Pain in the neck and back between the shoulder blades

Complications from ARVI or the onset of a heart attack

The answer to the question “Why does my neck hurt” depends on the nature and location of the unpleasant sensations. At the beginning of the examination, the doctor will definitely ask whether the patient has recently suffered from blows, bruises and falls, whether he has lifted heavy objects, or been exposed to excessive physical exertion. Once the possibility of injury has been completely ruled out, the patient may be given one of the following diagnoses:

Osteochondrosis of the cervical spine. From this disease, aching pain when turning the neck radiates to the shoulder blade, shoulder girdle, and the back of the head, movements in the shoulders are constrained, and the fingers go numb. I also often have headaches.
Intervertebral hernia. When the neck and right shoulder blade or left shoulder hurt, this may be a consequence of scoliosis or kyphosis. At first, the discomfort can be tolerated, although movements are constrained. However, gradually the nerves are pinched more and more, and the nagging pain increases. The intervertebral disc protrudes into the surrounding space, that is, a hernia occurs. If it is not cured in time, only surgery will help get rid of it.
Diseases of the cardiovascular system. With minor attacks of angina, the neck, shoulder blade and arm on the left hurt, as well as pain in the heart area. As a rule, such attacks can be relieved with pharmaceutical drugs. However, if the drugs do not help, the pressure decreases, and the skin turns white, it’s time to call an ambulance, as there is a risk of a heart attack.
Cholecystitis, pancreatitis, exacerbation of stomach ulcers. If a burning pain is felt at the shoulder blades, in the abdomen and in the side, this happens when the bile duct is blocked or an ulcer perforates.
Renal colic, pyelonephritis. Discomfort extends to the lower part of the shoulder blades and lower back. The patient feels nauseous, his temperature rises, and pain occurs when urinating.
Pneumonia, pleurisy. The shoulder blades ache with every breath, the temperature rises, and a cough is possible. As a rule, this becomes a complication of acute respiratory viral infection or influenza.

If you have pain in your neck and between your shoulder blades, but you are sure that the spinal column and back muscles are in order, contact a therapist, and he will refer you to a specialist doctor. If the pain is unbearable, immediately call an ambulance, as this may be a sign of a heart attack, an attack of cholecystitis, or perforation of an ulcer.

Causes of back pain in children

Benign musculoskeletal pain and injury are the most common causes of back pain in children.

The sources of musculoskeletal pain in most cases are muscles, ligaments, joints (facet and sacroiliac), intervertebral discs and bone structures of the spine.

The most common source of back pain in children and adolescents is muscular-tonic, myofascial syndrome

(MFS). This syndrome can develop both against the background of orthopedic pathology (severe scoliosis, kyphoscoliosis, asymmetry of the pelvis, leg length), and against the background of muscle strain and injuries. More often, muscle pain is localized in the area of the paravertebral muscles, trapezius muscles, with irradiation to areas of reflected pain from myofascial points with aggravation during twisting and extension.

Several factors have been identified that are associated with muscle back pain in children and adolescents:

Wearing a heavy backpack. According to the recommendations of the American Association of Pediatrics, the weight of the backpack should be no more than 10–20% of the child’s body weight [11].

Use of soft mattresses (associated with pain and morning stiffness in the back) [12].

Intense sports/violations in training technique (improper position on a bicycle, incorrect selection of running shoes, etc.) [13].

Psychosocial distress, anxiety/depression [14].

In most cases, muscle pain in the back regresses spontaneously; in case of unexpressed pain, it is preferable to use non-drug methods of therapy (physical therapy, massage).

With bone sources of pain, as a rule, pain is localized along the central axis of the spine with intensification with extension and rotation, which, however, is not a specific sign. As already noted, bone causes of back pain in children are quite rare. Among them, the most common are spondylolysis, spondylolisthesis, scoliosis, juvenile Scheuermann-Mau kyphosis, less commonly juvenile osteoporosis, congenital absence of a vertebral pedicle, fracture of the vertebral apophysis or Limbus vertebra

(displaced vertebral apophysis), stress damage to the SIJ during sports.

Spondylolysis and spondylolisthesis.

