Pain under the scapula is a type of spinal pain that can occur against the background of muscle spasms, myofascial syndrome, chronic vertebrogenic diseases, as well as be a consequence of injuries and physical and mechanical damage to the musculoskeletal system. Localization of pain in the back from the back can indicate not only vertebral pathologies, but also indicate possible disturbances in the functioning of internal organs: the cardiac region and fundus of the stomach, spleen, peritoneum, and respiratory tract. Cardiac pathologies, for example, myocarditis, angina pectoris or myocardial infarction, can also manifest as pain under the scapula on the left side. In approximately 8.3% of cases, intense pain under the scapula on the left side is a surgical symptom and can occur when the spleen is ruptured (or one of its lobes is bent), as well as ischemic damage to the organ parenchyma as a result of occlusion of blood vessels and arteries.
Pain under the left shoulder blade from the back
Possible reasons
There are many reasons that can cause pain and tenderness under the shoulder blade. It is necessary to begin the diagnosis by excluding the traumatic factor and possible damage to the scapula. If the pain under the shoulder blade appears suddenly or its occurrence was preceded by any physical or mechanical impact on this area (impact, fall), you should contact a traumatologist and have an x-ray taken. A scapula fracture is a fairly serious pathology, which is characterized by extensive displacement of bone fragments, so the treatment and rehabilitation period can take several months.
Scapula fracture
If the emergency room did not diagnose any injuries (including dislocations, soft tissue bruises, displacement of the thoracic and proximal lumbar vertebrae, etc.), it is recommended to consult a surgeon or orthopedist for pain in the scapula area. The doctor will conduct an initial examination and, if necessary, give a referral to specialized specialists: a neurologist, neurosurgeon, cardiologist, pulmonologist or gastroenterologist.
At an appointment with an orthopedist
Pathologies of the bone frame
This is the most common cause of spinal pain localized in the shoulder blades. Since the scapula bone is part of the upper shoulder girdle, painful sensations (in most cases – chronic, without timely medication and physiotherapeutic correction):
- osteochondrosis;
- spondylosis;
- osteosclerosis;
- bone marrow edema;
- intervertebral hernia and protrusion;
- radicular syndrome;
- rheumatoid arthritis;
- Bekhterev's disease, etc.
Spondylosis deformans
Pain under the shoulder blade on the side of the spine can be a sign of osteoporosis, a disease characterized by a pathological decrease in bone mass. Osteoporosis, regardless of the location of the pathological process, always leads to disability of the patient, therefore bone densitometry can be included in the complex of diagnostic measures.
Osteoporosis of the spine
It is also important to exclude infectious lesions of the scapula - acute hematogenous purulent-necrotizing osteomyelitis (purulent arthritis of the sternoclavicular joint). The pathology has a fairly severe course and is almost always caused by pathogenic bacteria capable of producing pus (staphylococci, mycobacterium tuberculosis). The clinical picture of osteomyelitis is quite pronounced and allows for preliminary diagnosis of the disease during the initial examination.
Important! Treatment for osteomyelitis of the scapula should begin as early as possible, since the progressive growth of bacteria can lead to purulent melting of the bone and the development of a systemic inflammatory reaction.
Osteomyelitis is
Muscle diseases
A large number of muscles are attached to the shoulder blades (for example, the triceps and biceps brachii muscles, deltoid and omohyoid muscles), so inflammatory, infectious and other lesions of the muscle fiber can also be one of the causes of pain in this area. The following diseases most often belong to this group of pathologies.
- Myositis. This is an inflammation of muscle tissue, which can develop both against the background of infectious pathologies and as a result of traumatic exposure. The prognosis in the vast majority of cases is favorable (myositis ossificans is an exception).
Shoulder myositis - Ossification of the subscapularis muscles . This is a serious disease, with a progressive course inevitably leading to disability and death of the patient. The process is the ossification of muscle tissue, in which muscles are replaced by bone formations.
- Myopathy . A chronic muscle disease that occurs primarily when protein metabolism is disrupted. An extreme form of myopathy is rhabdomyolysis, a pathology in which muscle cells are destroyed and toxic protein breakdown products are released into the blood.
What is myopathy
Pain under the shoulder blade can also be associated with irritation of trigger points - muscle tension nodes, when exposed to which a person feels pain of varying intensity (mainly aching or cutting). Myofascial pain syndrome can be not only a manifestation of chronic pathologies of the musculoskeletal system, but also the result of excessive physical exertion, especially if the person did not have sufficient physical training before starting classes.
Anatomy of the shoulder joint
Reason 5. Diseases of internal organs
In some cases, “bones and joints” specialists will not help, since they will not detect any abnormalities. But do not rush to complain about their incompetence, because the source of back pain can be internal organs.
First of all, these are gynecological (uterus, appendages) and andrological (prostate) diseases. Inflammatory processes in the pelvic organs and menstruation radiate to the lower back. The pain is nagging, aching, dull. For diagnosis, consult a gynecologist or andrologist, respectively.
Kidney diseases (pyelonephritis, renal colic) cause pain. It is quite strong, spreads throughout the lower back, and intensifies with light tapping in the lumbar region. If this applies to you, a nephrologist will help.
