Stitching and pain under the shoulder blade

Pain under the scapula is a clinical sign of many pathological conditions, which may include gastrointestinal, cardiological, neurological diseases, as well as osteochondrosis, intervertebral hernia, bronchopulmonary pathology and others.

The pain symptom can vary in intensity and location – under the right or left shoulder blade, and sometimes limit a person’s motor activity. Pain under the scapula is most often associated with spasms of skeletal muscles due to tension or with a reflection of pain emanating from the internal organs located in the scapular region.

Causes of pain under the shoulder blades

Regio scapularis is the name of the scapular region, which is limited by lines – in the upper part of the body between the unpaired spinous process of the most protruding 7th cervical vertebra and the clavicles, below – by the medial vertical line along the lower edge of the shoulder blades, as well as by the line from the armpits to the edge of the deltoid muscle . Diagnosis of pain under the scapula depends on the nature of the symptom, its location and accompanying clinical signs, since the scapular area itself can only hurt due to injury – a blow, a bruise.

The causes of pain under the shoulder blades may be as follows:

Symptoms of pain under the shoulder blades

Symptoms of pain under the shoulder blades are so varied that in clinical practice there is still no single standard algorithm for differential diagnosis. Each medical specialization has its own schemes for collecting anamnesis, examination, testing and examinations, however, there are often cases when a pain symptom is “masked” and does not indicate the true cause. That is why the patient is required to describe as accurately as possible the nature of the pain and all the circumstances under which it occurs. In addition, chronic pain, to which a person has become accustomed, often blurs the diagnostic picture, as a result of which time is wasted and the therapeutic effect is much more difficult to achieve.

What symptoms of pain under the shoulder blade require immediate medical attention?

• Drawing, constant back pain radiating under the shoulder blade, which does not subside within 2-3 days.
• Pain under the shoulder blade during static tension (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 elevated body temperature.
• Pain accompanied by numbness of the arm and shoulder.
• Pain that causes pressure, burning, starting from the middle of the chest.
• Pain that is not relieved by heart medications or sedatives.
• Girdle pain radiating under the shoulder blade.
• Acute, severe pain with vomiting.

Symptoms of pain under the shoulder blades are most often described as follows:

• Sharp pain in the middle of the back, radiating under the left shoulder blade. The pain appeared in the morning and intensified with movement.
• Sharp, severe pain under the shoulder blades.
• Dull pain below the shoulder blades, worsening with raised arms.
• Drawing, aching pain under the shoulder blade, spreading down to the lower back.
• Pain under the left shoulder blade and a feeling of tightness in the chest.
• Pain under the shoulder blades in the form of a localized area, burning.
• The pain intensifies when a cough appears.
• The pain under the shoulder blade is replaced by a burning sensation and numbness in the arm.
• Intense pain that goes away after vomiting.

Despite the variety of causes that provoke pain under the shoulder blades, there are differential signs – danger signals that allow an experienced doctor to exclude relatively benign diseases associated with dorsalgia. Alarming symptoms that may accompany pain in the shoulder blades are the following:

• Hyperthermia – 38-40 degrees.
• Spontaneous pain that increases and provokes a condition of “acute abdomen”.
• Shortness of breath, cyanosis of the skin.
• Swelling of the hands.
• Pain that does not subside at rest.
• Vomiting.
• Fall in blood pressure. pulse
• Fainting.

Back pain under the shoulder blades

Back pain in the scapular region can be associated with many diseases, but most often it is caused by deformation of the spinal column, especially if accompanied by a feeling of numbness in the limbs and tingling in the fingers.

In addition, back pain under the shoulder blades is provoked by the following diseases and conditions:

• Curvature of the spine – kyphosis.
• Herniated disc in the thoracic region.
• Lateral curvature of the spine – kyphoscoliosis.
• Cardiac ischemia.
• Humeroscapular periarthritis.
• Intercostal neuralgia.
• Frontal curvature of the spine – scoliosis.
• Angina pectoris – stress or rest.
• Protrusion (degeneration) of the thoracic spine disc without rupture.
• PUD – gastric ulcer.
• Cholecystitis.
• Hepatic colic with concomitant dyskinesia of the gallbladder.
• Dry pleurisy.
• Pneumonia.
• Inflammation of the interscapular muscles, tendons, supraspinous ligaments.