Spondylolysis is a congenital or acquired unilateral/bilateral defect (non-union/damage) in the area of the vertebral arch in the interarticular area. In most cases, spondylolysis occurs at the lower lumbar level, predominantly L5. With bilateral damage (or congenital nonunion), the vertebral body may move forward (spondylolisthesis) [15]. Risk factors for the development of spondylolysis and spondylolisthesis are participation in certain sports with a combination of frequently repeated flexion/extension and hyperextension in the lumbar region (for example, gymnastics and dancing, figure skating, weightlifting, volleyball, football, tennis). Typically, clinical manifestations of spondylolysis are observed in adolescence in the presence of provoking factors. Spondylolysis is characterized by acute shooting (piercing) pain in the lumbar region, intensifying with hyperextension and decreasing with rest. When examining the patient, increased muscle tension (with an emphasis on the side of the pathology) in the paravertebral muscles may be detected, with intensification during extension and/or bending to the side, as well as pain during passive straight leg raising and bending forward. Additionally, performing a single-leg hyperextension test, where the patient stands on one leg and bends backward with possible ispilateral increased pain, may be useful, but this test is not specific for spondylolysis [16].

During rapid growth in adolescence, in the presence of predisposing factors, spondylolysis can be complicated by spondylolisthesis, which is clinically associated with persistent pain.

Scoliosis

- lateral curvature of the spine with an angle (Cobb angle) of deviation of more than 10°. As a rule, scoliosis is combined with various variants of spinal rotation. Scolisis can be idiopathic or develop as a result of various pathological processes (congenital malformations, muscle spasms, infections, tumors). The idiopathic variant of scoliosis occurs in most cases - 80–85%. The prevalence of scoliosis in the adolescent population is about 3% [17]. Patients with scoliosis are significantly more likely to experience musculoskeletal pain syndrome. However, due to overdiagnosis of scoliosis, a comprehensive approach should be taken to identifying the causes of back pain with a general assessment of biomechanical, orthopedic and neurological manifestations. A deviation of less than 10° (Cobb angle) is considered within the acceptable physiological asymmetry.

Scheuermann-Mau disease.

Juvenile kyphosis is defined as anterior wedge-shaped deformation (compression) of 5° or more in at least 3 adjacent vertebrae and is usually detected by radiography [18]. The exact etiology of Scheuermann-Mau disease remains unknown. A variant of genetic predisposition is being considered, which is confirmed by data from studies among twins [19]. Long-term bed rest (for various reasons) and conditions accompanied by transient osteoporosis are most often noted as possible risk factors [20]. It was also noted that adolescents with this pathology are slightly taller than their peers and have a shortened sternum, which may lead to a predisposition to compression damage to the anterior part of the vertebrae. At the same time, there is no convincing data showing the relationship between sports (including weightlifting) and the development of Scheuermann-Mau disease.

The incidence of juvenile kyphosis is estimated to be in the range of 4–8%, and the disease is more common in boys [21]. The clinical manifestations of Scheuermann's disease are nonspecific: usually there is subacute pain in the thoracic and, less often, lumbar regions, without connection with injury, with an increase in physical activity and a decrease after rest. Juvenile kyphosis can be combined with spondylolysis and, less commonly, with pronounced changes, with myelopathy [22, 23].

With Scheuermann's disease, there is a hard (rigid) kyphosis with the formation of a relatively acute angle, which is not smoothed out when bending forward, extending and lying on the stomach. Also, upon examination, compensatory lumbar hyperlordosis and Hamstring syndrome can be detected. However, these manifestations do not serve as obligate signs of juvenile kyphosis; the “gold standard” for diagnosis is the analysis of radiographic images.

As a rule, conservative treatment is carried out with an emphasis on non-drug methods of therapy (therapeutic exercises, massage), limiting possible provocateurs of musculoskeletal pain (ergonomics of the student’s workplace); in case of acute pain syndrome, it is possible to use analgesics (paracetamol, ibuprofen). In case of kyphosis more than 60°, persistent pain syndrome, additional orthopedic disorders (spondylolysis, spondylolisthesis) or neurological complications (myelopathy), surgical orthopedic treatment is possible [24].

Discogenic pain syndromes.

Despite the fact that pain syndromes associated with damage to the intervertebral discs are less common in adolescence than in adults, about 10% of persistent back pain in adolescents is associated with discogenic pathology [25]. Risk factors for intervertebral disc extrusion are acute trauma, juvenile kyphosis, family history, obesity, and physical inactivity. Participation in certain sports is significantly associated with an increased risk of developing a disc herniation - weightlifting, artistic gymnastics, figure skating and sports with an increased risk of injury (alpine skiing, rugby, boxing, hockey, etc.) [26].

