Pain under the shoulder blade

Pain under the shoulder blade is a clinical sign of many pathological conditions, which may include gastrointestinal, cardiac, neurological diseases, as well as osteochondrosis, intervertebral hernia, bronchopulmonary pathology and others.

The pain symptom may vary in intensity and localization - under the right or left shoulder blade, and sometimes limit a person's motor activity. Pain under the shoulder blade is most often associated with spasms of skeletal muscles due to tension or with the reflection of pain emanating from the internal organs located in the scapular region.

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Causes of pain under the shoulder blades

Regio scapularis is the name of the scapular region, which is limited by lines - in the upper part of the body between the unpaired spinous process of the most protruding VII cervical vertebra and the clavicles, below - a medial-vertical line along the lower edge of the shoulder blades, as well as a line from the armpits to the edge of the deltoid muscle. Diagnosis of pain under the shoulder blade depends on the nature of the symptom, its localization and accompanying clinical signs, since the scapular region itself can hurt only with trauma - a blow, a bruise.

The causes of pain under the shoulder blades may be the following:

1. LRS - scapulocostal, scapulocostal syndrome or syndrome of the muscle that lifts the scapula. If the muscle that is attached to the transverse processes of the upper cervical vertebrae is overcooled, injured, inflamed or overstrained, it is unable to normally perform its function - to provide a tilt of the neck and elevation of the scapula. Symptomatically, LRS - scapulocostal syndrome manifests itself in the form of aching, sometimes intense pain in the shoulder girdle, at the top of the scapula and under it. Often the pain spreads to the shoulder, the lateral part of the sternum. The most painful point is the point of attachment of the muscle, if you press on it, the pain becomes acute, radiating up to the neck. In addition, a characteristic sign of LRS is the sound of crunching when moving the shoulders, arms. Dynamic constant loads, as well as static tension can create a condition in which the pain under the scapula becomes constant, aggravated by exposure to cold, draft.
2. Peptic ulcer disease is a gastric ulcer, as the most common cause of radiating pain under the shoulder blades. The symptom begins with dull, aching pain that increases or decreases after taking medications, vomiting. The pain is directly related to food intake, seasonality and most often radiates to the left - from the epigastrium to the left shoulder blade, to the chest and back. The pain symptom in gastric ulcer is usually divided into hunger, late or early pain. In addition, Peptic ulcer disease is usually accompanied by nausea at the peak of pain development, vomiting - in 75-80% of cases and heartburn.
3. Vegetative or as they are often called psychosomatic pains are also included in the causes of pain under the shoulder blade. Such sensations are similar to the signs of angina pectoris, cardiac pains, as they cause a feeling of squeezing, burning in the chest, which intensifies and radiates to the arm, under the shoulder blade, under the collarbone, more often to the left, to the heart area. The pain symptom can be both intense and aching, undefined in nature. The main differential sign of vegetative pains is the lack of effect after taking cardiac drugs - they do not relieve either pain or the feeling of pressure. As a rule, relaxants and sedatives help with a vegetative-vascular attack.
4. Osteochondrosis of the thoracic or cervical spine can cause one-sided dull, prolonged, aching pain, which most often begins in the back of the head and spreads down under the shoulder blade. The pain can occur in the early morning hours, increase with static load (sedentary work), with sudden body movements. This condition is accompanied by radiating pain in the arm, under the shoulder blade, paresthesia of the limb, dizziness, visual disturbances. The symptom is relieved by warming massages, ointments, a warm bath.
5. Intercostal neuralgia is the most common cause of pain under the shoulder blades. The symptom develops rapidly and is expressed in paroxysmal, one-sided pain of a girdle-like, intense nature. The pain spreads along the intercostal muscles, spaces and intensifies with deep breathing, coughing, sneezing, prolonged physical exertion, walking. In a clinical sense, intercostal syndrome is manifested by palpation of the innervating area, which is not typical for cardiac pathologies, osteochondrosis. Due to constant muscle tension, the pain can spread lower - to the lower back, but most often it manifests itself as stabbing sensations, burning under the shoulder blade.
6. An attack of angina begins with pain in the middle of the chest (retrosternal space), which quickly spreads, spills to the left and radiates under the collarbone, to the back, under the left shoulder blade. The pain is not always relieved by taking nitroglycerin, vasodilators, which can serve as a signal of myocardial infarction. In addition, there is a distinction between the causes of angina pain:
   • Severe, sharp pain in the left side of the chest, under the shoulder blade, is typical of angina pectoris, when a person is subjected to physical or psycho-emotional stress.
   • A nagging, aching pain may indicate an attack of resting angina, when there are no external provoking causes for the pain symptom.
7. Causes of pain under the shoulder blade may be associated with a severe, life-threatening condition - perforation of a gastric ulcer, which is accompanied by severe, sharp pains radiating under the collarbone and under one of the shoulder blades. A characteristic sign of perforation is vomiting, the patient's position - hands pressed, knees to the stomach (fetal position). This symptom requires immediate medical attention, as well as cardialgia.
8. Yuerth's symptom or a sign of an inflammatory process in the pericardium, accompanied by the release of exudate. The main manifestations of exudative pericarditis are chest pain, shortness of breath, high body temperature, and fever. The pain intensifies due to the accumulation of effusion and stretching of the pericardium when coughing, changing body position, the sensations can be aching in nature, but most often "shoot" into the neck area, under the left shoulder blade. Exacerbation of the inflammatory process often causes the clinical picture of "acute abdomen".
9. Dissection of the aorta - dissection of the wall (aneurysm) of the aorta. A life-threatening condition, accompanied by intense pain in the back, between the shoulder blades or with a shift under one of them. Most often, the pain shifts to the left, radiates to the arm and under the left shoulder blade, spreading along the dissecting aorta. The most dangerous consequences of this symptom can be a stroke (if the blood flow of the carotid arteries is impaired), a heart attack (if the blood flow of the coronary arteries is impaired), mesenteric thrombosis, paralysis of the legs (if the blood flow of the iliac arteries is impaired), damage to the spinal cord (if the blood flow of the vertebral arteries is impaired).
10. Herniated disc of the thoracic spine. The disease is rarely diagnosed, since the thoracic spine is quite stable in this sense. Constant, aching and increasing pain in the area of infringement and pathological focus gradually becomes intense, often similar to the symptoms of diseases of the bronchopulmonary or cardiovascular systems. The main characteristic sign of a hernia can be muscle tension between the shoulder blades and visible curvature of the spinal column. The diagnosis is confirmed by X-ray examinations, MRI.
11. Cholelithiasis - cholelithiasis, colic can also manifest itself as paroxysmal, unbearable pain radiating to the right, under the shoulder blade and above.
12. Causes of pain under the shoulder blade may be due to respiratory diseases - pneumonia or pleurisy. With pneumonia, the pain is localized in accordance with the pathological focus in the tissue; if the process develops in the back, pain appears in the back, between the shoulder blades or under them. Inflammation of the pleura is also accompanied by stabbing pain between the shoulder blades, often under one of them. The pain intensifies with a cough reflex, breathing.
13. Myositis is an inflammatory process in muscles as a result of hypothermia, acute respiratory viral infections, or overexertion, less often due to bruises. Pain occurs suddenly in acute cases, or develops gradually, and is of a pulling, aching nature in chronic inflammation. The pain symptom is associated with movements, physical activity, changes in posture, and bending.

