Painful sensations in the muscles, myalgia, as a symptomatic phenomenon have not been studied enough, especially pain in the muscles of the scapula. Until now, muscle pain symptoms are classified either as vertebrogenic diseases or neurological diseases, that is, they are associated with radiculopathy, spondyloarthrosis, osteochondrosis, and so on.

Relatively recently, separate nosological units have appeared in the classification of diseases – fibromyalgia and myalgia, which are directly related to muscle tissue. Despite the fact that soft tissue pathologies, including pain in the scapula muscles, have been studied since the 19th century, there is no unity in terminology and systematization of syndromes yet. Obviously, this is due to the close anatomical relationship between soft (periarticular) tissues and bone structures in the back and in the human body in general. Pathology of the back can cover several nearby anatomical zones at once; such pain is usually called dorsalgia, but pain manifestations in the region scapularis (area of ​​the shoulder blades) are more correctly and accurately called scapalgia.

Causes of pain in the muscles of the scapula

Unlike other muscle syndromes, the causes of pain in the scapula muscles most often have nothing to do with the “culprit” of all spinal pain – osteochondrosis. This is due to the lack of mobility and rather strong structure of the thoracic spine. Consequently, almost all painful sensations in the area of ​​the shoulder blades are associated with muscle tissue, as well as damage to tendons and supraspinous ligaments.

The main cause of aching pain in the middle of the back is explained by prolonged muscle tension, usually due to the specifics of professional activity. First of all, this applies to those who maintain the same position for a long time, often sitting – drivers, office workers, seamstresses, students, and so on. As tension accumulates in the shoulders and in the area of ​​the shoulder blades, it leads to compensatory shortening and contraction of the pectoral muscles, aggravating the condition and the habit of stooping, stretching the head and neck forward. As a result, the levator scapulae muscles, part of the trapezius muscle, sternoclavicular, deltoid muscles are overstrained, and others located in the middle of the back – the lower part of the trapezius, neck flexors, serratus anterior – are subject to compensatory stretching or weakening, all these abnormal, non-physiological phenomena provoke pain.

Also in clinical practice, the causes of pain in the scapula muscles are classified according to the types of muscular-tonic syndromes:

  • Pectoral muscle (pectoralis minor) syndrome or scalene syndrome. Pain in the area of ​​the shoulder blades manifests itself on the line of the 3rd-5th rib and feels like a burning, aching sensation. The symptom may be worse at night, when moving the body, or when abducting the arms (hyperabduction). Often such manifestations resemble angina attacks, which makes diagnosis much more difficult. In addition, chronic hypertonicity of the pectoralis minor muscle leads to infringement of the nerve and choroid plexus, a bundle located near the coracoid scapular process, resulting in loss of sensitivity in the hand and fingers. Pain in pectoral muscle syndrome is localized in the anterior deltoid zone, between the shoulder blades, and is transmitted along the ulnar (ulnar) surface of the shoulder and forearm.
  • Syndrome m. serratus posterior superior – the superior posterior serratus muscle is often provoked by a degenerative process in the upper thoracic intervertebral discs. The pain is localized under the shoulder blade, felt deep in the muscles, and is an aching, dull pain.
  • Syndrome m. serratus posterior inferior – the lower posterior serratus muscle is felt as a chronic, debilitating dull pain in the lower back (at the level of the chest). The syndrome limits body movements when bending and rotating.
  • Interscapular syndrome is felt as aching, aching pain between the shoulder blades. The symptom intensifies with prolonged horizontal position of the body, when bending, the pain can become quite severe when traveling over rough terrain (vibration). The pain is localized at the attachment point of the rhomboid, trapezius and latissimus dorsi muscles (the area of ​​the spine of the scapula), and can spread to the shoulder and forearm along the ulnar nerve.
  • Acquired pterygoid scapula syndrome, which causes paralysis of the serratus anterior, trapezius, or rhomboid muscles. Paralysis can be caused by both an infectious disease and injury, bruise, including professional ones (athletes, circus performers).

    • In addition, pain in the muscles of the scapula can be caused by an inflammatory process in the muscle tissue – myositis. Myositis, in turn, is provoked by the following factors:

  • Subcooling.
  • Infections, including viral ones.
  • Occupational diseases associated with muscle hypertonicity.
  • Back injuries.

