Pain under the shoulder blade: causes and treatment. Pain under the right shoulder blade from the back

It is necessary to pay attention and try to determine the cause of its occurrence.

People who, due to the specific nature of their work, constantly strain the muscles of the shoulder girdle, usually suffer from pain in the shoulder blades. This is a “professional” pain for drivers, typists, seamstresses, designers, etc.

The sensation of pain comes from the muscles of the subscapular region, tendons, and ligaments, which are under chronic strain.
The intensity of pain varies from moderate to burning-severe.

Nature of pain under the shoulder blade:

• Spicy.
• Aching.
• Tingling.
• Cutting.
• Compressive.

• Under right shoulder blade.
• Under the left shoulder blade.
• Between the shoulder blades.

What diseases can cause pain under the left shoulder blade?

2. Subphrenic abscess
A subdiaphragmatic abscess is a purulent collection in the cavity between the diaphragm and the underlying organs. The cause of its occurrence is bacterial infection of the body. This acute condition often occurs after transferred operations on the abdominal organs, during which the infection was introduced.

Characterized by acute sharp pain under the ribs, under the right shoulder blade; reflected in right shoulder. The pain intensifies with deep inspiration. An increase in temperature is observed. In atypical cases, pain may not appear.

3. Pyelonephritis and nephritis
Inflammatory kidney diseases give symptoms in the form of pain in the right lower back, reflected in the hypochondrium, right shoulder blade. Patients complain about frequent urge to urination that is painful; thirsty, chills. The pain is spreading, aching, and nausea may occur. Temperatures can rise to critical levels - 40 degrees.

4. Cholelithiasis
This disruption of the functioning of the gallbladder is manifested by colic and acute pain. Pain occurs on the right, in the hypochondrium, epigastrium. Gradually, the pain is localized in the area of ​​the gallbladder.
Nature of pain: intense, cutting, stabbing.

The pain is reflected to the right and upward, into the right shoulder, jaw, neck, under the right shoulder blade, and occasionally into the heart area ( so-called “cholecystocoronary syndrome”). Pain can affect the occurrence of an angina attack.

What can cause pain between the shoulder blades?

• Disc herniation in the thoracic spinal region;
• Kyphosis;
• Kyphoscoliosis;
• Ischemia;
• Angina pectoris;
• Protrusion ( protrusion) disc in the thoracic spinal region;
• Humeral periarthrosis;
• Osteochondrosis of the thoracic spine;
• Spondyloarthrosis;
• Peptic ulcer disease.
• Cholecystitis, hepatitis and other liver diseases.
• Pneumonia, pleurisy and other diseases of the respiratory system.

What diseases of the shoulder blades exist?

2. "Scapula crunch"
A crunch in the shoulder blade is felt during active movements shoulder joints. Accompanied by discomfort and moderate pain. Reason of this disease is inflammation of the subscapular bursa.

3. Acquired pterygoid scapula
This disease can occur after paralysis of those muscles that connect the scapula to the back of the chest; after myopathy, after damage to the thoracic nerve; after bruises on the shoulder girdle. Injuries and nerve damage are common among athletes and gymnasts.

4. Osteomyelitis of the scapula
This disease can be provoked by open injuries to the shoulder blades due to specific injuries ( gunshot wounds, for example).
Symptoms: pain, weakness, general intoxication. A purulent process may develop.

5. Tuberculosis of the scapula
Enough rare disease, occurs only in adults.

6. Tumors of the scapula
Tumors can be benign or malignant. Differentiated using biopsy and x-ray examination. If the tumor is malignant ( chondrosarcoma, reticulosarcoma) – the doctor can send the patient for interscapular-thoracic resection. During this operation, the body of the scapula, adjacent muscles, and the acromion process are removed.

Who should I contact if I complain about pain in my shoulder blades?

• Gastroenterologist
• Vertebrologist
• Traumatologist

Back pain in most cases is the main symptom of the underlying disease. Diseases of the back and musculoskeletal system rank second after cardiovascular diseases in terms of the percentage of disability to the number of patients. The situation is explained by the fact that people ignore painful sensations, trying to eliminate symptoms. If your back hurts in the shoulder blade area, doctors advise starting treatment immediately to avoid serious complications.

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Localization

According to statistics, back pain in the area of ​​the shoulder blades is the most common symptom when contacting to a specialized doctor. Unpleasant sensations in the lower back or chest are much less common. This is explained by the fact that, for example, thoracic vertebrae significantly less susceptible to deformation. The situation is the same with the lumbar region, where the average person has a stronger muscle corset.

Pain under the scapula, on the contrary, is a symptom that characterizes many diseases associated not only with osteochondrosis and degenerative changes in cartilaginous structures.

