Pain in the shoulder blade and below can occur with nerve damage, diseases of the spine, shoulder girdle, or somatic pathologies. The cause can be determined by clinical signs, conditions for the manifestation of the syndrome and anamnesis data.
Pain in the scapular region can be felt during inhalation, in the middle of the body, or in the entire arm. In certain cases, such symptoms are the "first bell" of the exacerbation period, which can be prevented after the provoking factor has been established.
Causes and location
Pain under the shoulder blade usually appears during movement - it is preceded by an uncomfortable turn, standing for a long time with a bent back. Indicates local damage that appears for various reasons.
Pathologies with unilateral lesions, in which it hurts only on the right or on the left under the scapula, are few; usually the severity of the symptom is individual. This is due to the symmetrical arrangement of the nerve roots that extend from the spinal cord.
If it hurts under the right and left shoulder blades, this may be the result of damage to the bones and muscle structure. The symptoms do not have a strict localization, the severity depends on the traumatic factor. The clinic is usually acute, begins abruptly and acquires a chronic course.
The causes of traumatic pain under the left or right shoulder blade are as follows:
- Bruises - in such cases, the pain is superficial, most often the muscles are damaged. Usually, the muscles of the back below the shoulder blades and below hurt, swelling and local inflammation develop. After 2-3 weeks, the symptoms disappear.
- Cracks and fractures are more serious injuries, the pain is concentrated in the scapula itself. At the slightest movement, it intensifies, the patient cannot move his arm or bend over.
- Subluxation and displacement of the vertebrae: This causes pain in the joints at the level of the shoulder blades and below, sometimes the bone structures compress the nerve roots.
The injuries are characterized by severe pain under the right or left shoulder blade, which appears spontaneously. During movements, there may be a crunch, and swelling often appears.
If the disease affects the thoracic spine, the patient has back pain near the shoulder blades and below. This is due to pinching of the nerves or spinal cord due to deformation of the articular disc. The pathology develops gradually, and as the distance between the vertebrae decreases, the clinic of the pathology worsens.
The location of the pain depends on the affected area:
- If osteochondrosis destroys the articular discs of the thoracic region from 2 to 6, pain is felt in the scapula. It usually radiates to the neck and arm. When the vessels are squeezed, dizziness appears, intracranial pressure may increase.
- When joints of 6-12 segments are affected, the pain radiates below the left or right shoulder blade, spreads down to the corresponding half of the body and lower back.
Spinal roots from the thoracic region give rise to plexuses that innervate the arms and torso. Therefore, when they are squeezed, the pain spreads along its course.
With osteochondrosis, the discomfort is one-sided: it hurts in the shoulder blade on the right or left side and below, depending on the inclination of the spine.
This is a curvature of the spine in the transverse direction due to overexertion of the muscles that support posture. This leads to pinching of the roots and spinal cord, the appearance of pain under the shoulder blade on the right or left. Pathology is often accompanied by:
- Respiratory failure - a unilateral skew of the spine deforms the chest, which affects the functioning of the lungs, one of which is compressed, and the second assumes the lost function.
- Violation of the work of the heart - the frequency of contractions and pulse changes, shortness of breath and pallor of the skin appear.
- The appearance of a visible deformation of the chest is the main cause of pain under the right or left shoulder blade. The vertebrae, along with the ribs, are displaced laterally, as a result of which, on the side of the curvature, the bone structures are displaced downwards, damaging the spinal cord with its branches.
If the spinal cord is compressed during scoliosis, the back usually hurts between the shoulder blades and below, the focus is strictly limited. If the muscle spasms come together, the symptom spreads to neighboring structures.
It is characterized by backward bending of the spine, forward displacement of the shoulder girdle, and gradually stooping. There is pain over the shoulder blade, usually bilateral, occurring in the arm and neck. The following mechanisms are involved in its formation:
- Neurogenic - due to curvature, the distances between the vertebral bodies in the anterior sections decrease, which leads to impingement of the branches of the spinal cord. There is aching pain in the right and left shoulder blades, which can radiate to the clavicle, neck and shoulder.
- Muscular - deviation of the spine leads to overstrain of the muscles in the neck area, which can cause painful spasms in the area of the shoulder blades and below.
As a result of kyphosis, the vertebral artery is compressed and cerebral circulation is disturbed. The work of the internal organs gradually worsens.
If the right or left shoulder blade hurts, one of the reasons may be spondyloarthrosis - damage to the facet joints and intervertebral discs. It is accompanied by loss of mobility, stiffness appears, more pronounced in the morning.