Symptoms of pain under the shoulder blades

The symptoms of pain under the shoulder blades are so varied that there is still no single standard algorithm for differential diagnostics in clinical practice. Each medical specialization has its own schemes for collecting anamnesis, examination, testing and examinations, but there are often cases when the pain symptom is “masked” and does not indicate the true cause. That is why the patient is required to describe the nature of the pain as accurately as possible, all the circumstances under which it occurs. In addition, chronic pain, to which a person has “gotten used to”, often blurs the diagnostic picture, as a result of which time is lost and the therapeutic effect is much more difficult to achieve.

What symptoms of pain under the shoulder blade require immediate medical attention?

• A nagging, constant pain in the back radiating under the shoulder blade, which does not subside within 2-3 days.
• Pain under the shoulder blade with static tension (sedentary work) in people over 50 years of age.
• Pain radiating to the shoulder blades, increasing at night or in a horizontal position.
• Pain with elevated body temperature.
• Pain accompanied by numbness in the arm or shoulder.
• Pain that causes pressure, burning, starting from the middle of the chest.
• Pain that is not relieved by cardiac medications or sedatives.
• A girdle-like pain radiating to the shoulder blade.
• Sharp, severe pain with vomiting.

Symptoms of pain under the shoulder blades are most often described as follows:

• Sharp pain in the middle of the back, radiating under the left shoulder blade. The pain appeared in the morning and intensifies with movement.
• Sharp, severe pain under the shoulder blades.
• Dull pain below the shoulder blades, increasing when raising the arms.
• A nagging, aching pain under the shoulder blade, spreading down to the lower back.
• Pain under the left shoulder blade and a feeling of pressure in the chest.
• Pain under the shoulder blades in the form of a localized area, burning.
• The pain intensifies when a cough appears.
• The pain under the shoulder blade is replaced by a burning sensation and numbness in the arm.
• Intense pain that goes away after vomiting.

Despite the variety of reasons that provoke the pain symptom under the shoulder blades, there are differential signs - danger signals that allow an experienced doctor to exclude relatively benign diseases associated with dorsalgia. The following signs are alarming symptoms that may accompany pain in the shoulder blade area:

• Hyperthermia – 38-40 degrees.
• Spontaneous pain that increases and provokes a state of “acute abdomen”.
• Shortness of breath, cyanosis of the skin.
• Swelling of the hands.
• Pain that does not subside with rest.
• Vomit.
• Drop in blood pressure and pulse.
• Fainting.

Back pain under the shoulder blades

Back pain, in the scapular region, can be associated with many diseases, but most often it is caused by deformation of the spinal column, especially if accompanied by a feeling of numbness in the limbs, tingling in the fingers.

In addition, back pain under the shoulder blades is provoked by the following diseases and conditions:

• Curvature of the spine - kyphosis.
• Herniated disc in the thoracic spine.
• Lateral curvature of the spine – kyphoscoliosis.
• Ischemic heart disease.
• Scapulohumeral periarthritis.
• Intercostal neuralgia.
• Frontal curvature of the spine – scoliosis.
• Angina pectoris - exertion or rest.
• Protrusion (degeneration) of the thoracic spine disc without rupture.
• GU - gastric ulcer.
• Cholecystitis.
• Hepatic colic with concomitant dyskinesia of the gallbladder.
• Dry pleurisy.
• Pneumonia.
• Inflammation of the interscapular muscles, tendons, and supraspinous ligaments.

Pain under the left shoulder blade

Pain under the left shoulder blade may be associated with the following diseases:

1. Periodic pain under the left shoulder blade may signal a developing stomach ulcer. The pain quickly increases, accompanied by nausea and then vomiting, the symptom is associated with food intake or lack thereof - hunger pains. The pain begins in the epigastrium and spreads to the side - to the right or left, most often radiating under the left chest and under the left shoulder blade.
2. Vegetative crises are also characterized by left-sided pains, massaging under cardiopathies. Pain under the shoulder blade on the left, of a pulling, aching nature, often causing a feeling of fear, not relieved by nitroglycerin and other cardiac drugs - this is a typical sign of psychogenic conditions.
3. Myocardial infarction most often has clearly expressed clinical symptoms - a burning sensation in the middle of the chest, pain radiating to the left side of the jaw, to the arm, under the left shoulder blade, numbness of the limb, nausea.
4. Angina pectoris – attacks of pain can develop with exertion, stress (angina of effort) or as an exacerbation of the chronic form (angina of rest).
5. Intercostal neuralgia is accompanied by acute pain, often of a girdle nature, radiating to the right or left under the shoulder blade. The symptom may intensify with a change in body position, physical exertion. The pain is relieved by warming up, relaxing the muscles.
6. Osteochondrosis, both cervical and thoracic, is also one of the reasons that provokes pain under the left shoulder blade. The pain symptom is accompanied by dizziness, nausea, numbness of the hands or one hand.
7. Ulcer perforation is an acute condition that is expressed in very severe pain radiating to the collarbone area, under the shoulder blade. In addition to intense pain, the patient is characterized by a posture with knees pressed to the stomach, cold sweat, cyanosis, a drop in blood pressure and pulse.