When your back hurts in the area of ​​your shoulder blades, the doctor at your appointment will first of all try to determine the location of the discomfort. If pain is detected under the shoulder blade, this is an important sign for the doctor, thanks to which he begins to build theories regarding the alleged disease.

In modern medicine, it is customary to distinguish the following types of back pain in the area of ​​the shoulder blades:

• Pain under the shoulder blades;
• Unpleasant sensations between the shoulder blades;
• Direct pain in the shoulder blades.

It is clear that each patient is individual, but it is worth classifying yourself into one of three groups. Moreover, in advanced cases, all symptoms requiring complex treatment. On the other hand, the doctor will always help you understand which of the three above categories the patient should be classified into. correct setting diagnosis and prescription therapeutic therapy.





Causes of discomfort

Many people automatically associate pain under the shoulder blade with diseases of the musculoskeletal system. There is certainly a healthy grain in this, given that osteochondrosis is main reason See a doctor in this situation. Main, but not dominant. It is not at all necessary that the causes of back pain in the area of ​​the shoulder blades lie in diseases of the spine. You should not look for a direct connection with osteochondrosis.



For example, let’s look at some pathologies that cause back pain in the area of ​​the shoulder blades:

• Heart attack;
• Stomach ulcer;
• Intercostal neuralgia.

During attacks of osteochondrosis, patients often confuse the disease with a heart attack. However, the opposite misconception is also common, when heart problems are attributed to the back. The reason for this is similar symptoms. A heart attack is preceded by a severe attack of angina. The patient experiences pain not only behind the sternum, but also tingling in the entire back.

The main thing in this situation is to urgently call an ambulance, without thinking about osteochondrosis.





How to distinguish pain in the shoulder blades with osteochondrosis from a heart attack?

There is most surefire trick to determine the source of pain in difficult cases. If you feel discomfort in one specific place, then most likely your osteochondrosis has worsened or an attack of intercostal neuralgia is possible. When the pain spreads throughout the back and does not have a specific localization point, then you should suspect problems with the heart.



Remember that you should never take risks. At the first suspicion of a heart attack, call an ambulance!



Symptoms of a stomach ulcer

Gastric ulcers are the last thing patients think about. With this disease, first of all, stomach problems are expected, but few people realize the accompanying back pain. Usually the main place of localization of unpleasant sensations is the left shoulder blade.



Pain is most often associated with eating. With an ulcer, back pain is temporary. It can be described as increasing. After profuse vomiting in patients with ulcers, symptoms in the form of painful sensations in the shoulder blades usually recede.

Intercostal neuralgia

The cause, in the area of ​​the shoulder blades, may also be intercostal neuralgia. It is characterized by the following symptoms:

• Unpleasant sensations intensify with movement;
• Tingling occurs when sneezing and deep breathing;
• Characterized by acute pain throughout the entire back area.



Neuralgia is characterized by localized pain in the left side of the back, although there are exceptions depending on the severity of the disease.

Pain in left shoulder blade

Experienced doctors can quickly navigate the diagnosis if they recognize only the place that the patient points to. There is a list of diseases that accompany unpleasant tingling and other symptoms in the area of ​​the left and right shoulder blades. Of course, there are exceptions to the rules, but long-term medical practice confirms the full dependence of each specific disease on the symptoms diagnosed in the right or left shoulder blade.



If discomfort is felt on the left side, then many patients tend to identify cardiovascular diseases, but this is not always true. Unpleasant sensations in the area of ​​the left shoulder blade can occur for the following reasons:

• Problems with the spine;
• Bronchial diseases (pneumonia);
• Cardiovascular diseases;
• Diseases of the stomach and intestines.

Pay attention to the symptoms of a long-term cold. Pneumonia is one of the most insidious diseases in which pain in the shoulder blade occurs. If in all other cases the patient usually identifies unpleasant symptoms with a certain disease and knows that he has an illness, then pneumonia can remain an unpleasant surprise for the patient until the very end.

Advanced pneumonia threatens fatal. Be careful when acute symptoms The cold is accompanied by pain in the left side of the back. In case of insidious disease localization of unpleasant sensations can also be with right side. This circumstance depends on where, in fact, the source of pneumonia is located.



Pain in right shoulder blade

Unpleasant symptoms in the right shoulder blade have their own solid bouquet of diseases. These include:

• Osteomyelitis;
• Tuberculosis;
• Renal colic;
• Gallbladder diseases.

With osteomyelitis, pain most often occurs due to wound infection. For example, the cause could be a gunshot wound. In addition, recurrent pain indicates the spread of the infectious agent through the blood. Unfortunately, the course of the disease is very unfavorable, since similar symptom already indicates destruction of bone tissue.



