Pain under the left / right shoulder blade, back to back. Causes of aching, sharp, strong, sharp, pulling, burning. Neuralgia

Pain under the left or right shoulder blade - a symptom of not only diseases of the musculoskeletal system. Discomfort from behind, may radiate into this area with gastrointestinal, cardiovascular, urological and other diseases.

According to the Ministry of Health, back pain account for 40-50% of all pain syndromes in patients. Clinical management of such condition depends on the cause of the discomfort.

Anatomical features left and right scapula

The blade area is located under the acromion-clavicular joint. Its upper border is in the projection rib 2, and the bottom - at the level of the seventh. Shovel arm provides mobility for complex movements of the shoulder joint.

It has developed several ligaments and mucous bags. Most often, pain in the area due to disease itself blades associated with abnormalities in the chuck mucous bag.

Lifting arms in upright position can be done only with a blade at its lower end is displaced significantly - up to 9-11 cm and 19 cm from the spine line sideways. This movement is also provided by the middle part of the deltoid muscle.

To the front and rear surface of the vane belt attached Muscle upper extremity. The pain caused by a violation of the blade and the change in its normal position, is primarily concerned with the serratus anterior muscle.

The compound of this area to the central nervous system is controlled by the suprascapular and subscapular nerves. Here are the back of the chest nerves, which causes damage to the blades of asymmetry. If damaged cervical roots (their squeezing, inflammation or injury) is a disturbance sensitivity and activity of the muscles involved in the movement of the blade.

Therefore, in patients the pain of this localization is often accompanied by headache and osteochondrosis of the cervical spine. Acute pathology in the shoulder area can be associated with purulent inflammation of arthritis of the shoulder joint.

Possible causes of pain under the right shoulder blade, back to back, between the shoulder blades

Pain under right shoulder blade from behind, may have the following character:

• If the source of discomfort is a muscle, there is a feeling of tension, heaviness in the upper back. A characteristic feature of this anatomical reasons is that during a massage or workout soreness goes away.
• If the source of the pain is in the tendons, periosteum, ligaments and nerve endings that physical activity does not help to solve it. Discomfort can spread around the spine and give in the heart area. They can manifest as numbness, tingling, "frozen".

Among the causes of pain in this location are the following groups of pathologies (in brackets their prevalence among patients):

• musculo-skeletal (20-50%);
• cardiovascular (13-16%);
• pulmonary (5-20%);
• gastrointestinal (8-19%);
• psychogenic (8-17%).

Risk factors for the occurrence of this symptom are:

• elderly age;
• female;
• spine injury history;
• tall and stoop;
• obesity;
• musculoskeletal pain at other sites;
• grind or excessive physical activity, particularly related to lifting and carrying heavy loads;
• Exposure to a stationary state, an uncomfortable posture of the body and hands;
• the effects of vibration.

Drawing and shooting pain

Drawing and shooting pain under the right shoulder blade may appear as an additional symptom of diseases such as:

• Liver or biliary colic. This condition occurs when occlusion bile duct stones (cholelithiasis) or their dyskinesia (dysmotility). Exacerbation usually evident within a few hours after administration of acute or fatty foods, and also after prolonged operation in inclined position. In this case, the patient experiences a very strong pain in the right upper quadrant, which can also be given throughout the abdomen, under the collarbone in his right shoulder and neck, in the heart area. Its intensity is permanent. Further symptoms are nausea, vomiting, skin pallor.
• Subphrenic abscess, which is a collection of pus under the diaphragm. Its localization in the right department observed in 70% of cases. The reason for such a condition is an acute inflammatory disease - appendicitis, cholecystitis, peritonitis. The pain may be reflected in the right shoulder and aggravated by breathing. Other features are: high fever, chills, shortness of breath, cough, general weakness.
• renal disease (nephritis and pyelonephritis), A typical feature of which is pain. It can also be given in the upper quadrant. Other symptoms are: painful and frequent urination, cloudy urine color and the presence of blood in it, the sensation of thirst, nausea, fever and general weakness.