Pain under the shoulder blade on the left

A pain symptom under the left shoulder blade may be associated with the following diseases:

• Periodic pain under the left shoulder blade may indicate a developing stomach ulcer. The pain increases quickly, accompanied by nausea and then vomiting, the symptom is associated with food intake or lack thereof – hunger pain. The pain begins in the epigastrium and spreads sideways – to the right or left, most often radiating under the left chest and under the left shoulder blade.
• Autonomic crises are also characterized by left-sided pain, massaging under cardiopathy. Pain under the shoulder blade on the left, pulling, aching in nature, often causing a feeling of fear, not relieved by nitroglycerin and other heart medications – this is a typical sign of psychogenic conditions.
• Myocardial infarction most often has clearly expressed symptoms in a clinical sense – a burning sensation in the middle of the chest, pain radiating to the left side of the jaw, to the arm, under the left shoulder blade, numbness of the limb, nausea.
• Angina – attacks of pain can develop during exertion, stress (angina pectoris) or as an exacerbation of a chronic form (angina at rest).
• Intercostal neuralgia is accompanied by acute pain, often of a girdling nature, radiating to the right or left under the scapula. The symptom may intensify with changes in body posture and physical activity. The pain is relieved by warming up and relaxing the muscles.
• Osteochondrosis, both cervical and thoracic, is also one of the reasons that provokes pain under the left shoulder blade. The pain symptom is accompanied by dizziness, nausea, numbness of the arms or one arm.
• Perforation of an ulcer is an acute condition, which is expressed in very severe pain, radiating to the collarbone area, under the scapula. In addition to intense pain, the patient is characterized by a posture with knees pressed to the stomach, cold sweat, cyanosis, a drop in blood pressure and pulse.

Pain under the shoulder blade on the right

The pain symptom that appears under the right shoulder blade is associated with the following diseases:

• Biliary colic with spasm of the bladder, ducts due to blockage with stones. The pain is sharp, cutting, localized under the right rib and radiating to the back under the shoulder blade.
• Pain under the shoulder blade on the right can be caused by a diaphragmatic abscess. The symptom is very acute, intensifies with inhalation, even not deep, and most often radiates to the right.
• Acute pyelonephritis begins with pain in the lumbar region, which subsequently spreads higher and radiates under the right shoulder blade. The purulent process in the right kidney is accompanied by painful urination and elevated body temperature.
• Myofascial syndrome is also the cause that provokes pain under the scapula on the right. These are chronic muscle pains associated with irritation of certain trigger points.
• Among the factors that provoke a pain symptom under the right shoulder blade, sometimes there is herpes – herpes zoster. This is a viral disease that is not considered life-threatening, but it causes very severe, excruciating pain, burning and numbness. Herpes is typical of a rash, itching, and muscle pain extending to the shoulder blade.
• Osteochondrosis is one of the reasons that often provokes radiating pain under the shoulder blades, including the right one.
• Right-sided pneumonia. Pain during pneumonia most often manifests itself in the acute stage; there may be increased body temperature and a feverish state.

If the pain radiates under the shoulder blade

Any pain symptom that “gives away” is called irradiation. The impulse of visceral pain can be so intense that the irritation of the primary nerve branch is rapidly transmitted along the chain to the final branch, that is, far from the original source. The pain radiates under the shoulder blade most often from an organ affected by inflammation and can be provoked by the following reasons:

• Increased pressure in the intestines due to inflammation and ulcerative process. With an ulcer, the postbulbar portion of the duodenum radiates to the right under the scapula.
• Biliary colic (gall bladder, liver).
• Acute pain radiates under the left shoulder blade and during an attack of angina, when sensations of pressure and compression appear.
• Pericarditis may also present with referred pain under the shoulder blades.
• Dissection of the walls of the aorta (aneurysm) is manifested by severe substernal pain radiating to the neck, left side, shoulder, and under the scapula.
• Pneumothorax (spontaneous) – acute pain in the chest with reflection under the scapula, in the area of ​​the scapula.
• Exacerbation of pancreatitis.
• Renal colic.
• Acute musculoskeletal dorsalgia.
• Myocardial infarction.
• Osteochondrosis of the cervical spine.