Clinical manifestations of discogenic pathology in adolescents are similar to those in adults. A distinction is made between axial discogenic pain and radicular pain syndrome with the possible development of radiculopathy or myelopathy. With discogenic pain, forward bending can often be limited with increased pain.

Diagnosis of the cause of back pain in children and adolescents

The initial examination of a child with back pain should be aimed at excluding specific causes of pain with further determination of the optimal tactics of treatment and prevention. The main nonspecific and specific causes of back pain in children are presented in Table 1.

Anamnesis analysis, orthopedic and neurological examinations in most cases make it possible to identify the source of pain and make a correct diagnosis and formulate a treatment plan. For musculoskeletal pain, as a rule, no additional examination is required. Additional examinations (laboratory diagnostics and imaging) are required if there are signs of a specific etiology of the pain syndrome, the so-called “danger signals” or “red flags” (Table 2).

The diagnostic algorithm for back pain in childhood is presented in Figure 1.

The spine complains quietly

When the spine in the neck and shoulder blades hurts slightly, “straining”, many do not attach much importance to this and do not consult a doctor in a timely manner. However, this is exactly how spinal column problems manifest themselves. The sensations become unbearable only when the disease is advanced and difficult to treat.

If the neck and shoulder blade hurt sharply and sharply on the left side, this most likely indicates damage to the lungs or heart. If other internal organs are affected, the pain can shoot in several areas at the same time: in the side, under the shoulder blades, between the ribs. This is often accompanied by weakness, shortness of breath, and dizziness.

Does it hurt under your shoulder blade?

Sharp pain between the shoulder blades, any movement causes pain;
Severe cutting pain between the shoulder blades;
The pain is just below the shoulder blades, the pain is rather dull, and it is most noticeable at the moment when the arms are raised;
Drawing pain under the shoulder blades, down the spine to the lower back, compressing the chest;
Aching pain under the left shoulder blade, sometimes it can radiate a little lower;
Constant cutting pain under the left shoulder blade, with any body movement the pain intensifies, when moving the left arm the pain is clearly sharper, inhalation and exhalation is difficult with painful sensations;
For several days, there has been aching pain between the shoulder blades (closer to the right side). The pain occurs mainly after walking or standing for a long time. First there is pain, which then turns into burning or cold;
The pain radiates through to the right shoulder blade. If you raise your right hand and move it to the side and hold it like that, the pain goes away.

X-ray, ultrasound, throat swab

If you experience pain between the shoulder blades in the spine to the neck, consult an orthopedist and neurologist. They will first take a medical history and then give directions for an X-ray, CT scan or MRI of the chest. An X-ray will reveal pathologies inside the bone tissue - and if there are none, then the problem lies in neighboring organs. CT scans can also help identify bone lesions or injuries.

But MRI will give the most comprehensive picture. This is the most informative technique for examining ligaments, intervertebral discs and surrounding soft tissues. MRI determines the presence of hernias, protrusions, and pinched nerve endings. After establishing the location and cause of the pathology, blood or intra-articular synovial fluid tests may be required.

If the pain from the neck to the shoulder blade on the left or right is not caused by damage to the spinal column, you should also visit a pulmonologist, cardiologist and gastroenterologist. If there are suspicions of diseases of the gallbladder, pancreas, liver, kidneys, the doctor will prescribe an ultrasound of the abdominal cavity, and if there are problems with the cardiovascular system, an ultrasound of the heart and an electrocardiogram.

If the doctor decides that the malaise is caused by a gastric ulcer, a gastroscopy will be performed. To assess the condition of the respiratory system, you need to do a CT scan of the lungs or a fluorogram, and also take a throat smear if pneumonia is suspected. Most likely, the patient will also be sent for biochemical tests of urine and blood.

Why does pain occur?

Coughing is a natural reflex of the body, which is aimed at clearing the airways of foreign objects, dust, and mucus. In itself, it is not an alarming sign and is treated in combination with other symptoms. But if your back starts to hurt during the process of coughing, this should be a warning sign. In most cases, this is normal, since the chest thrust is carried out by a group of muscles, some of which are located in the back. Their frequent contraction provokes discomfort, which leads to pain.

But it is not always the norm, since in most cases it is a sign of the development of pathology in the spine. The nature of the pain can be aching, constant, diffuse, pulsating, cutting. A clear definition helps in making a diagnosis. If there are other symptoms besides pain, you should immediately consult a doctor.