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Pain under the shoulder blade on the right

The pain symptom that appears under the right shoulder blade is associated with the following diseases:

• Biliary colic with spasm of the bladder, ducts due to blockage by stones. The pain is sharp, cutting, localized under the right rib and radiating to the back under the shoulder blade.
• Pain under the shoulder blade on the right can be caused by a diaphragmatic abscess. The symptom is very acute, intensifies with inhalation, even shallow, and radiates most often to the right.
• Acute pyelonephritis begins with pain in the lumbar region, which subsequently spreads higher and radiates under the right shoulder blade. The purulent process in the right kidney is accompanied by painful urination and elevated body temperature.
• Myofascial syndrome is also a cause that provokes pain under the shoulder blade on the right. This is chronic muscle pain associated with irritation of certain trigger points.
• Among the factors that provoke a pain symptom under the right shoulder blade, sometimes there is herpes - shingles. This is a viral disease that is not considered life-threatening, but it causes very strong, excruciating pain, burning, numbness. Herpes is characterized by a rash, itching, muscle pain, radiating under the shoulder blade.
• Osteochondrosis is one of the reasons that often provokes radiating pain under the shoulder blades, including the right one.
• Right-sided pneumonia. Pain in pneumonia most often manifests itself in the acute stage, there may be an elevated body temperature, a feverish state.

Read also: Pain under the right shoulder blade

If the pain radiates under the shoulder blade

Any pain symptom that "radiates" is called irradiation. The impulse of visceral pain can be so intense that irritation of the primary nerve branch is rapidly transmitted along the chain to the final branch, that is, far from the original source. Pain radiates under the shoulder blade most often from an organ affected by inflammation and can be provoked by the following reasons:

• Increased pressure in the intestines during inflammation, ulcerative process. The postbulbar part of the duodenum during ulcer radiates to the right under the scapula.
• Biliary colic (gallbladder, liver).
• Acute pain radiates under the left shoulder blade and during an attack of angina pectoris, when a feeling of pressure and compression appears.
• Pericarditis can also present as referred pain under the shoulder blades.
• Dissection of the aortic walls (aneurysm) is manifested by severe chest pain radiating to the neck, left side, shoulder, and under the shoulder blade.
• Pneumothorax (spontaneous) – acute pain in the chest radiating under the shoulder blade, into the shoulder blade area.
• Exacerbation of pancreatitis.
• Renal colic.
• Acute musculoskeletal dorsalgia.
• Myocardial infarction.
• Osteochondrosis of the cervical spine.

Reflected pain may be transient, but it may also signal that an acute condition is developing that requires immediate medical care. If the pain radiates under the shoulder blade and is not relieved by antispasmodics or cardiac medications, you should consult a doctor who will conduct an examination, differential diagnosis, and prescribe adequate treatment.

Pain under the shoulder blades when inhaling

A painful symptom under the shoulder blade, which intensifies when inhaling, is a signal characteristic of the following pathologies:

• Dry pleurisy is an inflammatory process in the pleura, the lining of the lungs. The pain may increase with bending, movement, and subside in a horizontal position or on the side. Fluid accumulating in the pleural cavity causes swelling and pain under the shoulder blade when inhaling.
• Pericarditis is an inflammatory process in the pericardial sac, the disease manifests itself as weakness, chest pain, which becomes more intense when inhaling.
• Pain under the shoulder blades when taking a deep breath may indicate intercostal neuralgia, which manifests itself in the form of girdle pain that seems to tighten the chest.
• Gallbladder diseases, spasms, colic, can also be accompanied by a painful symptom associated with inhalation.
• Renal colic (pyelonephritis, kidney abscess) can also be accompanied by pain in the hypochondrium, so intense that it spreads throughout the epigastric region, radiates under the shoulder blade and intensifies when inhaling.

Aching pain under the shoulder blade

Aching pain under the shoulder blade is evidence of a chronic process both in muscle tissue, in the spine, and in internal organs, which can signal their pathologies with reflected pain.

Scapulocortoid syndrome - SCS - is the most common cause of aching pain. This syndrome is characterized by vegetative pain - aches, aching sensations, dull pain, which are often associated with weather conditions. In a clinical sense, aching pain under the shoulder blade is not a specific sign of a particular disease, so pain differentiation should be carried out by excluding threatening conditions. Often, the aching nature of pain in the shoulder blade area can serve as the first signal of an attack of angina at rest, myocardial infarction can also be manifested by such a symptom, which does not always have a clearly expressed clinical picture. However, the main factors that provoke aching pain are osteochondrosis, scoliosis, kyphosis and other degenerative, dystrophic pathologies of the spine.

In addition, aching pain under the shoulder blade can be caused by psychogenic factors, vegetative crises, fibromyalgia. The most alarming symptom is one that is accompanied by nausea and vomiting, since this may be the beginning of an exacerbation of a stomach ulcer or duodenal ulcer.