The discomfort between the shoulder blades

Pain between the blades, which may be either sharp, cutting and burning and aching, chronic, It occurs when the following pathologies not related to the musculoskeletal system:

• Pneumonia and pleurisy, which causes include infections, tumors of the respiratory system, thorax injuries. The main symptoms are shortness of breath, cough, wheezing, high body temperature, signs of intoxication (general weakness, muscle and headache).
• Tuberculosis. The clinical picture is similar to the previous group of diseases, the patient has a prolonged cough with phlegm.
• Polio, due to a viral lesion of the spinal cord gray matter. The disease is accompanied by fever, diarrhea, abdominal pain, and muscle, "catarrhal symptoms", rash, shortness of breath, paralysis.
• angina - chest pain suddenly occurs during physical exertion, stress, or after eating, when staying in the low temperature conditions at elevated arterial pressure. Discomfort may also be given in the left shoulder, the lower jaw, neck, abdomen, below the left shoulder and last for 10-15 minutes. A characteristic feature is the discomfort in the chest (squeezing, burning), as well as shortness of breath, palpitations, arrhythmia, an intense fear of death. Causes of angina is coronary atherosclerosis, more rarely - allergic and infectious diseases. Similar symptoms occur during an attack of myocardial infarction, coronary heart disease.

By diseases of the musculoskeletal system, in which the patient feels pain between the shoulder blades include:

• trauma of breast or cervical spine;
• low back pain, accompanied by degenerative changes in the intervertebral discs;
• curvature of the spine, congenital or acquired as a result of injury, poor posture, rickets, tuberculosis, senile changes;
• spondiloartroz cervical or thoracic spine (degenerative changes in the intervertebral joints);
• sciatica - inflammation and compression of the spinal nerve roots, degenerative disc disease is a complication and spondyloarthrosis;
• disc herniation in the thoracic spine;
• connective tissue dysplasia.

when driving

Pain under right shoulder blade from behind, arising out of or aggravated by motion, may be associated with the following pathologies:

• Subscapularis crunch which is formed due to inflammation of the mucous bags, neurodystrophic processes at the site of attachment of muscles or abnormal growths ribs.
• tuberculosis bladesManifested in defeat her neck and back surface. In osteoporosis bone develops - decrease its density, which leads to a reduction in its strength. At the initial stage it may appear a feeling of stiffness when moving a hand, then there is pain.
• Benign and malignant tumors. The pain in this case occurs due to compression of nerves and surrounding soft tissues. Rapid tumor growth may be indicative of a malignant process development.
• injuries most commonly associated with the punches and falling back. If you fall on the side exposed to the forward arm may be broken scapula.

  

• pterygium syndrome blade, at which its surface stops fit snugly to the chest. This deflection occurs after thoracic nerve damage, injuries and other types of injury, as well as inflammatory and infectious processes and muscular dystrophy.

After inoculation ADSM

Subscapular pain may also occur following vaccination Td (diphtheria-tetanus vaccine in small doses). It is usually made in the thigh, but when the patient developed subcutaneous layer of fat it is performed in the upper arm or in the chuck area.

The appearance of redness and seals in the injection - is a normal reaction, which takes place on their own without treatment within 3-4 days. Heat the bump to its dispersal is impossible, as this can cause tissue abscess, which will have to remove surgically.

Burning

Burning sensation in the area of ​​the blades may occur in the following diseases:

• Compression of the spinal nerve roots (Low back pain, sciatica) in the cervical and thoracic spine. Risk factors for the development of this state are sedentary lifestyle, heavy physical exertion, hypothermia, trauma, infectious disease.

  

• Herpes zoster (or shingles). Pain in this disease is preceded by the appearance of lesions and lasts from 1 to 4 months. A special feature of this disease is that it is, in most cases one-sided (the defeat of the left or right side is observed with the same frequency). Gradually, its intensity is reduced in the resolution of lesions. Additionally, there are other symptoms characteristic of infection - high temperature, fever, intoxication, lymphadenopathy. Besides burning pain can be felt as a constant, dull, pressing, stabbing, shooting pain.

Possible causes of pain under left shoulder blade, from behind,

The causes of pain under left shoulder blade, associated with diseases of the musculoskeletal system, the same as for the localization of the right side. Main symptoms and disease characteristics for a given state are shown in the table below.

The nature of pain	Possible reason	other symptoms
Chronic, aching	gastric ulcer	Abdominal pain and thoracic spine, nausea, vomiting, decreased appetite, heartburn, belching.
Sharp, cutting, pressing, constricting	myocardial infarction	Bouts of chest pain and chest, shortness of breath, arrhythmia, the intensity of the pain does not affect movement, change in body position; pain relief while taking nitroglycerin.
Aching, dull, acute or chronic	Osteochondrosis and other degenerative diseases of the spine	Increased pain when moving, and in the morning, after the weakening of the heat; stiffness; headaches, dizziness.
Burning, tingling, constant encircling	Intercostal neuralgia	Increased pain when coughing, sneezing, movements; muscle tension.

When it is essential: a sore left or right?