    • Quite often, pain symptoms in the area of ​​the shoulder blades are poorly differentiated by sensation, so it is difficult to determine what actually hurts – muscles, bone tissue, tendons, or whether this symptom is referred pain, indicating possible pathologies, such as the following:

    • IHD – coronary heart disease.
    • Angina pectoris.
    • Myocardial infarction.
    • Protrusion or herniation of intervertebral discs of the thoracic spine.
    • Kyphoscoliosis.
    • Intercostal neuralgia.
    • Spondyloarthrosis.
    • PUD – gastric ulcer.
    • Diseases of the respiratory system – pneumonia, pleurisy.

    In order to correctly determine the causes of pain in the scapula muscles, it is necessary to describe the characteristics of the symptom as accurately as possible.

    How does pain in the scapula muscles manifest?

    Symptoms of muscle pain are characterized by sensations of tension and stretching. Unlike joint aching pain, symptoms of pain in the muscles of the scapula are often aching in nature. Although the interscapular muscles located between the spinous processes can hurt quite intensely, similar to the joints. If a patient complains of persistent pain in the area of ​​the shoulder blades, radiating to the left, not subsiding when changing body position, accompanied by a feeling of coldness in the back, this is most likely evidence of damage not only to muscle tissue, but also to tendons and ligaments.

    The nature of pain in the scapula area can be different, depending on the source of the pain signal and the cause that provokes it: Parameters by which symptoms of pain in the scapula muscles are differentiated:

    • Description of the sensation: sharp, aching, stabbing, squeezing, aching pain.
    • Localization of pain – between the shoulder blades, under them, under the right or left, at the top of the shoulder blades.
    • Duration of pain – transient, long-term, chronic.
    • Dependence on body position – subsides when changing position, intensifies with certain movements.
    • Distribution by type – visceral (referred), neuropathic or muscle pain only.

    How to distinguish the types of muscle pain in the shoulder blade?

    Symptom

    • Muscular
    • Reflex, visceral
    • Neuropathic

    Description

    • Precise characteristics, including indication of localization
    • The description is vague, the pain is diffuse, comes from the inside, from the depths to the muscles
    • The pain spreads in the direction of the nerve roots, radiates

    Are there any movement restrictions?

    • Often limits physical activity
    • Movements are not limited
    • Movement of the limbs is slightly limited; restrictions concern the range of motion of the chest and back

    Effect of movement on pain

    • Pain worsens with movement
    • Does not provide
    • Provides only axial load, as well as reflex movements – coughing, sneezing

    Determination by palpation

    • The spasmodic areas are well palpated. Palpation makes pain worse
    • The source of the symptom cannot be identified by palpation
    • Possible definition

    Pain in the muscles under the shoulder blade

    Pain in the muscles under the shoulder blade can be both a sign of true myalgia and a signal of more dangerous diseases, such as:

    • Gastric ulcer, which is most often localized in the epigastric area, but can radiate to the left side – to the chest area, under the left shoulder blade. The pain is not differentiated by structural type; it is difficult to determine what exactly hurts – muscles, ribs. Therefore, if pain under the shoulder blade is associated with eating, most likely it is caused by a disease of the gastrointestinal tract.
    • An attack of angina often resembles pain in the muscles under the shoulder blade. It is difficult to differentiate these two symptoms on your own, however, with angina, the pain subsides after taking vasodilators; muscle pain cannot be neutralized by these drugs.
    • Intercostal neuralgia can also manifest itself as paroxysmal, girdling pain in the lower part of the scapular area. The pain intensifies when coughing, sneezing, painful areas are easily determined by palpation.
    • Muscular spasticity of the gallbladder, blockage of the bile ducts often manifests itself in the form of colic, and the pain can be sharp, cutting, radiating to the right upper part of the body, under the shoulder and right shoulder blade.

    In any case, a simple pain symptom that a person considers to be muscular should resolve without specific treatment within a maximum of 1-2 days. To relax the muscles, rest and relaxation are enough; if the pain under the shoulder blades does not subside, you must urgently seek medical help.

    Diagnosis of pain in the scapula muscles

    The task of diagnostic measures in determining the cause of muscle pain in the area of ​​the shoulder blades is, first of all, to exclude possible life-threatening pathologies – angina attack, myocardial infarction, perforation of a gastric ulcer and the following diseases:

    • Oncological processes in the spinal column.
    • Oncological processes in internal organs.
    • Neurological pathologies requiring urgent therapy.
    • Psychogenic factors, diseases, including psychopathologies.

    This is due to the fact that the diagnosis of pain in the muscles of the scapula is difficult due to the nonspecificity of the symptoms; the clinical picture rarely indicates a specific diagnostic direction; in addition, almost all dorsalgia rarely correlates with the results of instrumental examinations. Quite often there are cases when there is a pain symptom, but the examination does not reveal a single reliable pathological source of pain; it also happens that studies identify pathology that is not accompanied by a clearly expressed clinical sign.