Referred pain may be transient, but can also signal that an acute condition is developing that requires immediate medical attention. If the pain radiates under the shoulder blade and is not relieved by antispasmodics and heart medications, you should consult a doctor who will conduct an examination, differential diagnosis and prescribe adequate treatment.

Pain under the shoulder blades when inhaling

A painful symptom under the shoulder blade, which intensifies with inhalation, is a signal characteristic of the following pathologies:

• Dry pleurisy is an inflammatory process in the pleura, the lining of the lungs. The pain may intensify with bending and movement, and subside in a horizontal position or on the side. The accumulating fluid in the pleural cavity provokes swelling and pain under the shoulder blade when inhaling.
• Pericarditis is an inflammatory process in the pericardial sac of the heart; the disease is manifested by weakness, chest pain, which becomes more intense when inhaling.
• Pain under the shoulder blades when taking a deep breath may indicate intercostal neuralgia, which manifests itself in the form of girdle pains that seem to tighten the chest.
• Diseases of the gallbladder, spasm, colic, may also be accompanied by a pain symptom associated with inhalation.
• Renal colic (pyelonephritis, kidney abscess) can also be accompanied by pain in the hypochondrium, so intense that it spreads throughout the epigastric region, extends under the scapula and intensifies with inhalation.

Aching pain under the shoulder blade

Aching pain under the shoulder blade is evidence of a chronic process both in muscle tissue, in the spine, and in internal organs, which can signal their pathologies with reflected pain.

Scapular-costal syndrome (SRS) is the most common cause of aching pain. This syndrome is characterized by vegetative pain – aches, aching sensations, dull pain, which are often associated with weather conditions. In a clinical sense, aching pain under the scapula is not a specific sign of a particular disease, so differentiation of pain should be carried out by excluding threatening conditions. Often, the aching nature of pain in the area of ​​the shoulder blades can serve as the first signal of an attack of resting angina, and myocardial infarction can also be such a symptom, which does not always have a clearly defined clinical picture. However, the main factors that provoke aching pain are considered to be osteochondrosis, scoliosis, kyphosis and other degenerative, dystrophic pathologies of the spine.

In addition, aching pain under the shoulder blade can be caused by psychogenic factors, autonomic crises, and fibromyalgia. The most alarming symptom is one that is accompanied by nausea and vomiting, since this may be the beginning of an exacerbation of a stomach or duodenal ulcer.

Severe pain under the shoulder blade

Intense severe pain under the shoulder blade – left or right – is a reason to seek medical help; often such a painful symptom cannot be relieved on your own, and it may also indicate life-threatening conditions. Severe pain under the shoulder blade can be caused by the following diseases:

• Daggering, sharp, shooting pain, which intensifies during inspiration, and is 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, and enlarged (compensatory) veins in the neck.
• Severe pain that radiates under the scapula and is accompanied by arterial hypertension indicates an exacerbation of osteochondrosis of the thoracic spine. Simultaneous back pain under the shoulder blade, headache and jump in blood pressure is a clear symptom of pinched nerve endings in the cervical or thoracic region. The pain may intensify when turning the body, shoot through when bending or moving, and is not relieved by heart medications or sedatives.
• Severe pain under the shoulder blade may be associated with a perforation of an ulcer in the upper stomach. If the perforation progresses quickly, the pain intensifies literally every minute, the general clinical picture of the ulcer is typical – acute pain with irradiation, possible vomiting, cold sweat, cyanosis of the face, a characteristic posture – knees tucked to the chest.
• Hepatic (biliary) colic also manifests itself as severe pain radiating upward to the right, under the shoulder blade, in the neck and even in the area of ​​the right eye. The pain symptom is associated with blockage of the bile ducts after eating fried, fatty foods.
• A purulent process in the area between the diaphragm and the organs below, a subdiaphragmatic abscess, is an acute condition that requires immediate medical attention. A developing bacterial infection in this form can provoke general intoxication and sepsis. In essence, this is purulent peritonitis, limited to the diaphragm, manifested by severe pain in the hypochondrium, radiating to the right – the shoulder, under the scapula. Also typical hyperthermia up to 40 degrees, fever, nausea.