The most dangerous, life-threatening conditions in which there is pain of this localization are:

• pain under the right shoulder blade: attack of hepatic biliary colic, subdiaphragmatic abscess;
• pain under left shoulder blade or in between - myocardial infarction, gastric ulcers.

In the presence of other related symptoms characteristic of these diseases (as described above), it is necessary to immediately seek medical attention.

Diagnostics

Pain under the left or right shoulder blade, back to back, can be caused by various diseases.

For the diagnosis of lesions of the musculoskeletal system include basic survey methods used:

• X-ray examination, or traditional rentgenokonstrastnoe (for the diagnosis of tumors, hernia of intervertebral discs);
• Ultrasound examination of the shoulder joint;
• Magnetic resonance imaging;
• Computed tomography of the cervical and thoracic spine, the shoulder joint;
• electroneurogram and electromyography (determination of conduction velocity of nerve impulses along nerves emanating from the spinal cord, and muscles).

The following types of studies may be required when you suspect the presence of diseases of other organs and systems:

• ECG;
• fluorography;
• pleural puncture (to confirm the diagnosis of pneumonia or pleurisy)
• bronchoscopy;
• EGD;
• puncture of the tumor for microscopic examination (for suspected cancer);
• Ultrasonography of the abdomen and chest.

From the laboratory methods used such as:

• Clinical (total) and blood chemistry analysis;
• general urine analysis;
• suspected disease respiratory organs - the analysis of sputum, or Diaskin Mantoux test, blood or urine for the presence of mycobacteria;
• to detect polio - the analysis of cerebrospinal fluid, ELISA or PCR throat mucus, blood or feces.

In the first diagnostic step is necessary to the physician which can assign further consultation with a neurologist, surgeon, trauma, cardiology, gastroenterology, a TB, an infectious disease specialist, psychotherapist.

Treatment

To eliminate the following main methods of treatment causes of pain under the shoulder blades are used:

• Diseases of the musculoskeletal system:

1. spondylarthrosis (Bone proliferation processes) - in the initial stage of NSAIDs used in the form of creams, ointments, gels, tablets, or injections (the most common drugs listed below). When severe pain - therapeutic blockade. Physical therapy methods - UHF-therapy, laser therapy, electrophoresis, UFO, physiotherapy. In the later stages of the disease is carried out surgical intervention.
2. Low back pain, sciatica - reception of NSAIDs in acute prescribers injection. Also used are drugs that enhance metabolism in the intervertebral disc (chondroitin sulfate, glucosamine, vitamins of group B). When severe pain - glucocorticoids for therapeutic blockade. The rehabilitation period - manual therapy, massage, physiotherapy, physical therapy, spa treatment.
3. Slipped disk - injection of drugs, laser therapy, surgical intervention. Massage and warming up in the acute period is not allowed.
4. Malignant tumors - surgical removal.
5. Intercostal neuralgia - sleep mode, NSAIDs, analgesics, muscle relaxants, during rehabilitation - physiotherapy, massage.
6. Rachiocampsis - wearing an orthopedic corset, physiotherapy, in severe cases - surgery.
7. scapular fracture - the imposition of bandages, tires for 1 month; physiotherapy, painkillers.

• Pathology of other organs and systems:

1. Pleurisy or pneumonia - antibiotics (cephalosporins, macrolides, penicillins), means diluting sputum, corticosteroids; ultraviolet irradiation, paraffin and ozokerite applications.
2. Tuberculosis - chemotherapy (Isoniazid, rifampicin, ethambutol, streptomycin, pyrazinamide), clinical nutrition, hormones, surgery.
3. gastric ulcer - antibacterial agents (metronidazole, omeprazole, clarithromycin and other), H₂blockers (ranitidine, famotidine, Gistodil and others), antacids, or enveloping means (Almagel, Maalox, Fosfalyugel) surgery.
4. Bile-hepatic colic - ursodeoxycholic acid medications (Ursofalk, Ursosan, ursodiol and others), lithotripsy, antispasmodic drugs (No-Spa, Drotaverinum) surgery.
5. Pyelonephritis and nephritis - antibacterial agents (fluoroquinolones, cephalosporins etc.), analgesics, antipyretics, diet, surgical intervention.

conservative

Pain at the left, right scapula posteriorly from behind, is removed by means of drugs indicated in the table below.

