Patients rarely pay due attention to recurrent pain in the scapular region. However, this symptom is a "wake-up call" for serious changes not only in the musculoskeletal system, but also in the internal organic complex. Such conditions can threaten the patient with disability and death. How not to miss the disease and cure back pain in the shoulder blade area, read on.
Etiology
The spine is the main component of the human musculoskeletal system. Thus, the lion's share of pressure during statics or dynamics falls on the spinal column. Therefore, it is not surprising that pain in the area of the shoulder blades is a common reason for consulting a doctor.
However, the pain syndrome is quite variable: often the pain is not caused by the spine itself, but by a violation of the functions of the internal organs. This fact makes it difficult to diagnose the underlying cause of the pain syndrome and leads to treatment errors.
Among the main causes of pain, there are pathologies of the musculoskeletal and internal systems.
The first group includes:
- osteochondrosis;
- spinal deformities;
- trauma and spondylolisthesis;
- spondylosis;
- osteoporosis;
- ankylosing spondylitis.
Among the non-vertebral causes, the most common are diseases of internal organs (pneumonia, heart attack, intercostal neuralgia, gastric ulcer, cholecystitis). Also, tumor processes or mental lability (fibromyalgia, psychogenic pain) can cause pain.
Variations of pain
Why does my back hurt in the shoulder area? In general, the pain syndrome can be localized both directly in the area of the shoulder blades and between them. The pain is bilateral (in scoliosis) or is mostly on one side (gastric ulcer, cholecystitis).
By the nature of back pain between the shoulder blades, it can be acute (occurs abruptly with a rapid increase in strength) or chronic (weak and prolonged). The main difference in practice is that the patient can accurately state the time of onset of the acute pain syndrome. Remembering the circumstances of the onset of chronic pain will be difficult.
Pathology options
Numerous diseases can cause back pain in the area of the shoulder blades, but we will focus on the most common of them.
- Osteochondrosis.Osteochondrosis is a disease during which the "aging" of the intervertebral disc occurs. In advanced cases, such pathological changes lead to hernial disc protrusion. When osteochondrosis affects the thoracic spine, patients are concerned about sharp back pain between the shoulder blades, which occurs when bending or staying in uncomfortable positions for a long time. It is possible to add palpable weakness of the back muscles, disorders in the perception of temperature and pain.
- Spinal deformities.One of the causes of pain between and in the area of the shoulder blades is the curvature of the spine. As a rule, the pain causes kyphosis (bending, hump) or scoliosis (C, S or Z-shaped spine). With significant deformities of the spine, there is a painful pain, intensified by physical activity. Episodes of respiratory failure (shortness of breath, inability to "breathe deeply") are common. The clinic is also accompanied by increased fatigue and headache. In rare cases, the chest is bent.
- Injuries.Acute pain often occurs with direct trauma to the spine or the shoulder blades themselves. Similar injuries occur when falling from a height, hitting a blunt object, transport or industrial accidents. Spinal injuries are associated with palpable pain, reflex contraction of the back muscles and bruising. In some cases, an attachment of neurological pathology is possible. When the scapula is traumatized, the pain is acute, intensified by swinging the arms. It is sometimes combined with bleeding in the cavity of the shoulder joint - hemarthrosis.
- Spondylosis.Spondylosis is called senile destructive processes in the spine. Usually bone tissue grows in the area of the intervertebral joints - osteophytes are formed, which can be complicated by the enlargement of the vertebrae towards each other. In such cases, severe pain, neurological and vascular disorders occur.
- Osteoporosis.Osteoporosis is a disease associated with a decrease in the density of the skeletal system. Usually, back pain in the scapular region occurs when a fracture of the thinned thoracic vertebrae occurs. Posture curvature appears - the formation of scoliosis and / or kyphosis. In some cases, the disease is complicated by radicular syndrome (disappearance of motor activity and sensitivity).
- Ankylosing spondylitis. . . Ankylosing spondylitis is a disease that affects the intervertebral joints. Usually, the clinic begins with pain between the shoulder blades or in the lower back. The pain is accompanied by stiffness of movement, which intensifies after a night's rest. With the development of pathology, the spine is deformed, curved, leading to curvature of the chest and respiratory failure. In such a pathological position, ankylosis (immobilization) of the intervertebral joints occurs, due to which the patient can no longer bend. In this case, the disease can further affect the cardiovascular and urinary systems.