Severe pain under the shoulder blade

Intense severe pain under the shoulder blade - left or right - is a reason to seek medical help, often such a pain symptom cannot be relieved on your own, it can also indicate life-threatening conditions. Severe pain under the shoulder blade can be caused by the following diseases:

• A stabbing, sharp, shooting pain that intensifies during inhalation, reflected in the shoulder, may be a sign of spontaneous pneumothorax. Additional clinical symptoms of pneumothorax are rapidly developing dyspnea, tachycardia, a drop in blood pressure, a slow pulse, and an increase (compensatory) in the veins in the neck.
• Severe pain that radiates under the shoulder blade and is accompanied by arterial hypertension indicates an exacerbation of osteochondrosis of the thoracic spine. Simultaneous pain in the back under the shoulder blade, headache and a jump in blood pressure are a clear symptom of pinched nerve endings in the cervical or thoracic spine. The pain may intensify when turning the body, shoot when bending or moving and is not relieved by cardiac drugs or sedatives.
• Severe pain under the shoulder blade may be associated with perforation of the ulcer of the upper stomach. If the perforation progresses quickly, the pain increases literally with every minute, the general clinical picture of the ulcer is typical - acute pain with irradiation, possible vomiting, cold sweat, cyanosis of the face, a characteristic pose - knees pulled to the chest.
• Hepatic (biliary) colic also manifests itself as severe pain, radiating upward to the right, under the shoulder blade, into the neck and even into the area of the right eye. The pain symptom is associated with blockage of the bile ducts after eating fried, fatty foods.
• A purulent process in the area between the diaphragm and the organs located below, a subdiaphragmatic abscess, is an acute condition that requires immediate medical care. A developing bacterial infection in this form can provoke general intoxication, sepsis. In essence, this is purulent peritonitis, limited by the diaphragm, manifested by severe pain in the hypochondrium, with irradiation to the right - the shoulder, under the shoulder blade. Also typical hyperthermia up to 40 degrees, fever, nausea.

It is not recommended to tolerate a strong radiating pain symptom for more than an hour; if it cannot be relieved by available means, you need to call an ambulance.

Dull pain under the shoulder blade

The nature of pain under the shoulder blades can vary from aching, dull to very intense, sharp. Dull pain under the shoulder blade indicates that the cause is most likely related to the muscular system, tendons and ligaments.

In clinical practice, there is data confirmed by long-term observations:

• 85-90% of all pain symptoms in the back and shoulder blades are caused by inflammation, strains, damage to muscles and tendon-ligament apparatus. As a rule, these pains are dull and aching.
• 5-7% of pain symptoms in the back, under the shoulder blades, in the shoulder blade area are associated with neurological pathologies (radicular syndrome). These are intense, sharp pains.
• 3-4% are caused by other reasons – diseases of the respiratory system, heart, gastrointestinal tract, biliary pathologies. The pain is usually intense, sharp and requires immediate medical attention.

A dull pain under the shoulder blade is most often a reflex, vertebrogenic syndrome, which is characterized by the following symptoms:

• The pain has a clear localization - under the right or left shoulder blade, in the middle of the back between the shoulder blades.
• The pain does not radiate to the limbs or other parts of the body.
• The pain is dull and aching.
• The pain symptom intensifies with physical exertion on the damaged muscles and ligaments.
• The painful area is painful upon palpation.
• Absence of symptoms of disc prolapse and compression (radicular syndrome).
• Absence of vegetative-vascular disorders.

Typical causes that provoke aching, dull pain under the shoulder blades are the degenerative process in the intervertebral discs (osteochondrosis) of the cervical spine in the C5-C7 zone. In addition, dull pain can be a consequence of the inflammatory process in the intervertebral joints, a signal of developing severe pathology - Bechterew's disease (ankylosing spondylitis). Often, the dull nature of the pain is a sign of arthrosis, hidden trauma to the intervertebral joints, spondylosis, scoliosis.

Among the causes that provoke a dull, aching pain symptom under the shoulder blade are also diseases of the internal organs:

• Pleurisy.
• Chronic bronchitis.
• Chronic pneumonia.
• Atony of the gallbladder - dyskinesia of the hypotonic type.
• Chronic pyelonephritis (sclerotic process of kidney tissue).
• An oncological process in the liver and pancreas at an early stage.
• Also, a dull pain under the left shoulder blade often signals developing cardiovascular pathology – pericarditis, myocarditis.
• The pain symptom increases gradually, intensifies in stressful situations, with concomitant infectious and viral diseases. Also often manifests itself latent bronchitis in atypical form, pneumonia, when the pain increases only when coughing or if you go to sleep on the "unhealthy" side.

Sharp pain under the shoulder blade

A sharp pain in the area of the shoulder blades, under them, indicates a serious, sometimes life-threatening, condition.

The reasons that cause sharp pain under the shoulder blade may be the following:

• Dissecting wall of the thoracic aorta (aneurysm). The pain is sharp, intense, radiating along the spine, most often to the left, to the shoulder, under the shoulder blade.
• Initial stage of pleurisy. The pain is sharp, acute, intermittent, often localized under the right or left shoulder blade in the area of fluid accumulation in the pleura. If pleurisy is accompanied by intercostal neuralgia, the pain becomes encircling.
• Spontaneous pneumothorax, which manifests as a sharp pain under the shoulder blade (reflected from the chest). The condition is characterized by severe shortness of breath, acrocyanosis.
• An attack of acute pancreatitis. The disease is accompanied by sudden sharp pain in the epigastrium with reflection to the left in the chest, in the shoulders, in the heart area, under the shoulder blade.
• Myocardial infarction is most often characterized by increasing pain, but it can manifest itself as a sharp, intense pain that quickly spreads from the chest, radiating to the left into the shoulder, jaw, under the shoulder blade, and into the back.

Pain in the back under the shoulder blades

Pain behind the shoulder blades, between them, is usually not intense, so a person does not pay attention to the symptom, considering it temporary, transient. Untimely determination of the cause, the factor provoking such pain, can lead to the development of chronic, difficult to treat diseases.

Persistent, persistent pain between the shoulder blades, under them is most often caused by muscle tension, which in turn is explained by professional specifics - sedentary work in the office, at the sewing machine, behind the wheel of a car, and so on. Usually, pain in the back under the shoulder blades is not associated with life-threatening pathologies and even with degenerative changes in the spinal column, since the thoracic region is not distinguished by mobility, it is quite stable, resistant. Most often, disorders, changes, less often - inflammation, affect the muscular system of the interscapular region, ligaments and tendons can also be stretched.

This type of pain associated with muscles is characterized by a feeling of heaviness and tension, which quickly goes away with active movements (exercises), massage or warming up.