Tuberculosis of the scapula is now very rare in people with reduced immunity. The occurrence of the disease in children is practically excluded.

If we talk about problems in the internal organs, then shooting unpleasant tingling sensations indicate renal colic. The pain is unbearable. Please note that it intensifies when the patient takes a breath. In this case, it is necessary to urgently call an ambulance. An acute attack of renal colic, in addition to pain in the right shoulder blade, is characterized by a decrease in blood pressure. In advanced cases, a person loses consciousness, unable to withstand the pain attack.

With gallbladder diseases, pain in the area of ​​the right shoulder blade below occurs due to muscle spasm. The situation is in many ways similar to renal colic. The main difference is that unpleasant sensations are not permanent. At similar problems body pain varies depending on food intake. Harmful products provoke more severe attacks.



Pain in the muscles under the shoulder blades

Another complaint from patients is back pain below the shoulder blades and above the lower back. It is important to understand here that osteochondrosis is unlikely to be the reason for visiting a doctor. Theoretically, of course, degenerative change cartilage tissue can cause a condition where the back muscles under the shoulder blades hurt, but this usually happens in advanced cases. Then patients no longer have a reason to see a doctor, since the situation is critical and osteochondrosis requires immediate surgical intervention.



Most of these sensations are associated with either muscle tissue or tendon damage. At risk, first of all, are people whose professional activities place significant stress in one position:

• Office workers;
• Drivers;
• Seamstresses;
• Pupils and students.

If your back hurts under your shoulder blades, this means that the muscles are tired from DC voltage in one pose. The most important thing here is prevention measures. It is necessary to move more and after the first symptoms appear, give your back a rest.

Unfortunately, muscle pain under the shoulder blades can also indicate inflammatory processes in muscle tissue. For example, myositis.



Sign of cancer

The worst scenario is when pain in the shoulder blade indicates cancer. There are not too many such cases in percentage terms, but the probability still exists. The main problem is that with such back pain in the area of ​​the shoulder blades, rarely does anyone admit the possibility of an oncological process.



It is very difficult to independently identify cancer in yourself, but you need to be wary when pain in the shoulder blades is characterized by the following signs:

• It has a pronounced localization and invariably worries in one place;
• Every day unpleasant condition worsens despite taking medications or using ointments;
• Appears regardless of movement.

As cancer develops, a kind of swelling appears above the tumor site. In such a situation, of course, everyone will go to the doctor, but it is important to do this at the first suspicion. With any cancer disease, even one day of delay can result in fatal consequences.

The prognosis for cancer, one of the symptoms of which is pain in the shoulder blade, depends on many factors. If the tumor is malignant, the five-year survival rate for such patients is approximately 60 percent. With a benign course of the disease painful symptoms appear in a milder form. The survival prognosis is favorable with appropriate treatment.



How to relieve pain under the shoulder blades?

What to do if the pain is very severe? In acute painful attacks, full treatment fades into the background. The main thing for a person is to get rid of symptoms and relieve pain. At the same time, in the future, you still need to start full-fledged treatment, otherwise the underlying disease will progress.

The following medications can be used to relieve pain:

• Nise;
• Ibuprofen;
• Diclofenac.



These ointments will help relieve pain. Within a week you must use one of the products according to the instructions.

A competent massage will bring short-term relief. By influencing special points, a specialist can relieve muscle tension. However, sometimes the simplest movements will help you come to your senses when your back hurts below the shoulder blades.

If you have no one to ask, then try massaging the painful area yourself. Don't try to put too much pressure on the muscles - the main goal is to increase blood circulation. Usually such procedures are enough to relieve an acute attack. After this, it is better to immediately consult a doctor so that a specialist can help you choose the right ointment and other medications for full treatment.



General treatment

Naturally, no doctor will treat a patient for pain in the shoulder blades. He will, of course, help you choose remedies to eliminate pain symptoms, but the main goal is to identify the underlying disease. Further actions will depend on it.



However, sometimes situations occur when the back in the area of ​​the shoulder blades hurts, not only interfering with active life, but also leaving a person bedridden. In this case, it is recommended to undergo a special course of treatment in a hospital, aimed specifically at eliminating pain symptoms.

On average, hospital treatment lasts about ten days. Specialists carry out a number of procedures aimed at relieving discomfort. Therapy is a kind of symbiosis medicines, active exercises, massage, ultrasound therapy and laser exposure. Depending on the patient’s condition, he is given a strict schedule, which he follows while in the hospital.

Usually a person recovers within two weeks, but pain in the shoulder blades can return within a short time if care is not taken. own health. At the same time, repeated treatment in a hospital will no longer be so effective, and few people will want to return to it a second time in a short period of time.