drugs group	appointment	Name (active ingredient), Composition	The dosage for adults mg per day	Features reception
Nonsteroidal anti-inflammatory drugs	Pain relief, reduction of inflammation and edema	Ksefokam (lornoxicam) Tablets	8-16	Contraindicated in gastric ulcer, inflammatory bowel pathologies, increased risk of bleeding, intolerance acetylsalicylic acid, severe hepatic, renal failure, pregnancy, lactation and in children under 18 years.
Nimesulide (nimesulide) Tablets	100-200, 2 times a day
Diclofenac (diclofenac), ointment, gel	Application to the skin 3-4 times a day	Contraindications child up to six years, pregnancy from 3rd trimester and lactation, aspirin intolerance, impaired integrity of the skin at the site of application.
Ketoprofen (ketoprofen), tablets, gel, solution for injection	Pill: 150 every 12 hours	Contraindications: ulcerative lesions of the gastrointestinal tract in the acute stage, liver and kidney failure, pregnancy with the third trimester and during lactation, children under 15 years.
analgesics	Elimination of chronic neuropathic pain	Gabapentin (gabapentin) capsules	300, three times a day	Prescription. Contraindications - idiosyncrasy, acute pancreatitis, pregnancy and lactation.
Pregabalin (pregabalin) capsules	150-600, in 2 or 3 doses	Children under 17 years, pregnancy and lactation, hypersensitivity.
Tebantin (gabapentin) capsules	900-1200	The same as that of gabapentin.
Muscle relaxants	Decreased muscle tone	Sirdalud (tizanidine), capsules, tablets	2-4, 3 times	Children under 18 years of age, hypersensitivity, severe liver disease.
Mydocalm (tolperisone), a solution for injection, tablets	50-150, 2-3 times	Hypersensitivity, autoimmune disease myasthenia gravis.

In less severe forms of the disease, local NSAIDs can be used (creams, ointments, gels, patches).

Physiotherapy

For pain under the shoulder blades in congestive processes, as well as during rehabilitation can be recommended following a simple set of exercises to strengthen the muscles of the back:

1. AND. P. - lying on his back, arms apart. Bend your head to your chest, pull the toes themselves, to strain the neck muscles for 3-5 seconds.
2. AND. P. - lying on his back, legs bent at the knees. Take hands tibia, bend back. Stand with 3-5.
3. AND. P. - standing, arms pulled back and hooked into the lock. Take his hands back, bend, stretch the muscles for 3-5 seconds.
4. AND. P. - lying on his stomach, arms forward. Raise both arms and legs, bend. Hold the position with 5-8.
5. AND. P. - standing. Bend sideways, raising one hand. Then repeat in the opposite direction.
6. AND. P. - sitting on a chair. Take arms back behind your head, throw in the castle. Bend in the back muscle tension holding for 5 seconds.
7. AND. P. - standing. One hand lift and pull behind his back, the other to bring the bottom and try to throw in the castle. Sustain position for 5 seconds.

All the exercises are repeated at 5-8 approaches.

Folk remedies

Pain under the left (right) shoulder blade behind his back can be treated well by the following folk remedies:

• Pour fresh marigold flowers (marigold) medical, camphor spirit and triple cologne (they are taken in equal proportions 100 ml). Insist 2 weeks. Rub the affected area according to the composition of the morning and evening for 10-14 days.
• Dandelion roots, grains of coriander, birch buds and mint leaves mixed in equal proportions. 3 tbsp. l of this mixture pour ½ art. of boiling water, then at low heat for 5 minutes. Pour ½ st. vegetable oil, add 5 tablespoons. l. butter and keep the fire until it is completely melted. This ointment stored in the refrigerator and apply 1 time per day to the affected area of ​​the back, rubbing the skin.
• Lard previously melted, mixed with the grinded into powder hop cones (1 hr. l. each component). The ointment is also applied on trituration subscapular region.

Prognosis and complications

For fractures of the blade, as well as in degenerative disorders of the musculoskeletal system initially favorable prognosis. Sometimes after a strong fragmentation of the bones, as well as non-compliance with rest mode, patients develop a deforming arthrosis.

In advanced cases, if left untreated, there is a strong limitation of movement of the shoulder joint.

In other diseases can cause serious complications:

• herpes zoster - encephalitis, blindness, hearing loss, gastrointestinal damage and the cardiovascular system;
• myocardial infarction - heart failure and death;
• polio, spinal injuries - mobility impairments, paralysis;
• Tuberculosis - bone deformation, abscesses;
• pyelonephritis - acute renal failure, renal abscess;
• stomach ulcer - bleeding, perforation, peritonitis, death.

Pain under the left or right shoulder blade is both independent sign of changes in the surrounding tissue, and is accompanied by many other diseases. Unpleasant sensations arising in the subscapular area from behind, can be completely eliminated only in the treatment of the underlying pathology. To do this, the physician should make a careful history and detailed diagnostics.

Registration of the article: Vladimir the Great

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