Pain caused by damage or stretching of tendons is felt differently, it causes a feeling of aching under the shoulder blades, often the pain symptom is reflected in the heart area. A person also complains of numbness in the hands, a tingling sensation, "crawling ants". It is not possible to neutralize such pain with cardiac drugs, but it is possible to get rid of it and it is quite simple:

• Change your body position periodically, preferably every half hour. If your job is sedentary, you need to stand up, walk around, make circular movements with your arms, shoulders, bring your shoulder blades together and apart.
• It is advisable to devote 20-30 minutes daily to exercises for stretching the muscles of the interscapular zone, and for the general muscle tone of the body. Regular exercises will help prevent muscle spasms and pain behind the shoulder blades.
• It is necessary to periodically massage the shoulder-scapular area and the collar area.
• You can periodically do the following exercise: place a small (tennis) ball on the floor, lie on it with your upper back and “roll” on the ball, passing it vertically and between the shoulder blades.

If the pain symptom from the back under the shoulder blades is accompanied by a cough, subfebrile temperature, the pain increases with breathing, cough reflex, you should consult a doctor, get examined to exclude diseases of the bronchopulmonary system.

Aching pain under the shoulder blades

The pulling nature of the pain is most often caused by increased muscle tone due to pinched nerve roots. The reason for the development of pulling pain under the shoulder blades may be myofascial syndrome, as well as osteochondrosis of the cervical spine, less often an intervertebral hernia with protrusion.

Degenerative changes that reduce the height of the intervertebral openings, causing the vertebrae to shift to the right or left, are accompanied by inevitable pinching of nerve endings. Unlike intercostal neuralgia, characterized by acute symptoms, girdle pain, dystrophic pathologies of the spine develop more slowly and are accompanied by aching, pulling, constant pain.

In addition, a nagging pain under the shoulder blades can be provoked by scapulocostal, scapulocostal syndrome - LRS. In addition to painful sensations, a person clearly hears a specific sound - crunching. Also, reflected pains are typical for LRS, which spread to the shoulder, neck, and often to the back of the head. The course of the disease is long, it recurs, but the prognosis is quite favorable.

Pain under the shoulder blade when moving

Severe, intense pain that increases with movement or breathing indicates compression of the nerve roots. Compression is caused by muscle spasms, hernia, protrusion and provokes pain under the shoulder blade when moving.

The causes of such pain are most often associated with diseases and conditions:

• Neuropathy of the thoracic and suprascapular nerve as a result of overexertion (sports), injury, viral disease.
• Intercostal neuralgia, the typical symptoms of which are sharp, encircling pain that intensifies with movement, interferes with breathing and bending. The pain is paroxysmal and unilateral, during the peak of pain the person "freezes", it is difficult for him to breathe. Intercostal neuralgia is a consequence of advanced, not detected in time thoracic osteochondrosis. The thoracic spine is characterized by stability, deformation of the discs develops over a long period of time and is accompanied by unexpressed periodic dull pain, which can also intensify with movement. Due to the non-specificity of the symptoms, unexpressed pain, osteochondrosis of the sternum is often "masked" by the symptoms of other diseases - cardiological, bronchopulmonary. The acute stage of the disease is compression of the intercostal nerves, in which the intensity of pain depends on the position of the body, motor activity.

Any reflected pain increases with movement. Irradiating pain is associated with diseases of the lungs, heart, gastrointestinal tract, gall bladder. Such symptoms require differential diagnosis.

Constant pain under the shoulder blade

If the pain is constant, this is direct evidence of a developing inflammatory process either in the musculoskeletal tissue or in the internal organs.

Reasons that provoke constant pain under the shoulder blade:

• Osteochondrosis of the cervical spine, which is accompanied by constant, dull, one-sided pain. The sensation of aching pain begins at the bottom of the back of the head, spreads down to the middle of the back and shifts toward the deformed vertebrae, reflecting under the shoulder blade, less often - in the arm. The pain may periodically subside with warming up, massage.
• The onset of intercostal neuralgia may not be typical and not be accompanied by acute symptoms. Constant pain, burning under the shoulder blade may indicate osteochondrosis of the thoracic region, which in the acute stage turns into intercostal neuralgia, that is, into compression squeezing of the nerve roots.
• Muscle hypertonicity due to chronic static tension also manifests itself in the form of constant pain in the back, under the shoulder blades. This symptom is typical for many professions associated with monotonous movements or poses - drivers, office workers, students.
• Constant pain under the shoulder blade may indicate inflammation of the hollow organ located in the shoulder blade area. Such pain is often the first sign of a stomach ulcer, perigastritis.
• Constant, intense, encircling pain, reflected under the shoulder blade, is also characteristic of herpes zoster - shingles, herpes. The pain begins in the chest and lasts until the underlying cause is neutralized.

Pain under the shoulder blade when coughing

• Pain under the shoulder blade and in the back when coughing is a typical sign of bronchopulmonary diseases.
• Pleuropneumonia is a complex pathology accompanied by intense or aching pain depending on the stage of development. The pain increases with the cough reflex.
• Tracheitis (inflammatory process in the mucous membrane of the trachea). The pain starts from the upper, middle part of the chest, can radiate to the back, under the shoulder blades when coughing. The nature of the pain symptom is sharp, stabbing, if the cough subsides, the symptom also becomes less intense.
• Tuberculosis is an infectious pathology of the bronchopulmonary system, in which symptoms can develop both slowly and quickly. The main visible sign of tuberculosis is a persistent cough for 1-1.5 months with sputum production, hyperthermia, and chest pain. If the disease is unilateral, the pain intensifies when coughing and is reflected in the back, under the shoulder blade.
• Oncological process in the lung, malignant tumor. Pain is evidence of a late stage of the process, often terminal. The pain can be reflected in the shoulder girdle, neck, back and under the shoulder blade. Painful sensations increase with coughing, deep breathing.
• Pain under the shoulder blade when coughing can also accompany lobar pneumonia, an acute, life-threatening condition characterized by a very high body temperature, stabbing pain that increases with coughing, and shortness of breath.