Lifestyle change

The most important aspect when dealing with all possible causes of pain in the shoulder blades is physical activity. Unpleasant sensations are a kind of signal for help from your body. He makes it clear that there is an urgent need to change our lifestyle. Try the following:

• Get rid of bad habits;
• Try to level up physical activity;
• Reduce your consumption of sweets.

Three simple points may not help overcome pain, but they certainly won’t make it worse. The most common human weaknesses have a detrimental effect on the body. Of course, it is impossible to give up your usual lifestyle overnight, but starting with small changes is simply necessary.



Increasing your level of physical activity helps increase blood circulation. Light jogging in the morning, complex physical therapy during the day and a walk in the fresh air in the evening - good complex for any healthy person.

It is important to avoid extremes. Don’t think that pain in your shoulder blades will go away if you quickly build up your muscles. This is completely wrong thinking. If you have been driving for a long time sedentary image life, you have moved little and feel pain in your shoulder blades, then you need to start with small loads, focusing on the condition of your body.

Pain in the scapula area- one of the frequent complaints of patients of various age groups, it often interferes with breathing, moving, and occurs against the background of serious illnesses. In addition, many doctors will agree that this particular pain is the most dangerous.
Dr. Ignatiev’s clinic diagnoses and treats pain around the shoulder blades. The main task of specialists is to eliminate the cause and prevent the disease in the future.

It can hurt on one side (right/left shoulder blade) or on both. Usually this pain occurs against the background of diseases of the spine, especially if there were other symptoms previously.

The first step that the doctor and the patient must find out is to find an answer - where the pain under the scapula comes from. It can come from muscles, ligaments, facet joints, nerves, damaged internal organs, after injury, etc.

Pain under the shoulder blade may occur due to problems with the stomach, heart, and breasts in women. This is the so-called visceral pain. As a rule, symptoms are accompanied by nausea, vomiting, loss of consciousness, etc. This condition can occur after 40-50 years.

If you have a combination of these symptoms, you should contact your doctor immediately.

If the pain occurs against the background of other diseases, then it is more likely to be sharp, strong, occurring abruptly, or, conversely, an aching and dull pain, radiating and pulling with movements of the chest. Stitching or burning pain occurs much less frequently.

• Thoracic osteochondrosis - a degenerative-dystrophic disease of the spine in the middle section is caused by pain below the shoulder blade;
• Protrusion of the thoracic region – complicated osteochondrosis;
• Disc herniation, intervertebral hernia of the thoracic region - protrusion of the disc with rupture of the fibrous ring;
• Increased kyphosis of the thoracic region - increased bending in the area of ​​the shoulder blades, reminiscent of stooping, hunchback.
• Intercostal neuralgia – pinching of the intercostal nerve;
• Scoliosis of the cervicothoracic, thoracolumbar regions - lateral curvature of the spine;
• Kyphoscoliosis, juvenile kyphosis (Scheuermann Mau disease);
• Shoulder-scapular periarthrosis, spondyloarthrosis;
• Coronary heart disease (CHD), angina pectoris, myocardial infarction;
• Stomach ulcer and duodenum, gall diseases;
• Pleurisy, pneumonia and other lung diseases;
• Consequences of injuries;
• Tumors, malignant neoplasms.

From statistics, pain is most often caused by disc herniation Th8-Th9, Th10-Th11, Th11-Th12.

Thoracic spine

All patients shoulder blade hurts in different ways, the most common types of sensations are:

• Pain worsens on the right/left with a deep breath;
• My back was pinched under my shoulder blade;
• Burns (burns) between or under the shoulder blades;
• Pain near the right (left) shoulder blade;
• Stitching, burning, burning, etc.;
• Neck pinched after sleep and radiates to shoulder blade;
• The pain radiates to the arm.

Typical complaints of patients with spinal diseases:

• A burning sensation appeared under the right shoulder blade, especially strong after long work sitting. It goes away a little when lying down, gets worse when you inhale or tilt your head forward;
• It torments for a long time pain in the area of ​​the right shoulder blade, it stings when turning the body, as if something had shifted there or someone had hit it and now there was discomfort;
• After an MRI of the cervical spine, a small protrusion of C4-C5 was found. Why does my back hurt in the shoulder blade area?
• For many years now, the muscle/nerve under the shoulder blade has been pinched in this area; there is a slight numbness that radiates to the fingers of the left hand;
• Salt deposits caused acute pain, help eliminate it.

The first step is to exclude diseases of the lungs and heart. To do this, you can consult a cardiologist and therapist. An ECG or ultrasound may be needed.

If the pain occurs near or near the shoulder blade and intensifies with movements of the spine, then the problem should be looked for in the back. Often these symptoms become severe, which resembles the symptoms panic attacks, VSD.