In general, almost all inflammatory diseases can cause back pain. With lung diseases, pain occurs between the shoulder blades; problems with the liver and stomach are reflected in the lower back at waist level.
Neuropathic pain under the left shoulder blade
Neuropathic pain is a fairly common type of pain in this localization, so diagnosis for complaints of pain under the scapula always begins with excluding possible neurogenic causes (after excluding the traumatic factor).
Neuropathic pain – what is it?
The scapula is a bone located in the upper shoulder girdle and serves as the articulation of the skeletal base of the shoulder (tubular humerus) and the collarbone. The anterior surface of the scapula has a slightly concave shape and is called the costal surface. The posterior surface (dorsal) is adjacent to the spinal column, which consists of five sections and vertebrae connected in a vertical sequence, therefore one of the main causes of pain in this localization is diseases of the spine.
Factors that cause pain in the lungs when coughing
When collecting anamnesis, the specialist pays attention to factors such as the patient’s commitment to smoking. Long-term addiction to a bad habit weakens local pulmonary immunity, which facilitates easy penetration of the tuberculosis bacillus. Combustion products contained in cigarette smoke lead to the development of oncology of the respiratory system and the occurrence of asthmatic syndrome. A prolonged cough is also caused by pathologies of the gastrointestinal tract, heart and vascular network.
An unfavorable factor is also the systematic use of certain medications necessary to maintain normal heart function. Chronic dry cough often appears among women who have crossed the threshold of menopause. A history of acute respiratory disease serves as the starting point for the appearance of an anomaly that cannot be cured. In this case, only symptomatic treatment is used, taking antitussives.
What other diseases should be excluded?
Pain under the scapula, localized from the back, can also be a manifestation of pathologies of internal organs, for the diagnosis of which a careful collection of an initial history is of great importance. When contacting a doctor, the patient must describe in detail the existing symptoms, as well as assess the relationship of the pain syndrome with various factors: food intake, physical activity, psycho-emotional state, etc. The most likely causes of pain under the left shoulder blade, as well as their symptoms, are listed in the table below.
Table. Diseases of the internal organs as a cause of pain under the left shoulder blade.
| Organ | Possible diseases | Possible symptoms |
| Heart | Myocardial infarction, cardiomyopathy, myocarditis, myocardial infarction (necrosis), angina pectoris, arrhythmia. | The most typical manifestations of heart pathologies are changes in the number of heartbeats, shortness of breath, pain in the left side of the sternum, and breathing problems. With a progressive course, arterial instability is observed, signs of hypoxia - oxygen starvation (headaches, dizziness, migraines, hypertension) may appear. |
| Organs of the respiratory system (left side) | Pleurisy, bronchitis, pulmonary tuberculosis, pneumonia. | The leading symptom of respiratory pathologies is cough, but it is important to consider that in some diseases, for example, asymptomatic pneumonia, the cough is of low intensity and can occur in the form of coughing up to 4-6 times a day. In a typical course, the following symptoms are observed: headache, fever, pain in the chest area, which can radiate to the scapula area, sputum or purulent exudate. |
| Spleen | Splenic rupture. | This is a surgical pathology, the symptoms of which depend on the type of rupture. The most characteristic signs include tension in the abdominal wall (breathing is carried out superficially, the abdominal muscles do not take part in the act of breathing) and the forced position of the body adopted by the patient. The classic position for a ruptured spleen is to lie on your left side with your legs brought up to your chest. |
| Stomach (cardia and body of the stomach) | Gastritis, polyposis, stomach ulcer. | The main symptoms of gastroenterological pathologies: stomach pain, nausea, lack of appetite, bitterness and metallic taste in the mouth, stool upset. Pain under the left shoulder blade when the cardiac part of the stomach or its body is affected is of a reflected nature and occurs mainly during exacerbations as radiating pain. |
Symptoms of a heart attack in men and women
Intercostal neuralgia
If you experience girdling pain during coughing, you can suspect intercostal neuralgia, a disease associated with the development of pathological processes occurring in the area of the nerve roots of the spinal cord. The pathology is also characterized by difficulty in movement and increased pain during attempts to change body position, with a deep breath.
Intercostal nerve
Intercostal neuralgia can be provoked by:
What to do?
Self-treatment of pain under the left shoulder blade at home is impossible due to the large number of reasons that can provoke the occurrence of this symptom. To do this, you need to see a doctor and undergo the minimum required set of diagnostics, including x-ray examination, MRI or CT (if necessary), electromyography and densitometry (if osteoporosis or osteosclerosis is suspected).
Electromyography
Without visiting a doctor, it is only permissible to use emergency first aid measures in cases where the patient can determine with great certainty what exactly caused the pain.
Treatment
The choice of treatment method will directly depend on the cause of the pain. If pathology of the musculoskeletal system is to blame, the doctor may recommend taking analgesics or using pain-relieving ointments to eliminate pain. Most drugs of this type can completely cope with the inflammatory process.
Therapeutic warming products
Application of anesthetic ointment
If the cause is lung disease, then it is important to take expectorants and drugs that eliminate the cough itself after clearing the lungs. If you have heart pathologies, you should follow all the instructions of the cardiologist.
Expectorants