Stabbing pain under the shoulder blade

The sensation of stabbing pain in the back, under the shoulder blade is most often caused by an inflammatory process in the pleura, especially if the interpleural ligament is shorter than normal. The cough with the syndrome is frequent, light, but constant. The cough, as well as the stabbing pain under the shoulder blade in this condition, intensifies during a conversation, deep inhalation or exhalation, as well as with loads, sometimes insignificant. The painful stabbing symptom can increase with prolonged walking, running.

Most often, stabbing sensations are not considered a sign of serious pathologies; such pains often go away on their own without treatment. However, systematic tingling under the shoulder blade that does not disappear within 2-3 weeks is a reason to see a doctor.

As a rule, stabbing pains are not caused by diseases of the bone or muscular system, and are not associated with the spine. Most often, the cause of such symptoms are bronchopulmonary, cardiological and neurological diseases. In addition, the following pathologies can be factors causing tingling in the shoulder blade area:

• Beginning perforation of a gastric ulcer.
• Vegetative-vascular syndrome.
• Osteochondrosis of the cervical spine with pinched nerve roots without protrusion or hernia.
• Intercostal neuralgia in the initial stage.
• Atypical development of myocardial infarction.
• Spasm of the bile ducts.
• Atypical course of pyelonephritis.

Stabbing pains under the shoulder blade require careful differential diagnostics, so pain sensations accompanied by nausea, hyperthermia, and blood pressure surges should not be ignored. It is necessary to undergo a comprehensive diagnosis and find out the cause of the pain.

Pain and burning under the shoulder blade

Burning is a characteristic sign of a deformed spine, since most often (80-90%) back pain is associated with the musculoskeletal system.

• One of the most common causes that provoke pain and burning under the shoulder blade is osteochondrosis of the cervical, less often thoracic spine. The pain begins in the neck and spreads as a burning, aching sensation downwards, often under the shoulder blade area. This is due to compression of the nerve roots by displaced vertebral processes. The pain is usually not intense, constant and changes depending on body position and movements.
• In addition, a burning sensation under the shoulder blade can be caused by an attack of biliary (hepatic) colic, blockage of the bile ducts.
• Renal colic, exacerbation of pyelonephritis quite often radiate under the shoulder blade and are accompanied by acute, burning pain. Such symptoms are very intense, especially with a drop in blood pressure, so they require emergency care.
• Pain and burning under the shoulder blade is one of the signs of reflux esophagitis in the acute stage.
• Intercostal neuralgia is often accompanied by a feeling of tingling, burning in the area of infringement, girdle pain radiating to the heart and back.

Pain when inhaling under the shoulder blade

A painful symptom that intensifies when inhaling and is localized under the shoulder blade can be caused by the following diseases:

• Stretching of muscles, ligaments of the interscapular region, pain from overexertion.
• Renal colic, which often manifests itself as a shooting pain upwards, increasing with deep breathing. Most often, this symptom develops in the right hypochondrium, spreads upwards, then radiates to the lower back, to the back.
• Pain when inhaling under the shoulder blade is a typical sign of intercostal neuralgia, when the nature of the pain is so strong that a person literally freezes. Each breath brings unbearable, sharp pain.
• Pain that occurs during deep breathing, more often during inhalation, radiating to the back, to the shoulder blade area, may indicate an exacerbation of cholecystitis, biliary colic.
• Often, the factor causing such pain can be an injury, both visible and hidden. A rib fracture is not always accompanied by severe pain, often a bruise is accompanied by a fracture, but a person suffers discomfort. The only sign of hidden damage to the rib, radiating under the shoulder blade, can be pain when inhaling and coughing.

Girdle pain under the shoulder blades

Paroxysmal, encircling pain under the shoulder blades is a typical symptom of intercostal neuralgia. Compression of nerve endings by deformed vertebrae (discs) provokes severe pain, which can start on one side of the body and move, as if in a circle along the location of the intercostal spaces. The symptom is reflected in the lower back, in the back, is accompanied by difficulty breathing and intensifies with an awkward turn, bend, physical activity. Also, the pain can increase under stress.

A girdle-like pain radiating to the back and shoulder blades may be a sign of exacerbation of pancreatitis. This condition is characterized by severe pain, fever, cold sweat, and cyanosis of the skin.

Perforation (breakthrough) of a gastric ulcer (cardiac part of the wall) usually radiates pain to the subclavian region, but can often manifest itself as girdle pain.

It should be noted that there are no precise diagnostic criteria for spinal pain, so any pain, especially acute pain that lasts for several hours, requires urgent medical attention.

Burning pain under the shoulder blade

A burning pain under the shoulder blade is a sign of osteochondrosis, pinching, compression of nerve roots. Often such pain is disguised as cardialgia, it is especially similar to attacks of angina at rest or clinical manifestations of myocardial infarction.

How to distinguish what burning pain under the shoulder blade means?

Attack of angina:

• The pain is of a pressing, squeezing, spastic nature.
• The pain symptom is most often localized in the chest area, on the left, and can spread higher, reflected under the shoulder blade, into the arm, into the jaw, into the neck.
• An objective external cause that provokes pain is stress, emotional tension, physical exertion.
• The pain rarely lasts more than 15 minutes.
• The pain symptom is relieved by taking nitroglycerin and other cardiac drugs (after 5-10 minutes).
• The pain may subside with rest.
• The pain is not dependent on movement.

Burning pain under the shoulder blade when pinched is directly related to movement, activity, posture, and does not subside after taking cardiac medications. It is relieved by nonsteroidal anti-inflammatory drugs, straightening the spine, and other methods.

Pain in the spine under the shoulder blades

Most often, pain in the spine under the shoulder blades is not actually associated with diseases of the skeletal system, that is, the spinal column. The most common causes of such pain are caused by neuralgia, myalgia. A number of compression-ischemic conditions, diseases of the peripheral nervous system, intercostal neuralgia and other factors are the primary cause of painful sensations under the shoulder blades in the spine.

