Pain under the left shoulder blade.observed in musculoskeletal pathologies (osteochondrosis, myofascial syndrome, injuries), heart diseases (myocardial infarction, angina pectoris, rheumatic and non-rheumatic carditis), gastrointestinal diseases (pancreatitis, stomach ulcers). Rare causes of the symptom include damage to the spleen, ulcers, and skin tumors. Diagnostic methods are selected depending on the underlying syndrome: x-rays, ultrasound, and endoscopic examinations are used. To relieve pain, analgesics are prescribed, after which medical or surgical treatment of the underlying disease is performed.
Causes of pain under the left shoulder blade.
radicular syndrome
The pathological condition develops with thoracic osteochondrosis or intervertebral hernia. Less commonly, radicular pain occurs with spondylolisthesis and ankylosing spondylitis. Sharp pain in the projection of the left scapula is noted when the third and sixth thoracic roots are involved in the process, discomfort directly under the scapula indicates the localization of damage to the seventh and eighth vertebrae. Typically, pain spreads from the scapula to the lateral surface of the chest and intercostal spaces.
Myofascial pain syndrome
Poor posture and prolonged stay in an uncomfortable position cause constant muscle tension. The syndrome manifests itself as pain in the area of the scapula on the left, when the load is predominantly on this side. The patient feels the discomfort as deep and moderately intense. At first, the pain is experienced only during movement and exertion, but over time it becomes constant. Sometimes radiating pain appears in the forearm or left hand.
Injuries
Severe pain develops after a crack or fracture of the scapula or a soft tissue hematoma over this area. If the integrity of the bone is preserved, the pain is moderate, the person can breathe deeply and move freely. When traumatic damage to bone structures occurs, acute pain occurs, and mobility of the arm and shoulder girdle is usually limited. When changing position or pressing on the injured area, a sharp pain is felt.
Boils and carbuncles
Purulent inflammation of the skin surrounding the left shoulder blade is accompanied by severe pain, which, as a rule, is clearly localized. As the boil matures, "pulling" sensations occur, which intensify when the swollen area is palpated or rubbed with clothing. Once the tire ruptures and the necrotic core comes out, the pain subsides. With a carbuncle, the pain is more intense and the patient's general condition often worsens.
Heart diseases
Heart damage is a typical cause of pain under the left scapula, which is associated with the proximity of the anatomical location and the features of innervation. In this case, the symptoms are accompanied by chest pains of various types, a feeling of cold or interruptions in the functioning of the heart. Tachycardia and other rhythm disturbances are generally detected. Pain under the shoulder blade manifests itself as:
- Myocardial infarction.Patients experience an unbearable burning sensation that extends from the precordial region to the left arm and shoulder blade and, less frequently, to the clavicle and neck. The condition occurs suddenly and is accompanied by a strong fear of death and a state of fainting.
- Stable angina.Episodes of squeezing pain radiating to the subscapular area are specific to attacks of ischemic heart disease. Unpleasant symptoms are provoked by physical activity or emotional stress and last on average 10-15 minutes. After resting or taking nitrates, the pain goes away.
- Inflammatory heart diseases.Dull or stabbing pain in the chest, radiating to the left shoulder blade and bothering the patient for several days, is typical for acute carditis (myocarditis, pericarditis). The person also complains of shortness of breath, increased body temperature, and swelling of the lower extremities.
- Rheumatism.Radiating pain in the left half of the back in combination with cardialgia is characteristic of the clinical picture of rheumatic carditis. The clinical picture is complemented by arthralgia, annular erythema of the skin and rheumatic nodules. Symptoms are detected more frequently in children and adolescents.
Pancreatitis
In acute pancreatic inflammation, pain is observed in the waist that travels from the left hypochondrium to the subscapular region. In addition to pain syndrome, patients are worried about debilitating vomiting with impurities of bile and mucus and tension in the abdominal muscles. Movement increases painful sensations, so the person tries to lie still on his side.
