Pain under the shoulder blade

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Pain under the shoulder blade. Question answer.
Topic: Questions and Answers
Pain under the shoulder blade
Topic: Encyclopedia of diseases

Title

Pain under the left shoulder blade
Pain under the right shoulder blade
Diagnostics
Treatment methods

Pain under the shoulder blade is a fairly common complaint among patients and often presents difficulties both for diagnosis and treatment. The pain can be localized both under the left and under the right shoulder blade.

Pain under the left shoulder blade

Pain under the left shoulder blade can cause great discomfort and affect the quality of life. Any pain under the left shoulder blade deserves attention and requires a visit to a doctor, since the causes of pain under the left shoulder blade are quite varied and among them there can be serious conditions, sometimes life-threatening.

Causes of pain under the left shoulder blade

Injuries. Injuries to the scapula are quite common and can occur both after serious incidents (for example, falls or accidents) and when lifting and carrying heavy objects. Involutional changes in bone tissue can also lead to damage to the scapula due to weakening of bone tissue and damage can occur even with minor injuries
Incorrect position while sleeping. Incorrect sleeping position is the most common cause of pain in the shoulder and under the left shoulder blade.
Acute respiratory infection or flu. One of the first signs of an acute viral infection is pain in the muscles and body, including under the left shoulder blade.
Shoulder dislocation. Shoulder dislocations can be quite painful and include pain in the shoulder and under the shoulder blade.
Frozen shoulder. A lack of synovial fluid around the shoulder joint can lead to limited movement and sclerotic changes in the joint capsule and pain under the scapula.
Fracture. A shoulder fracture is one of the most painful causes of pain in the shoulder and under the shoulder blade.
Bursitis. Inflammation of the joint capsule is often the cause of pain in the shoulder and under the shoulder blade.
Rotator cuff tear. Excessive stress and dislocations can lead to damage to the rotator cuff, which can also cause pain under the shoulder blade.
Nerve compression. When the nerves in the shoulder area are compressed under various conditions, pain may occur under the shoulder blade and in the arm.
Trigger points. Trigger points in myofascial pain syndrome can be a source of pain under the shoulder blade. As a rule, trigger points are characterized by significant local pain of these points.
Subscapular inflammation. The subscapularis muscle is involved in rotating the arm counterclockwise and inward. Quite often this muscle is damaged in athletes, which leads to inflammation of this muscle and pain under the shoulder blade.
Impingement syndrome. This disease occurs when there is excessive load on the shoulder blade and inflammation of the tendons and joint capsules occurs. Impingement syndrome can cause damage to the rotator cuff.
Other reasons:
Gastric ulcers can also cause referred pain under the left shoulder blade.
Heart diseases (myocarditis, heart defects, ischemic heart disease) can cause pain under the left shoulder blade. Angina attacks are also sometimes manifested by pain under the left shoulder blade.
Inflammatory lung diseases (such as pneumonia) or pulmonary embolism can cause pain under the shoulder blade.

Causes of intercostal neuralgia

There are many sources that cause intercostal neuralgia. This can be external (poisoning with heavy metals, medications) and internal intoxication. The latter are usually associated with diseases in neighboring organs and tissues (pleurisy, spinal diseases).

Pain in the intercostal space is often caused by diffuse pathologies of the nervous system - hormonal spondylopathy, polyradiculoneuritis, multiple sclerosis, as well as infections such as tuberculosis and herpes zoster.

Often this symptom occurs due to spinal pathology, injuries, allergies .

Metabolic disorders and hypoxia of nervous tissue are promoted by anemia, diabetes mellitus, alcohol intoxication, hepatitis, malabsorption and decreased concentrations of B vitamins, atherosclerosis and hypertension.

As a rule, intercostal neuralgia, the symptoms of which everyone should know, develops under the influence of several factors. It is characteristic that it is never diagnosed in children. We can say that this is a disease of people mainly in the middle and older age categories.

Pain under the right shoulder blade

Pain under the right shoulder blade is common, but self-diagnosis, as with pain under the left shoulder blade, is quite problematic. Pain under the right shoulder blade can be a sign of life-threatening conditions, and only a doctor can adequately rule out serious causes of pain.

Causes of pain under the right shoulder blade.