List of possible factors associated with stretching of tendons, muscles, inflammation of nerves:

• Plexitis is a neuropathy of the brachial nerve. This is an inflammatory process in the nerve plexus, causing damage to the muscle tissue of the interscapular region, reducing the sensitivity of the skin on the surface of the shoulder, the median nerve. Clinically, neuritis of the brachial nerve (brachial plexus) manifests itself in paresis, peripheral partial paralysis of the arm due to atrophy of the internal brachial, deltoid and biceps muscles, the arm can hang like a whip, the pain is spontaneous, shooting, radiating under the shoulder blade.
• Intercostal neuralgia, which is characterized by sharp, encircling pain, which is most often one-sided, spreading around the chest. Pain in the spine under the shoulder blades is often the peak of the disease, it is so intense that the patient has difficulty breathing.
• Compression of the dorsalis scapulae - the dorsal nerve of the scapula, which innervates the rhomboid muscles, the muscle that controls the movement of the shoulders and shoulder blades.

It is quite difficult to check and determine what causes pain in the spine under the shoulder blades on your own, but it is possible to make a primary differentiation. A typical sign of neurological diseases of the interscapular region is a painful sensation in the "Napoleon pose" - crossing your arms in front, on your chest. If the pain is accompanied by an increase in temperature, a drop in blood pressure, tachycardia, a general severe condition, you should not engage in self-diagnosis and treatment, you need to immediately call a doctor.

Muscle pain under the shoulder blade

In order to determine what causes muscle pain under the shoulder blade. It is necessary to accurately describe the nature of the pain sensation, all the symptoms that accompany it. As a rule, muscle pain in the upper back is characterized by depth, pulling, aching character, any shooting pain is a sign of pinched nerve roots, and not inflammation of muscle tissue. Muscle symptom can occur spontaneously, without any apparent explainable reasons, but most often it develops against the background of overwork, after physical exertion or static tension of the body. The reason that can be a factor provoking muscle pain under the shoulder blade:

• Overstrain of the muscles of the interscapular region. This is a typical professional syndrome associated with performing monotonous work or a static body posture. Drivers, office workers, students, anyone who is forced to sit, stand in the same position, perform repetitive actions with one hand (painters, builders) during the day, sooner or later experience muscle pain in the back and between the shoulder blades. Also, a similar symptom can appear in pregnant women, whose spine is subject to increased stress due to changes in posture (the belly grows), weight gain.

Myositis is an inflammatory disease accompanied by muscle pain. The following factors can cause myositis:

• Drafts, severe hypothermia of the back and neck.
• Chronic muscle tension of a professional nature.
• Back injury, including hidden (bruise).
• Acute respiratory infections (ARI, ARI).
• Overexertion due to intense training (sports), improperly distributed load, or incorrectly performed preliminary warm-up.

Myositis is one of the most harmless causes of pain in the shoulder blade area; the pain symptom can be relieved by massage, hot rubbing, and taking anti-inflammatory drugs. More dangerous is myositis accompanied by a purulent process in the muscles; this is associated with an acute infection that can provoke an abscess, abscess in a certain area of the back. This condition is characterized by an increase in body temperature, intense pain, redness, swelling at the site of pus accumulation. Purulent myositis is treated both by conservative methods and by minor surgical intervention.

Throbbing pain under the shoulder blade

Throbbing in the back, under the shoulder blades can be associated with causes that are not life-threatening, but it can also be a sign of a developing serious disease. Periodic pulsating pain under the shoulder blade is most often caused by a protruding disc, its falling out of the contour of the vertebral body, developing compression of the nerve endings. It should be noted that protrusion is the initial stage of intervertebral hernia, when the fibrous ring remains intact, does not collapse, but the process of its destruction has already begun. Protrusion of the disc, which can be stopped and not allowed to develop, is manifested by periodic shooting pains or pulsation in the part of the back where the displacement occurs. Protrusion of the thoracic vertebrae, IMD (protrusion of intervertebral discs) can eventually transform into an intervertebral hernia, which in turn is manifested by intense pain and more severe symptoms. The etiology of protrusions is associated with degenerative processes in the spine - osteochondrosis, and the factors that contribute to the development of deformation are known to many of us:

• A sedentary lifestyle, physical inactivity, static tension in the body.
• Professional risks – sports, specialization features.
• Age over 50 years.
• Unhealthy diet (excess salts).
• Excess body weight.
• Harmful destructive habits – alcohol abuse, smoking.
• PMD - protrusion of the intervertebral discs of the thoracic region manifests itself as nagging pain in the initial stage; as the disease develops, the pain becomes intense, radiating to the scapula area, causing a pulsating sensation.

Throbbing pain under the shoulder blade is the beginning of radiating pain, when the transmission of a nerve impulse occurs pointwise, gradually. Painful sensations are tolerable, but require differential diagnostics, since pulsation can be associated with the atypical development of pathological processes in the internal organs - lungs, heart, stomach, gall bladder.

Pain under the shoulder blade after vaccination

Preventive vaccinations are one of the most harmless causes of pain in the back, in the area of the shoulder blades.

Pain under the shoulder blade after vaccination is usually associated with vaccination against diphtheria. Often the injection site swells, the skin is hyperemic, the area under the shoulder blade hurts. However, this condition does not last more than 2-3 days, usually on the second day all discomfort subsides.

Pain under the shoulder blade after vaccination is caused by the body's reaction to the introduced strains, viruses, bacteria, which are used to "train" the immune system to resist harmful microorganisms. The introduced vaccines consist of weakened agents, so there is no need to fear complications. A local reaction in the form of pain under the shoulder blade is an absolutely normal phenomenon, which indicates that the "acquaintance" process has taken place. You should not rub, wet the area in the shoulder blade area, lubricate it with painkillers or use warming procedures. As a rule, before vaccination, the doctor conducts explanatory work and informs the person in detail about possible unpleasant complications and actions in such cases.

