with deep breathing, coughing, sneezing, with prolonged physical exertion, walking. In the clinical sense, the intercostal syndrome is manifested by palpation of the area of innervation, which is not typical of cardiac pathologies, osteochondrosis. Due to constant muscle tension, the pain can spread downwards - to the lower back, but most often it manifests itself as stabbing, burning sensations under the shoulder blade.
An attack of angina pectoris starts with pain in the middle of the chest (retrosternal space), which spreads rapidly, spreads to the left and goes under the collarbone, in the back, under the left shoulder blade. Pain is not always relieved with the administration of nitroglycerin, a vasodilator, which can serve as a sign of myocardial infarction. In addition, there is a distinction between the causes of angina pectoris: severe, sharp 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 can indicate an angina attack at rest, when there are no external causes triggering for the pain symptom.
The causes of pain under the shoulder blade can be associated with a serious and life-threatening condition - perforation of a stomach ulcer, which is accompanied by sharp, sharp pains that radiate under the collarbone and under one of the shoulder blades. A characteristic sign of perforation is vomiting, the patient's posture is folded hands, knees to the stomach (fetal position). This symptom requires immediate medical attention, as well as cardialgia.
Yuert's symptom or sign of an inflammatory process in the pericardium, accompanied by the release of exudate. The main manifestations of exudative pericarditis are retrosternal pain, dyspnea, elevated 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 painful in nature, but most often they "shoot" in the neck, under the left shoulder blade. The exacerbation of the inflammatory process often causes the clinical picture of "acute abdomen".
Aortic dissection - dissection of the wall (aneurysm) of the aorta. A life-threatening condition accompanied by severe 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 dissected 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 blood flow to the vertebral arteries is disturbed).
Disc herniation of the thoracic spine. The disease is rarely diagnosed, as the thoracic region is quite stable in this regard. Constant, painful and increasing pain in the area of violation and the pathological focus gradually becomes intense, often similar to the symptoms of diseases of the bronchopulmonary or cardiovascular systems. The main characteristic sign of a hernia can be muscle tension between the shoulder blades and a visible curvature of the spine. The diagnosis is confirmed by X-rays, MRI scans.
GSD is a cholelithiasis, colic can also manifest as paroxysmal, unbearable pain radiating to the right, under the shoulder blade and above.
The causes of pain under the shoulder blade can be caused by 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, then there is pain in the back, between the shoulder blades or under them. Inflammation of the pleura is also accompanied by stabbing pains between the shoulder blades, often under one of them. The pain is aggravated by the cough reflex, breathing.
Myositis is an inflammatory process in the muscles as a result of hypothermia, SARS or overexertion, less often due to bruising. Pain occurs suddenly in the acute course, or develops gradually, has a pulling and aching character in chronic inflammation. The pain symptom is associated with movements, physical activity, changes in posture and bending.

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 the differential diagnosis. Each medical specialization has its own schedules for collecting anamnesis, examination, examinations and examinations, however, there are often cases in which the pain symptom is "masked" and does not indicate the true cause. That is why the patient must describe as accurately as possible the nature of the pain, all the circumstances in which it occurs. In addition, chronic pain, to which a person "has gotten 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 back pain radiating under the shoulder blade, which does not go away within 2-3 days.
Pain under the scapula with static stress (sedentary work) in people over 50 years of age.
Pain radiating 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, starting in the middle of the chest.
Pain that is not relieved by heart medications, sedatives.
Waist pain radiating under the shoulder blade.
Sharp, intense 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 and severe pain under the shoulder blades.
Dull pain below the shoulder blades, aggravated by lifting the arms.
Drawing, aching pain under the scapula, spreading 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, burning area.
The pain gets worse when the cough comes on.
Pain under the shoulder blade is replaced by a burning sensation, numbness of the arm.
Severe pain that disappears after vomiting.

Despite the variety of causes that provoke a symptom of pain under the shoulder blades, there are differential signs - danger signs that allow an experienced doctor to exclude relatively benign conditions associated with back pain. The alarming symptoms that can accompany shoulder blade pain 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 go away at rest.
To vomit.
Blood pressure drop. pulse.
faint.

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 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:

Spine curvature - kyphosis.
Disc herniation 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 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, supraspinous ligaments.

Pain under left shoulder blade

The symptom of pain 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 quickly increases, it is accompanied by nausea and vomiting, the symptom is associated with the intake of food or its absence - hunger pangs. The pain starts 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 pains on the left side, massaging under heart disease. Pain under the left shoulder blade, pulling, aching, often causing a feeling of fear, not stopping with nitroglycerin and other heart medications - 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, into the arm, under the left shoulder blade, numbness of the limb, nausea.
Angina pectoris - Pain attacks can develop with tension, stress (angina pectoris) or as an exacerbation of a chronic form (angina pectoris at rest).
Intercostal neuralgia is accompanied by sharp pain, often in the waist, radiating 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 a hand.
Ulcer perforation is an acute condition, which is expressed in very intense pain that radiates to the collarbone area, under the shoulder blade. In addition to intense pain, the patient is characterized by a posture with the knees pressed against the stomach, cold sweat, cyanosis, drop in blood pressure and pulse.