Cholecystitis. Gallstone disease or acute cholecystitis can lead to acute pain under the right shoulder blade. The pain may also radiate to the right shoulder. As a rule, gallstone disease requires surgical treatment (removal of the gallbladder).
Myocardial infarction (angina) can cause pain in the shoulder, under the right shoulder blade, in the right shoulder, in the neck. With an aortic aneurysm, pain may radiate to the back. Pain in such conditions is usually acute, intense and requires emergency hospitalization.
Liver diseases
Inflammatory processes, liver infections, and other liver damage can lead to pain under the right shoulder blade. Bacterial infections can lead to the formation of pockets of pus in the liver, and this will be accompanied not only by pain, but also by fever and general malaise. Liver cancer also often leads to pain under the right shoulder blade and in the shoulder. Liver cirrhosis, especially decompensated liver cirrhosis, can lead to fluid accumulation in the abdominal cavity and lead to pain under the shoulder blade and shoulder.
Mammary cancer
Breast cancer is one of the most common types of cancer and often causes pain in both the right and left subscapularis.
Arthritis of the shoulder joint can cause pain under the right shoulder blade.
Biomechanical reasons. Poor posture or prolonged static loads, such as working at a computer, especially in the wrong position, can cause muscle spasms, which will manifest as pain under the right shoulder blade.

Why do my shoulder blades hurt?

Typically, pain emanating from the muscles gives a burning sensation between the shoulder blades, heaviness, and a load in the upper back. But as soon as you move your shoulders, the pain immediately goes away. If the aching pain between the shoulder blades does not go away after changing body position and additionally radiates to the heart area, then its source can be both heart disease and problems in the thoracic spine. In order to identify the true cause, a comprehensive diagnosis is necessary.

Our diagnostics include:

consultation with a neurologist;
special orthopedic tests;
dynamic active and passive tests;
local palpation examination of damaged joints;
assessment of the state of the musculoskeletal system: posture;
gait;
uniform distribution of load on joints;
range of motion;
joint stability and strength;

making and explaining the diagnosis;

selection of individual complex motivated treatment.

If necessary, the doctor may also prescribe:

MRI;
Ultrasound;
X-ray;
Lab tests;
Diagnostic puncture of the joint.

Causes of pain between the shoulder blades

In some cases, the patient complains that he has pain between the shoulder blades. Such localization is typical, first of all, for diseases of the thoracic spine - osteochondrosis, scoliosis, kyphosis, spondyloarthrosis, intervertebral hernia, protrusion of the intervertebral disc. Also, pain between the shoulder blades can be observed with coronary heart disease, intercostal neuralgia, and gastrointestinal diseases.

The causes of pain that cause pain under the right or under the left shoulder blade are different.

Treatment of intercostal neuralgia

Treatment for intercostal neuralgia depends on what causes it. Statistics say that the vast majority of pain in this area is caused by mechanical causes - pathology of the spine and muscles - osteochondrosis, disc herniation, protrusion, myalgia and myofascial syndrome. Therefore, the answer to the question of how to treat intercostal neuralgia is obvious. Since most of the reasons are mechanical, then they should be eliminated mechanically. This means that the best way to treat thoracic intercostal neuralgia is manual therapy. Moreover, not ordinary, but soft manual therapy, which is not only softer, but also much more effective than simple realignment of the vertebrae. Gentle manual therapy works extremely gently and delicately. Its main advantage is the safe elimination of muscle tension that “pinches” the nerve and stiffens the spine. This is why a chiropractor is the primary physician for intercostal neuralgia. In cases where the problem is advanced, manual therapy can be supplemented with medications and physical therapy.

Treatment of intercostal neuralgia with herpetic lesions requires parallel treatment by a dermatologist. Rare and severe forms caused by fractures and tumors require high-tech and expensive medical care, which is carried out under government programs in specialized clinics.

How to relieve pain from intercostal neuralgia if a person finds himself far from full-fledged medicine and only a pharmacy nearby? Pain in acute intercostal neuralgia is best relieved with the combined use of non-steroidal and steroidal anti-inflammatory drugs. But, we draw your attention - see a specialist as soon as possible. This must be done even if the pain stops completely. It is in your best interests to be sure that nothing more serious lies behind the pain and intercostal neuralgia.

Pain under the shoulder blade: which doctor should I contact?

If you complain of pain under the shoulder blade, it is recommended to consult a general practitioner (general practitioner or family doctor). It is the general practitioner who must determine which specialists should be examined.

