Pain in the shoulder blade and below: what discomfort it may show

Pain in the shoulder blade and lower back can occur with nerve damage, diseases of the spine, shoulder girdle or somatic pathologies. The cause can be determined by clinical signs, conditions for the manifestation of the syndrome and history.

Pain in the shoulder blade can be felt during inhalation, felt in half of the body and or in the whole arm. In certain cases, such symptoms are the "first bell" of the exacerbation period, which can be prevented after the provoking factor is identified.

Causes and localization

Pain under the shoulder blade usually occurs during movement - it is preceded by an awkward turn, long standing with a curved back. It signals local damage that occurs for various reasons.

Pathologies with unilateral lesions, in which it hurts only on the right or left under the shoulder blade, are few - usually the severity of the symptom is individual. This is due to the symmetrical arrangement of the nerve roots coming out of the spinal cord.

Injuries

If it hurts under the right and left shoulder blades, it may be the result of damage to the bones and muscular frame. The symptoms are not strictly localized, the severity depends on the traumatic factor. The clinic is usually acute, begins abruptly and becomes chronic.

The causes of traumatic pain under the left or right shoulder blade are as follows:

1. Bruises - in such cases the pain is superficial, most often the muscles are damaged. Usually the muscles of the back under the shoulders and below hurt, swelling and local inflammation develop. After 2-3 weeks the symptoms disappear.
2. Cracks and fractures are more serious injuries, the pain is concentrated in the shoulder blade itself. At the slightest movement it intensifies, the patient cannot move his arm or bend over.
3. Subluxation and displacement of the vertebrae - this leads to pain in the joints at the level of the shoulder blades and below, sometimes the bone structures press on the nerve roots.

Injuries are characterized by severe pain under the right or left shoulder blade, which occurs spontaneously. There may be crunches and swelling during movement.

Osteochondrosis

If the disease affects the thoracic spine, the patient has back pain near the shoulder blades and below. This is due to pinching of the nerves or spinal cord due to deformation of the joint disc. The pathology develops gradually and with decreasing distance between the vertebrae the clinic of the pathology worsens.

The location of the pain depends on the affected area:

1. If osteochondrosis destroys the articular discs of the thoracic region from 2 to 6, pain is felt in the shoulder blade. It is usually radiated to the neck and arm. Dizziness occurs when the vessels are compressed, and intracranial pressure may increase.
2. When the joints of 6-12 segments are affected, the pain radiates under the left or right shoulder blade, spreading lower, to the respective half of the body and lower back.

The spinal roots of the thoracic region give rise to plexuses that innervate the arms and torso. Therefore, when they are pressed, the pain spreads along their course.

In osteochondrosis, the discomfort is one-sided - pain in the shoulder blade on the right or left side and below, depending on the curvature of the spine.

scoliosis

This is a curvature of the spine in the transverse direction due to strain on the muscles that support the posture. This leads to pinching of the roots and spinal cord, the appearance of pain under the shoulder blade on the right or left. The pathology is usually accompanied by:

1. Respiratory failure - unilateral curvature of the spine deforms the chest, which affects the functioning of the lungs, one of which is compressed, and the second takes over the lost function.
2. Impaired heart function - the frequency of contractions and changes in heart rate, shortness of breath and pale skin.
3. The appearance of visible deformity of the chest is the main cause of pain under the right or left shoulder blade. The vertebrae, together with the ribs, are displaced laterally, as a result of which on the side of the curve the bone structures are displaced downwards and damage the spinal cord with its branches.

If the spinal cord is compressed during scoliosis, the back usually hurts between the shoulder blades and below, the focus is strictly limited. If muscle spasms join, the symptom spreads to neighboring structures.

kyphosis

It is characterized by backward curvature of the spine, forward displacement of the shoulder girdle and gradual stooping. There is pain over the shoulder blade - usually bilateral, giving in the arm and neck. The following mechanisms are involved in its formation:

1. Neurogenic - due to the curvature, the distances between the vertebral bodies in the anterior areas decrease, this provokes pinching of the branches of the spinal cord. There is painful pain in the right and left shoulder blades, which can radiate to the clavicle, neck and shoulder.
2. Muscular - the deviation of the spine leads to strain on the muscles of the collar area, which can cause painful spasms in the shoulder blades and below.

As a result of kyphosis, the vertebral artery is compressed, the cerebral circulation is disturbed. The work of the internal organs is gradually deteriorating.

Spondylarthrosis

If the right or left shoulder blade hurts, one of the causes may be spondyloarthritis - damage to the facet joints and intervertebral discs. Accompanied by loss of mobility, stiffness appears, most pronounced in the morning.