Pain under the right shoulder blade

The symptom of pain that manifests itself under the right shoulder blade is associated with these diseases:

Biliary colic with spasm of the bladder, ducts due to blockage with stones. The pain is sharp, stabbing, located under the right rib and radiating to the back under the shoulder blade.
Pain under the right shoulder blade can be triggered by a diaphragmatic abscess. The symptom is very acute, aggravated by inhalation, even not deep, most often radiating to the right.
Pyelonephritis in the acute form starts with pain in the lower back, which later spreads higher and is given under the right shoulder blade. Purulent process in the right kidney is accompanied by pain when urinating, high body temperature.
Myofascial syndrome is also the cause that causes pain under the scapula on the right. These are chronic muscle pain associated with irritation of certain trigger points.
Among the factors that provoke a symptom of pain under the right shoulder blade, herpes - shingles is also sometimes found. This is a viral disease that is not considered life-threatening but causes very intense and 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 it often causes radiating pain under the shoulder blades, including the right.
Pneumonia on the right side. Pain with inflammation of the lungs is usually manifested in the acute phase, there may be fever, a feverish state.

If the pain subsides under the shoulder blade

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

Increased pressure in the intestines with inflammation, ulcerative process. The post-bulbar part of the ulcerated duodenum radiates to the right under the scapula.
Biliary colic (gallbladder, liver).
Sharp 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 scapula, in the region of the scapula.
Exacerbation of pancreatitis.
Renal colic.
Acute musculoskeletal back pain.
Myocardial infarction.
Osteochondrosis of the cervical spine.

Referred pain can be transient, but it can also signal that an acute condition is developing and requires immediate medical attention. If the pain subsides under the shoulder blade and is not stopped by antispasmodics, heart medications, then you should consult a doctor who will carry out an examination, differential diagnosis and prescribe appropriate treatment.

Pain under the shoulder blades when inhaling

A symptom of pain under the scapula, 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 may increase with bending, movements, decrease in a horizontal or sideways position. The accumulation of fluid in the pleural cavity causes 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 becomes more intense when inhaled.
Pain under the shoulder blades with a deep breath could indicate intercostal neuralgia, which manifests itself in the form of pains in the waist that feel like tightening in the chest.
Gallbladder diseases, spasm, colic, can also be accompanied by a pain symptom associated with inhalation.
Renal colic (pyelonephritis, renal abscess) may also be accompanied by pain in the hypochondrium, so severe that it spreads throughout the epigastric region, subsides under the scapula, and increases with inspiration.

Severe pain under the shoulder blade

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

Sharp, sharp, stabbing pain that 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, drop in blood pressure, slow pulse, (compensatory) enlargement of the neck veins.
Severe pain, which radiates under the scapula and is accompanied by high blood pressure, indicates an exacerbation of osteochondrosis of the thoracic spine. Simultaneous back pain under the scapula, headache and an increase in blood pressure are a clear symptom of pinched nerve endings in the cervical or thoracic region. The pain may increase when turning the body, trigger when bending or moving, and is not stopped by heart medications, sedatives.
Severe pain under the shoulder blade may be associated with the ulcer perforation of the upper part of the stomach. If the perforation progresses rapidly, the pain increases literally every minute, the general clinical picture of the ulcer is typical - sharp pain with irradiation, vomiting, cold sweat, cyanosis of the face, characteristic posture - knees bent to the chest.
Hepatic (biliary) colic is also manifested by severe pain, radiating 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 bacterial infection developing in this form can cause general intoxication, sepsis. In fact, it is purulent peritonitis, limited by the diaphragm, manifested by intense pain in the hypochondrium, radiating to the right - the shoulder, under the shoulder blade. Also typical hyperthermia up to 40 degrees, fever, nausea.

A severe radiating pain symptom is not recommended to last longer than an hour; if you cannot be stopped by available means, you will 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 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 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 dystrophic changes in the spine, as the thoracic region is not mobile, it is quite stable and stable. Most often, violations, changes, less often inflammation, related 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 passes quickly with active movements (exercise), massage or heating.

Pain, which is caused by damage, stretching of the tendons, is felt differently, it causes a feeling of pain under the shoulder blades, often the pain symptom is reflected in the heart region. In addition, a person complains of numbness in the hands, a tingling sensation, "creeping chills". It is not possible to counteract this pain with heart medication, but you can get rid of it and do it quite simply:

Periodically change your body position, 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 advisable to dedicate 20 to 30 minutes daily to 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 your shoulder blades.
It is necessary to periodically massage the shoulder-scapular area, the collar area.
Periodically, you can perform the following exercise: place a small (tennis) ball on the floor, lie on it with your upper back and "roll" on the ball, passing it vertically and between your 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 to exclude diseases of the bronchopulmonary system.