The clinical picture changes as the pathology progresses: >
- Destruction of cartilage - with a lack of blood circulation, the integrity of the connective tissue is violated, the articular disc becomes fragile, it is further damaged and recovers more slowly. At this stage, strong physical exertion leads to microtrauma, pain radiating to the area of the shoulder blades and downwards occurs.
- Deformation of the articular disc: seals appear that prevent mobility. This provokes a new destruction, which slows down the regeneration processes, the patient feels pain in the back and shoulder blades.
- The appearance of bone growths is characteristic of the advanced stage of the disease. Neoplasms damage joints, muscles, blood vessels, and nerves.
With spondyloarthrosis, the back may ache between the shoulder blades or below; an attack is usually preceded by physical activity. At rest, the symptoms disappear because the bony growths do not damage the surrounding tissues.
protrusion and hernia
In these conditions, acute pain under the left and right shoulder blades, which appears due to compression of the spinal cord or its roots, is of concern. As a result of pinching, the sensitivity along the nerve fibers is disturbed.
The location of the symptoms is as follows:
- Pain in the shoulder blades and above: protrusion or herniation in the cervicothoracic region or when 1-3 thoracic segments are affected. The symptom intensifies when you try to tilt your head, turn it to the side.
- Pain in the interscapular region - in this case, the middle sections may be affected, from 3 to 6. Discomfort increases when both hands are moved to the side, deeply inhaled or rotated.
- Severe pain under the right and left shoulder blades - articular discs from 6 to 12 are affected, the lower back may be involved in the pathology. In this case, there is a risk of developing a hernia, since this section of the spine is loaded more than the previous ones.
Unlike spondyloarthrosis, hernia and protrusion pain do not go away for a long time at rest. This is due to constant compression of the nerve, which is aggravated by muscle spasm.
This is a pinch of the lumbar roots, which are collected into a powerful sciatic nerve. If its upper sections are affected, the patient feels pain under the scapula and below, it is bilateral, aggravated by flexion and sudden movements.
As the disease progresses, additional symptoms may appear: >
- There are back pains that radiate to the lower extremity: a sharp stabbing pain is felt like an electric shock along the nerve.
- Burning pains in the back, in the lumbar region or under the shoulder blades indicate a prolonged pinching of the spinal roots in the lumbar region.
- Cramps and loss of sensation usually occur in the lower back, buttocks, sometimes there is numbness along the nerve fibers in the thigh, lower leg and foot.
This condition is understood as inflammation of the shoulder joint and surrounding tissues, stiffness occurs, which disappears only after warming up.
The pain is concentrated in the region of the right or left shoulder blade and below, depending on the development of hemispheric motor skills (right-handed or left-handed). It first appears after exercise and then at rest. Along the way, additional symptoms appear:
- hand numbness;
- violation of the mobility of the spine.
With humeroscapular periarthrosis, clinical manifestations increase when the arm is raised: it hurts in the region of the right or left shoulder, shoulder blade. Gradually, the range of motion decreases, stiffness progresses.
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, drafts. Most often affected:
- Suprascapular and supraspinatus nerves - there is pain in the right or left shoulder blade from the back, concentrated mainly in the clavicle. Sometimes the discomfort extends to the shoulder, indicating the defeat of the skin branches of this area.
- Subscapular and infraspinatus nerves: In this case, it hurts on the right or on the left under the scapula, depending on the side of the injury. If the eponymous muscles are involved, the clinical manifestations are aggravated when the arms are moved downward, abducted behind the back.
- Intercostal nerves - usually 1-4 pairs. These branches go along the lower edge of the rib, pain occurs not only in the area of the shoulder blades and below, but also on the sides of the chest, sometimes in the anterior sections.
Symmetry is not typical for neuralgia: if the left half of the body was exposed to drafts, pain in the neck, chest and shoulder blade is noted on this side.
Branches from the parasympathetic trunk, which is connected to the spinal cord and its roots, go to the heart. That is why heart disease can lead to pain in the scapula and below. Usually a mild form of myocardial infarction is latent. It may be accompanied by the following symptoms:
- Dull squeezing or burning pain felt behind the breastbone or under the left shoulder blade; it can last for hours, increase when walking, but disappear a little at rest.
- Difficulty breathing: accompanies pain, can manifest in a few days.
- Tachycardia - increased heart rate, sometimes rhythm disturbances occur.
- Other symptoms are increased pressure, dizziness, nausea and vomiting.
Problems with the gastrointestinal tract
Similar to the previous mechanism, the pain spreads along the nerve fibers. The clinical signs can be bilateral, but in most cases there is a certain pattern in which the symptoms appear depending on the location of the internal organs.
Pain under the left shoulder blade behind the back occurs with the following diseases:
- stomach ulcer.
Usually with these diseases, patients complain of dyspeptic disorders, nausea and vomiting. If internal bleeding occurs, pale skin, dark stools, decreased pressure, and weakness are noted.