To diagnose the spine, a regular X-ray will most likely not be enough; an MRI of the thoracic region is considered the most complete. But before conducting self-diagnosis, you should contact a vertebrologist to clarify the diagnosis.

Treatment at Dr. Ignatiev’s Clinic is carried out using non-surgical methods. Before any treatment it is established final diagnosis and treatment tactics are planned.

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After lifting weights (I moved an old model Sony TV), back pain arose. Especially a burning burning sensation under the left shoulder blade. Dull pain when taking a deep breath, when coughing, sneezing. The pain makes me want to bend over. Problems during sleep: it hurts on the back, on the right side too. On the left side - in one position and not for long. It's already 1.5 weeks. The pain does not go away and is constant. Painkillers hardly help. I use Comfrey ointment - 911 for pain in muscles and joints, special ointment with fir oil and formic alcohol. There is no MRI in our hospital; I live in a small Chukotka town. What can you suggest?

Good afternoon, please tell me what this could be. I’ve been having pain under my right shoulder blade for about 2 months now. It only hurts if, for example, I bring my shoulder blades together, or if I turn my torso to the left or right. When I inhale deeply, and then if I sit up straight and inhale normally, if I slouch and I take a breath and there is pain. When I bend back. Even today I was making dumplings and I seemed to be standing a little bent and there was a feeling in my back like heaviness or something. I noticed while I was in the hospital for 3 days with my child and slept on a hospital bed, my back didn’t hurt at all. As soon as we arrived home, I started sleeping on the sofa and this pain started again. In general, tell me what to do. (((((

Hello, the other day something shot in my back under the shoulder blade on the left, then the pain went away, after a few days it began to hurt on the right under the shoulder blade and it was very painful to breathe, nodules were felt under the shoulder blade, my back was tense!

Hello, I wanted to ask you.
For the past half a year I have been bothered by a strong burning sensation in both shoulder blades, a burning sensation as if there were mustard plasters, the skin on the shoulder blade becomes numb when I can’t feel it.
Please tell me what this could be and why?

This could be a simple pinched nerve ending. Contact a vertebroneurologist.

1. Hello, tell me, my grandmother had a herniated disc, and now for several years she has had pain and itching under her left shoulder blade. And her age does not allow her to go to the doctors. They thought it was subcutaneous herpes, but acyclovir did not help and they took medicine for the nerves, too, to no avail. What to do?

   I can’t sleep for two nights and it’s impossible to lie down. The pain when I breathe in and when I exhale doesn’t go away much above the lower back. I had pus in my kidneys during pregnancy. Could this be an exacerbation?

   Hello! Karina, 12 years old. For the past 2 years I have been experiencing pain in the area of ​​my left shoulder blade. Over the course of that year, the pain was frequent, about once or twice a month. Didn't bother me this year, started bothering me again today. The pain is aching. My heart is fine. Pain under the shoulder blade. What could it be? And which doctor should they contact?

   Hello...I'm 30 years old...weigh 56kg...For several years now I've been bothered by pain under my left shoulder blade closer to the spine...Before the pain was aching, but now it's a sharp burning pain and it feels like a needle stabbing...I don't feel the skin in this place at all...B large rooms dizziness, even to the point of loss of consciousness... Often there is not enough air and heaviness in the entire left side, which also covers the ribs... Constant weakness... Please tell me what disease may lie behind these symptoms...

   This can be either vertebrobasilar insufficiency or syndrome vertebral artery. Intercostal neuralgia. Consultation with a neurologist, vertebrologist.

2. Hello. Worry about burning pain in the right shoulder blade. The pain intensifies while sitting...it also swells a little. And there is a feeling of stiffness in the movement of the neck and as if something is inserted between the shoulder blades.

   Back pain between the shoulder blades is often accompanied by a feeling of numbness, freezing and crawling. It should be noted that most often those who experience pain in the area of ​​the shoulder blades are those whose work in one way or another involves excessive tension in the muscles of the shoulder girdle.

   Hello! Tell me, what could it be.
   Two months ago, I started to feel pain above my left shoulder blade, there was a tightness and a dull pain, but it was constant, checked the heart and lungs were normal, took an X-ray. They wrote that the height of the thoracic vertebral bodies was preserved. The contours of the vertebrae were clear. Kyphotic deformation of the vertebrae. Anterior cranial sharpenings of the bodies Tn 7, Tn8 .tn 9 tn10 vertebrae.gop at the level of tn 7 - tn 10.tell me what that means... It won’t be long before I go to the doctor because the child is sick (((can this be treated? And how can I get rid of this pain? Ointments and an injection of diclofenac didn’t even help relieve the pain for a minute pain. the pain is dull but constant. Thanks in advance.

   Hello. I have a dull, general pain under my right shoulder blade and a pain under my right thigh.