- Diseases of internal organs.In pneumonia (pneumonia), the detailed clinical picture is characterized by fever, sputum formation, and unilateral chest or back pain in the scapular region. During a heart attack, the pain is sharp (stabbing, burning), is determined in the chest and radiates to the left shoulder blade and upper extremity. The pain syndrome with intercostal neuralgia is acute and penetrating, manifesting itself in the form of seizures that interfere with the patient's breathing. The pain occurs along the ribs, is distributed under the shoulder blades, collarbone and lower back. In gastric ulcer, the pain is dull, localized in the upper abdomen, often accompanied by "hungry" pain (with long pauses between meals). In this case, the disease is characterized by indigestion, nausea, vomiting and acid regurgitation. Sometimes there is bleeding from the ulcer: patients feel dagger pain, which disappears at the peak of bleeding. Vomiting and stool become dark (almost black) due to blood impurities. Cholecystitis (inflammation of the gallbladder) is characterized by the appearance of a characteristic syndrome of paroxysmal pain in the right hypochondrium, which spreads to the right side and shoulder blade. The clinic of the disease includes digestive disorders, the provoking factor of which is the consumption of fatty and fried foods. Vomiting with bile impurities sometimes occurs.
- Tumors.Pain in the scapular region can occur in neoplastic diseases of the vertebrae or nerve sheath (neuroma). Metastases (daughter tumors) from the affected prostate or mammary gland can spread to the spine. In this case, the tumor process is characterized by an asymptomatic course, and the appearance of pain is associated with an increase in the neoplasm and its pressure on the neurovascular bundle. Cancer can be suspected by the "symptoms of a guard dog": pain, weight loss, fever and constant weakness for no reason.
- Mental lability.Psychological instability to stress and emotional outbursts can manifest as psychogenic pain. It occurs against the background of complete health: patients can experience sensations of varying intensity that cannot be treated even with painkillers. Stressful situations cause another idiopathic (causeless) pain - fibromyalgia. The disease takes place in the background of long-lasting feelings of pain, intensifying at certain (trigger) points.
Diagnosis
Radiography is the gold standard for spinal examination. Computed tomography can be used to determine the cause of back pain. Ultrasound or MRI is used to study other organs and systems. Laboratory or other instrumental testing methods may be required to rule out concomitant pathology.
Treatment
These pathological conditions require a special treatment plan; only a doctor can prescribe medication.
- Osteochondrosis.Nonsteroidal anti-inflammatory drugs and analgesics are used as pain therapy for pain relief. Physical therapy, therapeutic gymnastics and massage are also effective. In the later stages of the disease, surgery to remove the hernial sac is recommended.
- Spinal deformities.Conservative therapy of curvature of the spine consists of the use of supportive aids (corsets, bandages). You also need enough activity, massage and physiotherapy (paraffin applications, electrical stimulation). In case of significant deformity, surgical methods of treatment are indicated in order to fix the spine in an anatomically correct position.
- Injuries.Minor injuries are treated with rest, warmth and massage, and more serious injuries may require traction. If conservative methods are ineffective, the spine is reconstructed by an operative method.
- Spondylosis. Treatment of this pathology is aimed at slowing the progression of the disease. Therefore, hyaluronic acid injections, chondroprotectors, physiotherapy (shock wave therapy), as well as physiotherapy exercises are prescribed. In severe pain syndrome, the blockade is performed with painkillers.
- Osteoporosis.Osteoporosis care includes high doses of calcium and vitamin D supplements. Hormone therapy with female sex hormones, thyroid and other hormones is also possible.
- Ankylosing spondylitis.Inflammation and pain are controlled with anti-inflammatory therapy. An antimetabolite of the group of structural analogs of folic acid is prescribed to modify the immune response. During remission, physiotherapy, breathing exercises, therapeutic massage are performed.
- Diseases of internal organs.Treatment of pneumonia includes antibacterial agents, as well as drugs that relieve bronchospasm. During the rehabilitation period, vibration massage and therapeutic exercises are prescribed. Intercostal neuralgia is treated with warming and anti-inflammatory ointments. Distraction therapy with topical medications with red pepper extract or bee venom is often used. Treatment of gastric ulcer consists of combined antibiotic therapy, as well as drugs that reduce the acidity of gastric contents. Help with cholecystitis includes the use of antispasmodics and drugs that act on the bile. In some cases, antibiotic therapy may be needed. In the presence of large stones in the gallbladder, it is recommended to remove the latter - cholecystectomy.
- Tumors.Treatment of tumor processes consists of chemotherapy with antineoplastic drugs and surgical removal (if possible) of the neoplasm.
- Mental lability.Mental lability requires intensive psychotherapy as well as the use of antidepressants or anxiolytics. Limiting psychoemotional stress is an important part of treatment.
How to prevent?
To prevent back pain in the shoulder blade area, lifestyle modifications are needed: increasing the nutritional value of the diet, playing sports, quitting smoking and drinking. It is important to detect and treat chronic diseases in a timely manner, in order to avoid stress overload.
Remember, pain is not an independent disease, but a manifestation of a much more serious pathology that requires diagnosis and proper treatment!