The clinical picture changes with the progression of the pathology: >

1. Cartilage destruction - in the absence of blood circulation, the integrity of connective tissue is disrupted, the joint disc becomes fragile, more damaged and recovers more slowly. At this stage, strenuous exercise leads to microtrauma, there is pain that radiates to the shoulders and lower back.
2. Deformation of the joint disc - seals appear, which impede mobility. This provokes a new destruction, which slows down the regeneration process, the patient feels pain in the back and shoulders.
3. The appearance of bone growths is characteristic of the advanced stage of the disease. Neoplasms damage joints, muscles, blood vessels and nerves.

In spondyloarthritis, the back may hurt between the shoulder blades or below - the attack is usually preceded by physical activity. At rest, the symptoms subside because the bone growths do not injure the surrounding tissues.

Protrusion and hernia

In these conditions, acute pain under the left and right shoulder blades, which occurs due to compression of the spinal cord or its roots, is alarming. As a result of pinching, the sensitivity along the nerve fibers is impaired.

The localization of symptoms is as follows:

1. Pain in the shoulder blades and above - bulge or hernia in the cervicothoracic area or when 1-3 thoracic segments are affected. The symptom intensifies when you try to tilt your head, turn it to the side.
2. Pain in the interlopatal area - in this case, the middle areas may be affected, from 3 to 6. The discomfort is exacerbated by moving both hands to the side, deep breathing or turning.
3. Severe pain under the right and left shoulder blade - affected joint discs from 6 to 12, in the pathology may be involved the lower back. In this case, there is a risk of developing a hernia, as this part of the spine is more stressed than before.

Unlike spondyloarthritis, the pain of a hernia and bulge does not go away for a long time at rest. This is due to constant compression of the nerve, which is aggravated by muscle spasm.

Radiculitis

It is a pinching of the lumbar roots that are gathered in a powerful sciatic nerve. If the upper parts are affected, the patient feels pain under the shoulder blade and below, it is bilateral, intensified by flexion and sudden movements.

As the disease progresses, additional symptoms may occur: >

1. There is pain in the back, which radiates to the lower limb - a sharp piercing pain is felt as an electric shock along the nerve.
2. Burning pains in the back, lumbar region or under the shoulder blades indicate prolonged pinching of the spinal roots in the lumbar region.
3. Cramps and loss of sensation usually occur in the lumbar region, buttocks, sometimes there is tingling along the nerve fibers of the thigh, lower leg and foot.

Shoulder-scapular periarthrosis

This condition is understood as inflammation of the shoulder joint and surrounding tissues, stiffness occurs, which disappears only after heating.

The pain is concentrated in the area of the right or left shoulder blade and below it, depending on the development of hemispherical motor skills (right or left hand). It first appears after training, and then at rest. Additional symptoms appear along the way:

• headache;
• numbness of the hands;
• impaired mobility of the spine.

In humeroscapular periarthritis, the clinical manifestations increase when the arm is raised - pain in the right or left shoulder, shoulder blade. Gradually the range of motion decreases, stiffness progresses.

neuralgia

The next cause of pain under the right or left shoulder blade is inflammation of the nerves in this area. The disease is caused by hypothermia, currents. Most commonly affected:

1. Suprascapular and spinal nerve - there is pain in the right or left shoulder blade, concentrated mainly in the clavicle. Sometimes the discomfort spreads to the shoulder, which indicates the defeat of the skin branches in this area.
2. Subscapular and infraspinal nerves - in this case it hurts on the right or left under the shoulder blade, depending on the side of the lesion. If the muscles of the same name are affected, the clinical manifestations worsen when the arms move down, abducted behind the back.
3. Intercostal nerves - usually 1-4 pairs. These branches run along the lower edge of the rib, the pain occurs not only in the shoulder blades and below, but also on the side of the chest, sometimes in the front areas.

Symmetry is not typical of neuralgia - if the left half of the body has been exposed to currents, then there is pain in the neck, chest and shoulder blades on this side.

Heart disease

The branches of the parasympathetic trunk, which is connected to the spinal cord and its roots, go to the heart. This is why heart disease can provoke pain in the shoulder blade and below. The mild form of myocardial infarction is usually latent. It may be accompanied by the following symptoms:

1. Dull pressing or burning pain, which is felt behind the sternum or under the left shoulder blade - can last for hours, increase when walking, but disappears a little at rest.
2. Shortness of breath - accompanied by pain, may manifest itself within a few days.
3. Tachycardia - increased heart rate, sometimes arrhythmias.
4. Other symptoms include high blood pressure, dizziness, nausea and vomiting.

Gastrointestinal problems

Like the previous mechanism, the pain spreads to nerve fibers. Clinical signs may be bilateral, but in most cases there is a specific pattern in which symptoms occur according to the location of the internal organs.

Pain under the left shoulder blade behind the back occurs in the following diseases:

• Pancreatitis;
• gastritis;
• stomach ulcer.