In chronic pancreatitis, irradiation of pain under the scapula indicates an exacerbation of the process. Often, violations are provoked by errors in the diet: a big party, drinking alcohol. The pain is paroxysmal in nature and sometimes extends not only to the subscapularis, but also to the precordial region. The symptoms are combined with nausea, flatulence and steatorrhea.
Stomach ulcer
Pain under the left shoulder blade is a sign of localization of the defect on the posterior wall of the stomach, closer to the back. Unpleasant sensations appear 20 to 50 minutes after finishing a meal. The sooner symptoms appear, the larger the location of the ulcer. The discomfort becomes more severe when eating acidic, spicy or fried foods. To reduce the intensity of pain, patients induce vomiting.
Spleen diseases
Pain and fullness in the left subscapular area occur with splenomegaly caused by infectious, autoimmune, or myeloproliferative processes. With the gradual enlargement of the organ, periodic discomfort with heaviness develops in the affected area, and a rapid change in the size of the spleen is accompanied by sharp cutting pains radiating under the left shoulder blade.
A little less frequently, the cause of pain is surgical pathologies of the spleen: rupture, heart attack, volvulus. In this case, cutting or stabbing pains occur that radiate under the scapula and are aggravated by the slightest movement. Therefore, the patient adopts a forced position: lying on his left side or face up with his knees close to his stomach. The clinical picture is complemented by a sharp drop in blood pressure and tachycardia. In the absence of adequate pain relief, shock occurs.
Bronchopulmonary pathologies
Left-sided focal processes in the lungs often cause pain in the projection of the scapula. The discomfort increases with deep breathing, laughter and conversation, and with a coughing attack. The pain has a varied nature: sharp, stabbing, dull, oppressive. They are accompanied by fever, difficulty breathing and other typical respiratory symptoms. Most often, patients who develop pain under the left shoulder blade experience:
- Pneumonia.The patient feels a moderate dull pain, which has a clear localization in case of focal inflammation of the lungs or spreads throughout the entire area of the scapula in case of lobar pneumonia. A deep cough appears with the release of mucopurulent sputum. Symptoms last up to 2-4 weeks.
- Pleuritis.With exudative pleurisy, a person experiences pressure and bursting under the scapula and along the side wall of the chest. When palpating this area, the discomfort intensifies. Dry pleurisy is characterized by sharp pain in the chest and subscapular area, which worsens during movements.
- Tuberculosis.Tuberculosis infection lasts a long time, so low-intensity pain persists for several months. If the pain is localized in the area of the scapula, the pathological focus is more likely to be located in the posterior segments of the lung.
- Pulmonary infarction.The death of a section of the lung parenchyma is manifested by severe pain radiating under the left shoulder blade, clinically resembling an angina attack. The condition of patients is complicated by hemoptysis or pulmonary hemorrhage, dysfunction of external respiration and arrhythmias.
rare causes
- Neoplasms: osteoma and osteosarcoma, bone cyst, malignant tumors of the skin above the scapula (basal cell carcinoma, melanoma).
- Rare cardiovascular pathologies: cardiac syndrome X, descending aortic aneurysm.
- Acute surgical diseases.: retroperitoneal abscess, hemoperitoneum, strangulated diaphragmatic hernia.
Diagnosis
Patients with pain under the left shoulder blade are first referred for consultation to an orthopedic traumatologist. If there are no disorders of the musculoskeletal system, other specialists participate in the diagnostic search: neurologist, cardiologist, surgeon, etc. To establish the causes of pain, a full range of instrumental studies is prescribed, including:
- Bone scan. An x-ray of the scapula in frontal and lateral projections makes it possible to exclude or confirm a traumatic injury. Radiation imaging of the spine is indicated in suspected osteochondrosis, scoliosis, or spondylolisthesis. Simple x-ray of the thoracic cavity allows suspicion of damage to the lungs or heart.