Eliminate the root cause and apply a compress

If a patient has pain between the shoulder blades and radiates to the neck as a result of a spinal injury, this injury should first be eliminated with the help of a traumatologist. To restore the normal functioning of the spinal column and relieve static muscle strain, a specialist may recommend:

therapeutic massages (but in no case at home, but in a professional’s office);
sets of exercises for the musculoskeletal system;
compresses;
rubbing with ointments;
physiotherapy.

When pain when turning the neck in the scapula area is caused by diseases of the internal organs, it is necessary to get rid of the root cause of the disease with the help of medication, physiotherapy or surgery. The doctor will decide whether additional treatment for the spine will be needed after this or not.

Treatment methods

To relieve pain, you can use Diclofenac ointment.
Therapy should begin immediately after the appearance of characteristic symptoms. To alleviate the condition, the following tactics are recommended:

compliance with bed rest;
refusal of any physical activity;
taking medications (prescribed by a specialist).

Medications

Drug therapy helps reduce pain, restore the functions of affected muscles, prevent the chronicity of the pathology and the development of possible complications.

Different groups of drugs with local and systemic action are prescribed. NSAIDs and analgesics:

Tramadol;
Meloxicam;
Diclofenac;
Ibuprofen;
Nimesil;
Ketoprofen.

Mydocalm relaxes muscles
The next group is muscle relaxants:

Sirdalud;
Baclofen;
Toplerizine;
Mydocalm.

Local preparations:

Capsicam;
Nise gel;
Dolgit;
Finalgon;
Voltaren;
Ketonal;
Diclofenac;
Fastum gel.

Voltaren warming patch helps relieve inflammation and pain.
Patches with a warming effect:

Dorsaplant;
Voltaren;
Nanoplast;
Pepper;
Ketonal thermo;
Versatis.

When the first symptoms appear, anti-inflammatory ointments should be used. When the pain becomes less pronounced, the application of drugs with warming properties is allowed.

During pregnancy, medications must be selected with extreme caution, taking into account the current gestational trimester and individual contraindications.

Physiotherapy

Electrophoresis is used to deeply warm the tissues.
Physiotherapy is one of the most effective ways to treat the condition. They help relieve the inflammatory process and speed up recovery, restoring functionality to the muscles.

In practice, the following methods are prescribed to the patient:

ultrasound treatment;
electrotherapy;
radon, salt baths;
EHF;
magnetotherapy.

Reflexology techniques are effective - acupuncture, vacuum therapy, electroacupuncture. Additionally, sessions with a chiropractor, as well as a complex of physical therapy, may be prescribed.

Folk remedies

Cabbage leaf with honey can be applied as a compress to a sore spot.
At home, traditional medicine recipes can be used to alleviate the condition. The following products have proven themselves to be effective:

The cabbage leaf should be smeared with honey and used as a compress, applied to the area of inflammation. Take it off in the morning.
Combine 4 parts of lard with 1 part of crushed horsetail herb. Apply ointment to your back two to three times a day. The product is a good cure for inflammation of the muscles under the shoulder blade caused by hypothermia.
Prepare “strong” mashed potatoes. Fold a cotton cloth in several layers, put the puree on it, spread it in the form of a cake and apply it to the sore spot. After removing the compress, treat the skin with alcohol and insulate it with a woolen scarf/scarf.
Mix 100 g of melted goose fat and fir oil. Use as a compress (the duration of the procedure is no more than 1 hour) or simply smear the area of pain several times during the day.

Before starting treatment, you should consult a doctor.

Without excess weight and stress

Treatment of neck pain should also be accompanied by lifestyle changes.

If you sit at a computer or other work place for a long time, try to get up once an hour to walk around the room, bend, and turn your torso and head.

Sign up for fitness or physical therapy and get rid of excess body weight. Buy a comfortable mattress and pillow, avoid overwork and excessive physical activity. If possible, go on vacation to a sanatorium.

And try to protect yourself from stress - under the influence of negative emotions, we reflexively strain our backs and slouch.

Introduction

The most common causes of back pain in children are benign musculoskeletal pain and injury. Despite the high prevalence of musculoskeletal pain (about 50%), specific causes of pain syndromes can often be identified: infectious spinal pathology, inflammatory spondyloarthropathy, osteoid osteoma, thoracic Scheuermann-Mau hyperkyphosis, spodylolysis and spondylolisthesis [1]. In practice, it is important to train doctors of various specialties (pediatricians, orthopedists, neurologists) in the specifics of examining children with complaints of back pain and the use of evidence-based effective diagnostic and treatment algorithms.