3. Burning unpleasant feeling above the left shoulder blade, what could it be?

   Possible compression of the nerve ending in the cervical spine. You must come for an in-person consultation. We deal with such problems.

4. Physiological thoracic kyphosis is normally expressed.

   The height of the vertebral bodies is not changed. Initial degenerative-dystrophic changes in the thoracic spine in the form of slight subchondral sclerosis of the vertebral bodies, the height of the discs is not significantly reduced, a weak signal from the discs due to initial dehydration, the endplates of the Th10-Th12 vertebral bodies are deformed by small Schmorl hernias. Small marginal osteophytes along the anterolateral surfaces of the vertebral bodies.

   Dorsal protrusions/discs are visualized:

   – Th5-Th6 0.17 cm paramedian variant, moderate deformation of the dural sac, anterior subarachnoid space is narrow, sagittal size / canal 1.5 cm;

   – Th10-Th11 0.15 cm median variant, moderate deformation of the dural sac, sagittal size / canal 1.5 cm.

   The substance of the spinal cord is without pathological focal changes.

   Conclusion: MRI signs of initial degenerative-dystrophic changes (osteochondrosis) of the thoracic spine, protrusion of the IVD of the specified localization

   Please tell me, do you treat this?
   And approximately how much will it cost?

   The described pathology according to our profile. Consultation, drawing up an individual treatment plan, all information can be clarified by contact numbers.

Painful sensations in the muscles, myalgia as a symptomatic phenomenon has 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 area 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 painful manifestations in the region scapularis (zone of the shoulder blades) it is more correct and accurate to call it scapalgia.

Causes of pain in the muscles of the scapula

Unlike others 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 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, the sternoclavicular muscle, the deltoid muscle are overstrained, and others located in the middle of the back are Bottom part trapezius, neck flexors, serratus anterior undergo 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:

1. 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.
2. Syndrome m. serratus posterior - the upper posterior serratus muscle is often provoked by a degenerative process in the upper pectoral intervertebral discs. The pain is localized under the shoulder blade, felt deep in the muscles, and is an aching, dull pain.
3. 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.
4. Interscapular syndrome is felt as aching, aching pain between the shoulder blades. The symptom intensifies with prolonged horizontal position 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.
5. Acquired pterygoid scapula syndrome, which causes paralysis of the serratus anterior, trapezius, or rhomboid muscles. Paralysis can be caused by 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:

1. Hypothermia.
2. Infections, including viral ones.
3. Occupational diseases associated with muscle hypertonicity.
4. 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 - the muscles, bone, tendons or this sign is referred pain indicating possible pathologies such as the following:

• IHD – ischemic disease hearts.
• Angina pectoris.
• Myocardial infarction.
• Protrusion or hernia intervertebral discs thoracic spine.
• Kyphoscoliosis.
• Intercostal neuralgia.
• Spondyloarthrosis.
• YABZH – peptic ulcer stomach.
• 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?

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 left side– in the chest area, under 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 means.
• 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, while the pain can be sharp, cutting in nature, radiating to the right top part body, under the shoulder and right shoulder blade.

In any case, a simple pain symptom that a person considers to be muscular should pass 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

Task diagnostic measures when determining the cause muscle pain in the area of ​​the shoulder blades - this is, first of all, the exclusion of possible life-threatening pathologies - angina attack, myocardial infarction, perforation of a stomach 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 diagnosing pain in the scapula muscles is difficult due to the nonspecificity of symptoms, clinical picture rarely indicates a specific diagnostic direction, in addition, almost all dorsalgias rarely correlate with the results 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 pain 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.
  • Revealing possible scoliosis, abnormalities in the structure of the spine (Forestier's symptom test).
  • Mobility 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 symptoms in the muscles of the scapula can be divided into two stages - short-term, urgent measures and long-term tactics.

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. Also good result provides massage and training in relaxation techniques, including post-isometric relaxation.

How to prevent shoulder blade muscle pain?

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:

1. 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.
2. 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.
3. Muscle tone is well maintained by regular exercise, even if a person does not exercise professional types sports, simple morning exercises can easily replace complex workouts.
4. 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.
5. To maintain muscle tone and unload the spine, you need to monitor your posture and, if necessary, wear a corrective corset.