Pain under the shoulder blade during pregnancy

The period of pregnancy is often accompanied by atypical sensations for the expectant mother. These conditions are caused by hormonal changes, as well as an increase in the uterus and a shift in nearby organs. Also, the reason that can cause pain under the shoulder blade during pregnancy is often excessive load on the spine. If a woman had a history of osteochondrosis before conception, then pregnancy will only aggravate the deformation of the discs and provoke periodic pain in the back, under the shoulder blades.

In addition, factors that provoke pain in the scapular region may be:

• Intercostal neuralgia, which worsens due to colds, stress, and physical exertion.
• Latent pneumonia or pleurisy.
• Stretching of the ligamentous apparatus, which is associated with increased production of a specific hormone - relaxin.
• The center of gravity shifts forward (the belly has grown larger), tension in the muscular system.
• Rarely – exacerbation of pyelonephritis.

It should be noted that transient nagging pain under the shoulder blade during pregnancy is most often not a threatening symptom, because every woman undergoes a comprehensive examination before registering and is then subject to constant dispensary observation. Preliminary ultrasound, X-ray or fluorography, blood tests, urine tests, etc., allow the gynecologist to foresee possible complications in advance and take measures. As a rule, latent, nagging pain in the back, under the shoulder blade passes after the 20th week of pregnancy, in other cases, a woman should consult a doctor and undergo additional diagnostics to avoid unnecessary worries.

Sharp pain under the shoulder blade

Acute pain symptoms develop suddenly and are characterized by intensity and increasing pain. Acute pain under the shoulder blade can be associated with the following diseases:

• Biliary colic, an attack of acute cholecystitis. The pain "starts" on the right side under the ribs, has a girdle-like, sharp character and is reflected in the right shoulder, under the shoulder blade, neck, and often in the lower back. The symptom is caused by narrowing of the bile ducts, their blockage by an advancing stone. The cause of such a condition can be both the intake of fatty, fried food, and an infection, nervous or physical fatigue.
• Acute pain under the shoulder blade may be a signal of a penetrating gastric ulcer ("covered" perforation) with adhesions extending into the pancreas. The disease is accompanied by a constant painful sensation, periodically increasing acute pain, often encircling, reflected upward under the shoulder blade or downward into the lower back.
• Intercostal neuralgia, which is characterized by acute pain sensations, encircling, shooting. The pain intensifies with movement, bending, physical exertion.

Diagnosis of pain under the shoulder blade

Diagnosing pain under the shoulder blade is a complex and comprehensive task, since this symptom is not specific and can indicate many diseases with similar clinical manifestations.

The main steps involved in differential diagnosis of pain under the shoulder blade are:

• Collection of anamnesis.
• Determining the nature of pain from the patient's words and objectively.
• Measuring blood pressure and pulse.
• Palpation of the back, interscapular region.
• Conducting orthopedic tests.
• Identification of associated symptoms.
• Exclusion of acute conditions and life-threatening diseases.
• Exclusion or confirmation of psychogenic etiology of pain.
• Referral to a specialist to prescribe additional examinations - chest x-ray, spine, CT, MRI, heart ultrasound, cardiogram, bronchoscopy, FGDS, blood tests, urine tests, and so on, depending on the specifics of the disease.

It should be remembered that the diagnosis of pain under the shoulder blade is the prerogative of the doctor; no reference book or source can help a person accurately determine the source of the pain symptom, establish its specific cause in absentia.

Treatment for pain under the shoulder blade

The problem solved by treating pain under the shoulder blade is not limited to relieving the pain symptom. Of course, acute pain requires pain relief, relief, as well as life-threatening conditions - ulcer perforation, myocardial infarction, spontaneous pneumothorax, and others.

But the main goal in therapy is considered to be the elimination of the underlying cause, therefore, treatment of pain under the shoulder blade directly depends on the results of diagnostics, the patient’s condition, his age, and concomitant pathologies.

This is the reason for the lack of specific recommendations in this article regarding the treatment of pain under the shoulder blades; the amount of self-help that could be used at home is very limited.

If the pain in the shoulder blade area is associated with myalgia, muscle strain, it can be relieved at home with the help of reasonable exercise, performing a set of exercises, warming up, and warming up the muscles.

All other conditions caused by diseases of internal organs require the presence of a doctor who will choose the method and method of treating pain under the shoulder blade and the underlying disease. Therapy can be both conservative and surgical, for example, in the case of ulcer perforation or bile duct obstruction. In addition, various procedures can be prescribed, such as reflexology, massage, warming up, and possibly spinal traction.

It is necessary to pay attention to alarming, threatening symptoms that signal emergency conditions, these include:

• Angina pectoris.
• Gastrointestinal erosive processes.
• Bronchopulmonary diseases.
• Myocardial infarction.
• All cardiopathologies.
• Pyelonephritis, renal colic.
• Spontaneous pain under the shoulder blade, acute in nature.
• Pain behind the breastbone, radiating to the back, to the shoulder blade area, not relieved by taking cardiac medications.
• Pain that causes loss of consciousness.
• All syndromes accompanied by high temperature, vomiting, blood pressure surges, shortness of breath, slow or rapid pulse.

Treatment of pain under the shoulder blade can be quite successful with timely diagnosis and compliance with all medical prescriptions.

Prevention of pain under the shoulder blade

It is impossible to provide specific recommendations that would concern preventive measures against pain under the shoulder blades, since such pain symptoms can be associated with multiple diseases. Accordingly, prevention of pain under the shoulder blade is all possible measures that prevent the underlying disease that is diagnosed by a doctor.

In essence, the goal of preventive measures is to prevent relapses of pain and reduce the risk of exacerbation of the identified pathology.

In addition, if the symptom is associated with a neurological factor, muscle spasms, prevention of pain under the shoulder blade is simple rules:

• Control of static tension, performing various exercises that help relieve muscle tension.
• Regular exercise, maintaining muscle tone.
• Avoid hypothermia and drafts.
• Visiting massage sessions, physiotherapy procedures.

Pain caused by osteochondrosis can also be prevented by reasonable physical activity, performing a set of therapeutic exercises, and taking certain medications that restore the structure of bone and cartilage tissue.