- Electrocardiogram.A standard 12-lead ECG is a screening method, according to the results of which the doctor makes a preliminary diagnosis and identifies dangerous processes (myocardial infarction, life-threatening arrhythmias). The complex diagnosis is complemented by classic or transesophageal echocardiography and cardiac electrophysiology.
- Ultrasound of the abdominal organs.A quick, non-invasive method is used to detect common conditions that cause pain in the left shoulder blade. Ultrasound examination shows signs of stomach ulcer, inflammatory infiltration of the pancreas, and enlarged spleen. To clarify the diagnosis of peptic ulcer, EGD is used.
- Additional methods. To clarify the nature and severity of bone changes, a CT scan or MRI of the spine is performed. In case of probable bronchopulmonary diseases, bronchoscopy with biopsy and pleural puncture is performed. If there are difficulties diagnosing abdominal pathology, diagnostic laparoscopy is recommended.
Laboratory examination methods play an important role in making a diagnosis. A clinical blood test shows signs of inflammation or disruption of hematopoietic processes. Acute phase protein indicators and proteinograms are informative in case of possible heart damage or an autoimmune process. Specific myocardial markers are evaluated to detect anginal pain.
To diagnose gastrointestinal diseases, a coprogram is carried out: the presence of pancreatitis is indicated by a high content of undigested food particles, an increase in the number of striated muscle fibers and starch grains. In case of inflammatory processes of the lungs and pleura, bacteriological sowing of the biomaterial is necessary, followed by a test for the sensitivity of the isolated microorganisms to antibiotics.
Treatment
Help before diagnosis
Considering the variety of causes of pain under the left shoulder blade, it is extremely difficult for a doctor to give recommendations until the underlying pathology is identified. During the examination, it is advisable to reduce the load on the back muscles to eliminate simple fatigue and overexertion, which can lead to symptoms of persistent pain. If the sensations are unbearable, pain relievers are used and the patient is immediately hospitalized.
Conservative therapy
The treatment plan is selected only after a complete diagnosis and determination of the etiological factors of pain under the left shoulder blade. If the patient suffers from intense discomfort, anti-inflammatories and muscle relaxants are recommended, which quickly relieve painful sensations. For severe pain, therapeutic blocks and administration of narcotic analgesics are effective. Taking into account the disease, a mode of physical activity is selected.
Drug therapy is prescribed by a specialist of the appropriate profile. For pain due to heart damage, the cardiologist prescribes antianginal and antiarrhythmic drugs, antiplatelet and anticoagulant drugs, as well as antihypertensive drugs. Diseases of the bronchopulmonary system require the participation of a pulmonologist and the use of antibiotics, expectorants and specific anti-tuberculosis drugs.
For gastrointestinal pathologies, a suitable diet is selected and therapy is supplemented with enzyme preparations, prokinetics, antacids and antisecretory drugs. In neurology, neurometabolic agents, B vitamins and drugs that improve microcirculation and the rheological properties of blood are indicated to eliminate radicular syndrome.
For postural disorders and other spinal problems, non-drug methods are actively used: traction therapy, therapeutic massage, exercise therapy. Among physiotherapeutic methods, balneotherapy (sulfur and radon baths), mud therapy and reflexology are popular. It is possible to increase the effectiveness of drug treatment by electrophoresis of drugs directly on the affected area.
Surgery
Surgical methods are indicated when conservative treatment is ineffective or in acute life-threatening pathologies, when delay is dangerous for the life and health of the patient. The second group of operations includes methods of stenting, angioplasty and bypass surgery for myocardial infarction, assistance of abdominal or thoracic surgeons for injuries, purulent processes and internal bleeding.
Planned surgical interventions are often prescribed in neurosurgery for severe radicular syndrome and intervertebral hernia. To eliminate pain associated with compression of nerve structures, microdiscectomy and laser vaporization of the disc are performed. In rare cases, spinal stabilization operations (interbody fusion, application of a Halo device, transpedicular fixation) are resorted to.