    As a rule, diagnosing pain in the scapula muscles includes the following actions:

    • A brief history taking, a detailed description of the background history of the symptom is not required, since a painful muscle symptom is not considered pathognomic for a dangerous, threatening pathology.
    • Clarification of the nature and parameters of pain:
      • Localization, possible irradiation.
      • In what posture or body position does pain appear?
      • What time of day does the pain occur?
      • Relationship between symptoms and motor activity and other factors.
      • The rate of symptom development is spontaneous or increasing pain.
    • Visual examination of the patient:
      • Asymmetry of the glenohumeral zone.
      • Detection of possible scoliosis, abnormalities in the structure of the spine (Forestier symptom test).
      • Mobility of the spinal column in the thoracic region (Ott’s symptom test, Thomayer’s symptom).
      • Determination of possible pain along the spinous processes (Zatsepin’s symptom, Vershchakovsky’s test, bell’s symptom).
    • Instrumental examination is most often not required, since muscle pain is considered benign in 95% of cases. Research is needed only in cases of suspicion of the following pathologies:
      • Signs of an acute infectious process.
      • Signs of oncology.
      • Obvious neurological symptoms.
      • Injury.
      • Unsuccessful treatment for a month.
      • X-rays are also necessary if the patient is referred for manual therapy or physiotherapeutic procedures.
    • Electromyography may be prescribed to identify characteristics of muscle structure.

    It should be noted that the widely used practice of sending a patient with muscle pain for an x-ray can significantly complicate the diagnosis, since the vast majority of our contemporaries have certain signs of osteochondrosis and other diseases of the spine. The mere presence of a degenerative process in the spinal column does not exclude the myogenic factor that provokes pain in the muscles of the scapula and cannot be the basis for a correct diagnosis.

    Treatment of pain in the muscles of the scapula

    Treatment of pain in the scapula muscles can be divided into two stages – short-term, emergency measures and long-term tactics.

    Urgent measures

    Long-term events

    Neutralization of pain symptoms with analgesics or anti-inflammatory non-steroidal drugs

    Preventing the causes of muscle pain

    Prescription of myelorelaxants

    Gentle stretching or dynamic exercises

    Injection or acupuncture effects on TT (trigger points)

    Exercises aimed at correcting posture

    Relief, neutralization of comorbid symptom complexes

    Correction of professional load

    Normalization and weight maintenance

    Psychocorrection of pain symptoms

    Compliance with the rules of a healthy lifestyle, including physical activity

    In general, treatment of muscle pain is not difficult; as a rule, it is enough to rest overstrained muscles and eliminate factors that provoke the symptom. Massage and training in relaxation methods, including post-isometric relaxation, also give good results.

    How to prevent pain in the scapula muscles

    How to prevent muscle pain, wherever it develops, in the back, in the area of ​​the shoulder blades, lower back, neck? Obviously, there are no specific recommendations, because each human body is individual in its anatomical structure, physiological and other parameters. However, preventing pain in the scapula muscles means following well-known, but, unfortunately, rarely used measures in practice. These rules relate primarily to the following points:

  • If a person is undergoing treatment for muscle or other pain or disease, it is necessary to strictly observe and fulfill all medical prescriptions. Self-medication is an extremely common phenomenon, but its effectiveness is minimal, in contrast to the huge number of complications.
  • After completing a course of treatment for muscle pain, you need to maintain a gentle motor regimen, but this does not mean complete rest and inaction. Muscles need to be trained, otherwise the opposite effect of hypertonicity will occur – adynamia, atrophy and weakness of the muscle structure.
  • Muscle tone is well maintained by regular exercise, even if a person does not engage in professional sports, simple morning exercises can easily replace complex workouts.
  • All factors provoking static voltage should be excluded. If a person’s professional activity is associated with constant overstrain of the muscles of the shoulder blades, it is necessary to regularly change body position during the working day. do warm-ups.
  • To maintain muscle tone and unload the spine, you need to monitor your posture and, if necessary, wear a corrective corset.

    • Pain in the muscles of the scapula is a rather complex polyetiological symptom, and not an independent disease. Only a doctor can determine the exact cause of the pain, carry out all the necessary examinations and prescribe effective treatment. All that is required of the person experiencing discomfort in the area of ​​the shoulder blades is to take care of their health and promptly seek help at the first warning signs.

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