Severe pain under the right shoulder blade may indicate the following diseases:

• Acute vertebrogenic radiculopathy or pinched nerve roots due to right-sided displacement of intervertebral discs (intercostal neuralgia). This disease is secondary, developing against the background of chronic compression nerve endings in the area of ​​their exit - in the “tunnel”. The so-called “tunnel” is formed from various structures - osteophytes, hernia, articular tissue. The longer it lasts pathological process degeneration of intervertebral discs, the smaller the lumen in the tunnel becomes, the blood supply to the nerve endings is disrupted, swelling and pain symptoms appear, including reflected strong pain under the right shoulder blade.
• Pancreatitis in the acute stage is accompanied by characteristic girdle pains, as a rule they radiate evenly under both shoulder blades. However, when the head of the pancreas is inflamed, the pain spreads mainly to the right and is felt like a lumbago in the area of ​​the right shoulder blade. The general pain symptom is constant and does not subside when changing body position, does not increase with tension, inhalation or coughing.
• Cholecystitis in the acute stage is the main cause of pain referred to the right shoulder blade. The symptom is so characteristic that many patients with chronic illness, already know that inflammation has begun. In addition to pain radiating upward to the right, acute cholecystitis is accompanied by fever, nausea, vomiting and often yellowing of the skin.
• Hepatic colic is very similar to an attack of cholecystitis; it is also accompanied by severe pain under the right shoulder blade, but there is no nausea, vomiting, or hyperthermia.
• Spontaneous pneumothorax(traumatic perforation of the pleura) is characterized by sudden, pronounced pain in the middle of the chest, radiating to the area of ​​the scapula.

Dull pain under the right shoulder blade

• Nephritis or chronic pyelonephritis in stage II of the process, when changes in renal tissue are sclerotic in nature. The pain is felt periodically, like a pulling, dull, radiating to the lower back or upper body. With a right-sided process, the pain symptom radiates under the right shoulder blade. In addition to pain that is not clinically obvious, the disease is accompanied by painful urination, low-grade fever body, less often with nausea.
• Chronic cholecystitis also manifests itself as dull pain, which can occur in paroxysms, but does not cause obvious discomfort to the patient. The pain radiates to the epigastrium (under the stomach) and at the same time “stretches” under the shoulder blade.
• The causes of dull pain in the area of ​​the right shoulder blade are various malignant processes, localized in the internal organs located on the right. Tumors of the liver, pancreas, right kidney or right lung may manifest as intermittent dull pain under the right shoulder blade.
• Cirrhosis of the liver in initial stage, which, in addition to the characteristic clinical picture, manifests itself in the form of dull right-sided pain, reflected under the scapula.

Sharp pain under the right shoulder blade

This is usually an attack hepatic colic, acute cholecystitis or a symptom of cholelithiasis. Also sharp pain under the right shoulder blade may indicate a hypertensive form of gallbladder dyskinesia. Hyperkinetic dysfunction of the bile ducts can be provoked by both nutritional and neurological, psycho-emotional factors. Stress, emotional overload, violation of dietary rules (overeating, spicy, fried or fatty foods) are the main causes of ADHD, which is accompanied by periodic paroxysmal pain in the epigastrium radiating to the left or right, more often to the upper right side bodies. The pain spreads to the back, under the right shoulder. Acute pain under the right shoulder blade may intensify when inhaling or bending over. As soon as the provoking factor is eliminated, the pain goes away. In addition to the pain symptom, the patient has characteristic neurological signs - irritability, increased fatigue, bad dream, sweating.

Sharp pain under the right shoulder blade

This sign is typical symptom the final stage of a subdiaphragmatic abscess, when the sensation sharply intensifies with a strong inhalation and is reflected in the shoulder and right shoulder blade.

Also sharp pain in the area of ​​the lower lobe of the scapula may be one of the signs of renal colic or purulent infiltrate in the right kidney with pyelonephritis. The pain symptom extends to iliac region, in the hypochondrium, often under the shoulder blade. In addition to pain, purulent pyelonephritis is accompanied by fever, frequent and painful urination.

Hepatic colic is a sharp, acute pain that occurs most often at night. The pain is acute and spreads to the right shoulder, often radiating through the shoulder blade to the neck. If colic lasts more than 4-5 hours, the pain spreads throughout abdominal area, accompanied by nausea and vomiting, which indicates an acute clinical picture requiring hospitalization.

Stitching pain under the right shoulder blade

These are, as a rule, quickly passing sensations that are not associated with serious pathological disorders in internal organs. Most often, stabbing pain is a symptom neurological disorders with osteochondrosis of the cervical or thoracic spine. Unlike pain of a similar nature on the left side, which may indicate life-threatening cardiac diseases, transient pain on the right side is provoked by an uncomfortable posture, a sharp turn or physical strain. However, stabbing pain can also be a sign of spasm of the walls of the bile ducts and the onset of an attack of hepatic colic or exacerbation of cholecystitis. Therefore, if the pain recurs, increases or “spreads”, its character changes within 1-2 hours, you should consult a doctor or call emergency help.