It is not recommended to endure a strong, radiating pain symptom for more than an hour; if it cannot be stopped by available means, you need to call emergency help.

Dull pain under the shoulder blade

The nature of the pain under the shoulder blades can vary from aching, dull to very intense, sharp. A dull pain under the shoulder blade indicates that the cause is most likely related to the muscular system, tendons and ligaments.

In clinical practice, there is data confirmed by long-term observations:

• 85-90% of all pain symptoms in the back and shoulder blades are caused by inflammation, sprains, damage to muscles and tendon-ligamentous apparatus. As a rule, these pains are dull, aching in nature.
• 5-7% of pain symptoms in the back, under the shoulder blades, in the area of ​​the shoulder blades are associated with neurological pathologies (radicular syndrome). These are intense, sharp pains.
• 3-4% are due to other reasons – diseases of the respiratory system, heart, gastrointestinal tract, biliary pathologies. The pain is usually intense, sharp and requires immediate medical attention.

Dull pain under the shoulder blade is most often a reflex, vertebrogenic syndrome, which is characterized by the following symptoms:

• The pain has a clear localization – under the right or left shoulder blade, in the middle of the back between the shoulder blades.
• The pain does not radiate to the limbs or other parts of the body.
• The pain is dull, aching in nature.
• The pain symptom intensifies with physical activity on damaged muscles and ligaments.
• The painful area is painful on palpation.
• No symptoms of disc prolapse and compression (radicular syndrome).
• Absence of vegetative-vascular disorders.

Typical causes that provoke aching, dull pain under the shoulder blades are the degenerative process in the intervertebral discs (osteochondrosis) of the cervical spine in the C5-C7 area. In addition, dull pain can be a consequence of the inflammatory process in the intervertebral joints, a signal of the developing severe pathology – ankylosing spondylitis (ankylosing spondylitis). Often, dull pain is a sign of arthrosis, hidden injury to the intervertebral joints, spondylosis, and scoliosis.

Among the reasons that provoke a pain symptom under the shoulder blade of an aching, dull nature, there are diseases of the internal organs:

• Pleurisy.
• Chronic bronchitis.
• Pneumonia in chronic form.
• Atony of the gallbladder is dyskinesia of the hypotonic type.
• Chronic pyelonephritis (sclerotic process of renal tissue).
• Oncological process in the liver and pancreas in the initial stage.
• Also, a dull pain under the shoulder blade on the left often signals a developing cardiovascular pathology – pericarditis, myocarditis.
• The pain symptom increases gradually, intensifies in stressful situations, with concomitant infectious and viral diseases. Also, latent bronchitis often manifests itself in an atypical form, pneumonia, when the pain increases only when coughing or if you go to bed on the “unhealthy” side.

Sharp pain under the shoulder blade

The sharp nature of the pain in the area of ​​the shoulder blades, under them, indicates a serious, sometimes life-threatening, condition.

The reasons that cause sharp pain under the shoulder blade may be the following:

• Dissecting wall of the thoracic aorta (aneurysm). The pain is sharp, intense, radiating along the spine, most often to the left, in the shoulder, under the shoulder blade.
• The initial stage of pleurisy. The pain is sharp, acute, intermittent, often localized under the right or left shoulder blade in the area of ​​fluid accumulation in the pleura. If pleurisy is accompanied by intercostal neuralgia, the pain becomes girdling.
• Spontaneous pneumothorax, which manifests itself as a sharp pain under the shoulder blade (referred from the chest). The condition is characterized by severe shortness of breath and acrocyanosis.
• An attack of acute pancreatitis. The disease is accompanied by a sudden sharp pain in the epigastrium with reflection to the left in the chest, shoulders, heart area, under the shoulder blade.
• Myocardial infarction is most often characterized by increasing pain, but it can manifest itself as sharp, intense pain that quickly spreads from the chest, radiating to the left into the shoulder, jaw, under the shoulder blade, and into the back.