Pain under the right shoulder blade behind the back accompanies:
- liver cirrhosis;
- ulcerative lesion of the duodenum.
In addition to these factors, pain under the shoulder blades can lead to:
- Uncomfortable mattress - if you fail and sleep on your right side, then in the morning you may feel pain under the left shoulder blade from behind, as the curved spine pinches the spinal roots.
- Pleurisy - pain in the scapular region occurs when breathing due to the friction of the laminae with each other reaches a maximum point in a deep breath.
- Poliomyelitis - pathology is accompanied by neurological symptoms, back pain often appears.
- Poisoning: Severe poisoning or a cold can manifest with muscle aches, chills, and fever.
- VVD - vegetovascular dystonia is accompanied by a change in pressure, interruptions in the work of the heart and shortness of breath, and sometimes discomfort in the back.
- Kidney disease - these pathologies are characterized by pain or stabbing pain under the right shoulder blade, a change in diuresis and color of urine, and general symptoms.
- Subdiaphragmatic abscess - if suppuration is observed in the upper floor of the abdominal cavity, then when inhaling, pain under the shoulder blades, fever and symptoms of intoxication will be felt.
- Mental disorders: In some cases, pain in the shoulder blades and below can be the result of such disorders. The exact mechanism of appearance has not been studied.
The nature of pain
Pain in the area of the shoulder blades and below can be different, by its nature it is possible to assume a specific group of pathologies, sometimes a provoking factor can be established:
- For pinched nerves, lumbago is characteristic - a sharp stabbing pain that appears with a sharp turn of the body, raising the arm. This is the main difference from cholelithiasis, in which the symptom is not curved by movements.
- Aching, throbbing or burning pain indicates a pathology of the internal organs. This last option occurs by squeezing the roots of the spinal cord, but increases with movement and can turn into stitches.
- Severe, constricting pain in the area of the shoulder blades and below is characteristic of a hernia. Sometimes it is preceded by lumbago, numbness of the extremities.
- Cutting pain of varying intensity is characteristic of neuralgia, perforation often accompanies joint inflammation.
What doctor treats pain in the shoulder blades?
If you experience pain in the scapula and below, you should make an appointment with a neurologist. If there are no pinched nerves, the specialist will refer you to an orthopedist, cardiologist, gastroenterologist, or urologist, depending on the suspected condition
To identify the cause of discomfort in the area of the scapula and below, a laboratory and instrumental examination is performed:
- X-ray or computed tomography - using these methods, you can detect osteochondrosis, curvature of the spine, and the consequences of injuries.
- MRI >- The spine, shoulder joint or internal organs are examined, depending on the suspected pathology.
- ECG: Helps identify heart disease.
- Blood and urine tests are informative for some somatic pathologies, inflammation of muscles and joints.
- Ultrasound - is prescribed for somatic diseases, if it is impossible to undergo an MRI.
Usually pain under the shoulder blades is due to neurology. Therefore, CT and MRI are considered the "gold standard" in the diagnostic protocol.
General principles of treatment
The main task is to eliminate the symptoms and the provoking factor. First, the patient's well-being is stabilized, then the underlying pathology is treated.
The therapy program includes:
- Medications: Pain relievers are usually prescribed to relieve pain and inflammation. Then the funds are prescribed depending on the underlying disease: antibiotics, gastroprotectors, diuretics.
- Physiotherapy - strengthens the spine, treats somatic diseases. Medicinal electrophoresis is used in the area of the shoulder blades, heating procedures, SWT.
- Massage - heating is done with damage to the spine. From such procedures, the muscles above and below the shoulder blades relax, and posture improves. In this case, you need the professional help of a chiropractor or osteopath.
- Gymnastics - is carried out after the elimination of pain, the program is compiled, depending on the disease suffered by a physiotherapist, a rehabilitation specialist.
After successful treatment, patients are recommended to follow a preventive program that will prevent the recurrence of pathology:
- watch your posture;
- choose a mattress of moderate hardness and an orthopedic pillow;
- twice a week, massage in the area of \u200b\u200bthe shoulder blades and below;
- follow a low-calorie diet for obesity;
- get rid of bad habits;
- carry out prophylaxis of somatic pathology (if present in the anamnesis);
- visit a doctor every six months.
Pain in the shoulder blades and below can be neurological or somatic in nature. When the nerves are damaged, the symptoms are acute and sudden, appearing spontaneously.
Pathologies of internal organs and joints are characterized by gradual and prolonged pain, the clinic is always accompanied by additional symptoms. In the initial stages, painkillers are prescribed, after diagnosis, the program is supplemented with etiological therapy and strengthening procedures.