Nagging pain under the right shoulder blade

These pains are most likely associated with changes in the structure of the spine or with spasms muscular system shoulder girdle. Osteochondrosis cervical area the spinal column is characterized by aching, pulling sensations, which may intensify slightly with changes in body position or with static, constant load(same pose). The pain may appear in the morning after sleep and goes away during the day after moderate, distributed movements. Also, the pain symptom is relieved by heat or rubbing, which indicates spastic cause pain. For all other diseases, nagging pain under the right shoulder blade is uncharacteristic. An exception may be malignant tumor processes of internal organs - the liver, right kidney, head of the pancreas or right lung. Since oncological diseases develop latently and manifest themselves in the initial stages with minor, in a clinical sense, implicit symptoms. Pyelonephritis can also be accompanied by referred upward pulling pains, but, as a rule, this is atypical and rare.

Constant pain under the right shoulder blade

This is a clear symptom of ADHD hypotonic type. Dyskinesia of the bile ducts in this form in clinical practice is much more common than hyperkinetic form, especially in women and children. The pain develops gradually in the area of ​​the right hypochondrium and can be reflected upward into the right shoulder and under the shoulder blade. The pain symptom does not cause severe discomfort, as many patients note - it is tolerable. This constant nature of pain is “habitual” for those who suffer from gallbladder diseases. In comparison with an exacerbation of the process or an attack of cholecystitis, constant pain under the right shoulder blade is tolerated much easier by patients and does not require urgent treatment. However, the wave-like course of the underlying disease can increase and move from the remission stage to the acute phase, so anyone who experiences chronic radiating right-sided pain should undergo comprehensive examination and start treatment as soon as possible. The main danger of undiagnosed nagging pain gastroduodenitis, acute cholecystitis, cholelithiasis may develop in the right upper part of the body

Burning pain under the right shoulder blade

May indicate both infringement of nerve roots due to osteochondrosis, and serious pathologies requiring immediate treatment. These include right-sided pneumonia, which often develops asymptomatically in the initial stage and can manifest itself as periodic burning pain under the right shoulder blade. Also, such painful sensations may indicate atypically developing angina; it is characterized by left-sided referred pain, but in some cases there is also irradiation under the right shoulder blade. The very nature of the pain, which in clinical practice is called causalgia (from causis - burns and algos - hurts), indicates inflammation and or damage to the peripheral nerve processes. Thus, burning pain under the right shoulder blade can occur either when nerve roots are pinched or when nearby tissues atrophy, which is typical for pneumonia or angina pectoris - angina pectoris.

Osteochondrosis and pain under the right shoulder blade

Osteochondrosis. Pain under the right shoulder blade may be one of the symptoms of a cervical deforming process or osteochondrosis of the thoracic spinal column. This is typical for anyone involved in sedentary office work; this symptom is especially typical for schoolchildren or students. With such a static position, there is constant compression of the nerve endings, which results in chronic pain, reflected in the direction of displacement of the intervertebral discs. The pain can be aching, pulling, radiating to the neck or shoulder, as well as under the right shoulder blade. The symptom intensifies with awkward turns and movements, often in the morning after sleep. Often osteochondrosis and pain under the right shoulder blade are accompanied by numbness in the fingers and headache. Also, one of the causes of such pain may be S-shaped scoliosis of the thoracic spinal column.

Pain in the right shoulder blade

The pain radiates to the right shoulder blade - this is evidence of the following diseases:

If the pain radiates to the right shoulder blade and its intensity increases, emergency medical care should be called, especially for conditions accompanied by hyperthermia within 38-40 degrees.

Aching pain under the right shoulder blade

It's a dull pain in the area of ​​the right shoulder, in and under the shoulder blade, may indicate chronic process, which develops in organs distant from the scapula. Radiating (referred) pain that is not intense is a typical sign of lurking inflammatory process in the liver, kidneys, gallbladder or pancreas. Often, aching pain under the right shoulder blade does not encourage people to see a doctor, while patients try to use various home treatments and only aggravate the pathological process. Diagnosis of aching, referred pain is often difficult, since the clinical picture is not manifested, while the main pain symptom is relieved by “folk” methods - rubbing, warming, massages. Oncological diseases, which can develop over years and manifest themselves as periodic aching, radiating pain symptoms, also pose a danger. Identified on early stages, many oncological processes can be stopped, an acute pain symptom is, unfortunately, a sign of the terminal stage. Aching pain under the right shoulder blade can be a signal of the following diseases:

• Chronic cholecystitis.
• Chronic pyelonephritis.
• Cholelithiasis in the initial stage.
• Liver diseases, including cirrhosis or hepatitis.
• Chronic pancreatitis.
• Osteochondrosis.
• Chronical bronchitis.
• Latent pneumonia or pleurisy.
• Tumor processes.