Usually in these diseases patients complain of dyspepsia, nausea and vomiting. If internal bleeding occurs, pale skin, dark stools, decreased pressure and weakness are noted.

Pain under the right shoulder blade behind the back accompanies:

• cholelithiasis;
• hepatitis;
• cirrhosis of the liver;
• ulcerative lesion of the duodenum.

Other reasons

In addition to these factors, pain under the shoulder blades can provoke:

1. Inconvenient mattress - if you fail and sleep on your right side, in the morning you may feel pain under the left shoulder blade from behind, as the curved spine pinches the spinal roots.
2. Pleurisy - pain in the shoulder blade occurs when breathing due to friction of the sheets against each other, reaches a peak with deep breathing.
3. Polio - the pathology is accompanied by neurological symptoms, back pain often occurs.
4. Intoxication - severe poisoning or colds can be manifested by muscle pain, chills and fever.
5. VVD - vascular dystonia is accompanied by changes in pressure, interruptions in heart function and shortness of breath, and sometimes back discomfort.
6. Kidney disease - such pathologies are characterized by painful or piercing pain under the right shoulder blade, change in diuresis and urine color and general symptoms.
7. Subphrenic abscess - if suppuration is observed in the upper floor of the abdominal cavity, inhalation will cause pain under the shoulders, fever and symptoms of intoxication.
8. Mental disorders - in some cases, pain in the shoulder blades and below them may be the result of such disorders. The exact mechanism of occurrence has not been studied.

The nature of pain

Soreness in the area of the shoulder blades and below can be different, by its nature it is possible to accept a specific group of pathologies, sometimes a provoking factor can be identified:

1. Pinched nerves are characterized by lumbago - a sharp piercing pain that occurs when a sharp turn of the body, raising the arm. This is the main difference from cholelithiasis, in which the symptom does not twist from movement.
2. Pain, throbbing or burning pain indicates pathology of the internal organs. The latter option occurs when the roots of the spinal cord are compressed, but increases with movement and can turn into stitches.
3. Severe shrinking pain in the shoulder blades and below is characteristic of hernias. Sometimes preceded by lumbago, tingling in the limbs.
4. Cutting pain of varying intensity is characteristic of neuralgia, piercing often accompanies inflammation of the joints.

Which doctor treats shoulder pain?

If you feel pain in the shoulder blade and below, you should make an appointment with a neurologist. If there are no pinched nerves, the specialist will refer you to a consultation with an orthopedist, cardiologist, gastroenterologist or urologist, depending on the suspected disease.

Diagnosis

To identify the cause of discomfort in the shoulder blade and below, a laboratory and instrumental examination is performed:

1. X-ray or CT - with the help of these methods you can detect osteochondrosis, curvature of the spine and the consequences of injuries.
2. NMR >- the spine, shoulder joint or internal organs are examined depending on the suspected pathology.
3. ECG - helps identify heart disease.
4. Blood and urine tests are informative for some somatic pathologies, inflammation of muscles and joints.
5. Ultrasound - prescribed for somatic diseases, if it is impossible to undergo MRI.

Usually the pain under the shoulder blades occurs due to neurology. Therefore, CT and MRI are considered the "gold standard" in the diagnostic protocol.

General principles of treatment

The main task is to eliminate the symptoms and the provoking factor. First, the patient's well-being is stabilized, then the underlying pathology is treated.

The therapeutic program includes:

1. Medications - Analgesics are usually prescribed to relieve pain and inflammation. Then drugs are prescribed depending on the underlying disease - antibiotics, gastroprotectors, diuretics.
2. Physiotherapy - strengthens the spine, treats somatic diseases. Drug electrophoresis is used in the field of blades, warming procedures, SWT.
3. Massage - the warm-up is performed with damage to the spine. From such procedures the muscles above and below the shoulder blades relax, the posture improves. In this case, you need professional help from a chiropractor or osteopath.
4. Gymnastics - is carried out after the removal of pain, the program is made depending on the disease suffered by a physiotherapist, rehabilitation specialist.

Prevention

After successful treatment, patients are advised to follow a preventive program that will prevent recurrence of the pathology:

• watch your posture;
• choose a mattress with moderate firmness and an orthopedic pillow;
• twice a week massage in the area of the shoulder blades and below;
• follow a low-calorie diet for obesity;
• get rid of bad habits;
• conducting prevention of somatic pathology (if present in the anamnesis);
• see a doctor every six months.

Shoulder and lower back pain can be neurological or somatic. When nerves are damaged, symptoms are sharp and sudden, appearing spontaneously.

Pathologies of internal organs and joints are characterized by gradual and prolonged pain, the clinic is always accompanied by additional symptoms. In the initial stages, analgesics are prescribed, after diagnosis the program is supplemented with etiological therapy and strengthening procedures.