Pain behind the shoulder blades

The pain behind the shoulder blades, between them, as a rule, is not intense, so a person does not pay attention to the symptom, considering it temporary, transient. Failure to timely determine the cause, the factor that provokes such pain, can lead to the development of chronic, difficult-to-treat diseases.

Persistent, persistent pain between the shoulder blades and under them is most often caused by muscle tension, which in turn is explained by professional specifics – sedentary work in an office, at a sewing machine, driving a car, and so on. Typically, pain in the back under the shoulder blades is not associated with life-threatening pathologies or even with degenerative changes in the spinal column, since the thoracic region is not mobile, it is quite stable and resilient. Most often, disorders, changes, and less often inflammation, affect the muscular system of the interscapular region; ligaments and tendons can also be stretched.

Pain of this type, associated with muscles, is characterized by a feeling of heaviness and tension, which quickly disappears with active movements (exercises), massage or warming up.

Pain, which is caused by damage, stretching of the tendons, is felt differently, it causes a feeling of aching under the shoulder blades, often the pain symptom is reflected in the heart area. The person also complains of numbness in the hands, a tingling sensation, and “crawling goosebumps.” It is not possible to neutralize such pain with heart medications, but you can get rid of it and do it quite simply:

• Change your body position periodically, preferably every half hour. If the work is sedentary, you need to stand up, walk around, make circular movements with your arms and shoulders, bring your shoulder blades together and spread them apart.
• It is advisable to devote 20-30 minutes daily to stretching exercises for the muscles of the interscapular area, and for general muscle tone of the body. Regular exercise will help prevent muscle spasms and pain in the back of your shoulder blades.
• It is necessary to periodically massage the shoulder-scapula area and collar area.
• From time to time you can do the following exercise: put a small (tennis) ball on the floor, lie on it with your upper back and “roll” the ball, passing it vertically and between your shoulder blades.

If a pain symptom from the back under the shoulder blades is accompanied by a cough, low-grade fever, pain increases with breathing, cough reflex, you should consult a doctor and be examined to exclude diseases of the bronchopulmonary system.

Nagging pain under the shoulder blades

The nagging nature of the pain is most often caused by increased muscle tone due to pinched nerve roots. The reason why nagging pain develops under the shoulder blades may be myofascial syndrome, as well as osteochondrosis of the cervical spine, or, less commonly, intervertebral hernia with protrusion.

Degenerative changes that reduce the height of the intervertebral foramina, causing displacement of the vertebrae to the right or left, are accompanied by inevitable pinching of nerve endings. Unlike intercostal neuralgia, which is characterized by acute symptoms and girdle pain, dystrophic pathologies of the spine develop more slowly and are accompanied by aching, nagging, constant pain.

In addition, nagging pain under the shoulder blades can be caused by scapulocosteal, scapulocosteal syndrome – SRS. In addition to painful sensations, a person clearly hears a specific sound – crunching. Also typical for LRS are referred pains that spread to the shoulder, neck, and often to the back of the head. The course of the disease is long, it recurs, but the prognosis is quite favorable.

Pain under the shoulder blade when moving

Severe, intense pain that increases with movement or breathing indicates compression of the nerve roots. Compression is caused by muscle spasms, hernia, protrusion and provokes pain under the shoulder blade when moving.

The causes of such pain are most often associated with diseases and conditions:

• Neuropathy of the thoracic and suprascapular nerve as a result of overexertion (sports), trauma, viral disease.
• Intercostal neuralgia, typical symptoms of which are sharp, girdling pain, aggravated by movement, interfering with breathing and bending. The pain is paroxysmal and one-sided; during the peak of the pain, the person “freezes” and finds it difficult to take a breath. Intercostal neuralgia is a consequence of advanced, undiagnosed thoracic osteochondrosis. The thoracic area of ​​the spine is stable; disc deformation develops over a long period of time and is accompanied by unexpressed periodic dull pain, which can also intensify with movement. Due to the non-specificity of symptoms and not expressed pain, osteochondrosis of the sternum is often “masked” as symptoms of other diseases – cardiological, bronchopulmonary. The acute stage of the disease is compression of the intercostal nerves, in which the intensity of pain depends on the position of the body, the motor act