If the pain under the shoulder blade is associated with eating, accompanied by heartburn, belching, or a feeling of bitterness in the mouth, you will probably need to consult a gastroenterologist.

If there is reason to believe that the pain is related to the spine, for example, if the pain intensifies with movement of the torso or shoulder, then you will be referred to a neurologist, vertebroneurologist or chiropractor.

You must be prepared that you may need to consult a cardiologist or urologist.

Diagnosis of neuralgia

After collecting anamnesis, visual examination and palpation, the specialist will prescribe an instrumental examination:

X-ray of the bone tissue of the sternum (in the IntegraMed CDC (formerly NDC) is not performed);
Ultrasound of internal organs;
CT in combination with myelography - a contrast agent in the spinal canal (is not performed at the IntegraMed CDC (formerly NDC);
MRI of the costal space;
contrast discography of intervertebral discs (in the IntegraMed CDC (formerly NDC) is not performed).

To exclude infections and hormonal disorders, for example during menopause in women, blood is taken for analysis and a consultation with specialized doctors (infectious disease specialist, endocrinologist, etc.) is prescribed.

Symptoms of intercostal neuralgia

It is believed that the main symptom of intercostal neuralgia is pain in the intercostal space. But how can one distinguish intercostal neuralgia from one symptom, even such a striking one? After all, pain in the ribs also occurs with other pathologies. Obviously, for an accurate diagnosis, more signs of intercostal neuralgia are needed. Therefore, we decided to talk about the symptoms and causes of intercostal neuralgia in more detail.

The name intercostal nerves speaks for itself. They are actually located between the ribs. Starting from the spine, they cover the chest on both sides. The intercostal nerve cannot suffer from a small or even moderate bruise, since it is located deep under the rib. Therefore, the mechanical cause of intercostal neuralgia can be serious injuries, for example, a fracture; a tumor compressing a nerve, or dystrophic pathology of the spine - osteochondrosis, hernia and disc protrusion.

In addition to mechanical ones, there are also infectious causes of intercostal neuralgia, most often a herpetic infection. Due to its characteristics, it often affects these nerves. Herpes, as a sign of intercostal neuralgia, is easily recognized by characteristic rashes that coincide with the area of pain.

Thus, the causes of intercostal neuralgia are infectious and mechanical. But, the connection between intercostal neuralgia and breathing is a myth. Remember, at the beginning of the article we talked about the difference between real intercostal neuralgia and what many people mistakenly consider to be such. For example, the appearance of intercostal neuralgia after a cold is not neuralgia at all, but myofascial syndrome. If you are not aware, myofascial syndrome is a muscle disease in which small painful areas - trigger points - form in the muscles. These points may remain in a latent state for a long time and not manifest themselves in any way. But as soon as they are activated, pain immediately arises. The most common factor in the activation of trigger points is overload of the affected muscles. The intercostal muscles are classified as respiratory muscles, as they are involved in the act of breathing. A cough is a forced exhalation. Therefore, intercostal neuralgia when coughing or after a cold is not neuralgia, as many people mistakenly think, but myofascial syndrome, provoked by overload of the respiratory muscles from coughing. By the way, an indirect sign of how to distinguish intercostal neuralgia from myofascial syndrome is the duration of the disease. True intercostal neuralgia takes a long time to heal. Especially if it is caused by a fracture or tumor. And myofascial syndrome has a shorter treatment period. But it is impossible to say exactly how long intercostal neuralgia lasts without seeing the patient. Firstly, you need to make sure that it is intercostal neuralgia and not some other pathology, and secondly, it all depends on the situation. Agree, neuralgia from herpes and from a fracture will have completely different treatment periods.

Separately, it is necessary to say about the so-called false symptoms of intercostal neuralgia. Muscle tension, muscle twitching, increased pain when coughing, sneezing, turning the body; forced body position to relieve pain, sweating, high blood pressure and a number of other symptoms are not signs of intercostal neuralgia, although they are often attributed to it. These symptoms refer to pathologies similar to neuralgia. Being able to distinguish between similar pathologies is one of the basic skills of a doctor, which is specially taught, and which allows the doctor to make an accurate and correct diagnosis. It remains only to remind you that a doctor for intercostal neuralgia is a chiropractor, or even better, a chiropractor-neurologist.