Pain under the left shoulder bladeit is observed in pathologies of the musculoskeletal system (osteochondrosis, myofascial syndrome, injuries), heart diseases (myocardial infarction, angina pectoris, rheumatic and non-rheumatic carditis), gastrointestinal diseases (pancreatitis, gastric ulcer). Rare causes of the symptom include damage to the spleen, ulcers, and skin tumors. Diagnostic methods are selected based on the main syndrome: X-ray, ultrasound and endoscopic examinations are used. Analgesics are prescribed to relieve pain, followed by medical or surgical treatment of the underlying disease.
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 3rd-6th breast roots are involved in the process; Discomfort directly under the scapula indicates the localization of damage in the 7th-8th vertebrae. Typically, pain radiates from the scapula to the lateral surface of the chest and intercostal spaces.
Myofascial pain syndrome
Poor posture and staying in an uncomfortable position for a long time causes constant muscle tension. The syndrome manifests itself as pain in the scapula region on the left, when the load is mainly on this side. Anxiety is felt by the patient to be deep and moderately intense. At first, the pain is experienced only during movement and tension, but over time it becomes constant. Sometimes radiating pain appears in the forearm or left hand.
Injuries
Severe pain develops after a fracture or fracture of the scapula or decay of the soft tissue in 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 the mobility of the arm and shoulder girdle is often limited. Sharp pain is felt when changing the position or pressing on the damaged area.
Boils and carbuncles
Purulent inflammation of the skin around the left shoulder blade, as a rule, is accompanied by severe pain that is clearly localized. As the boil matures, "pulling" sensations occur, which intensify when the inflamed area is palpated or rubbed with a cloth. After the tire is broken and the necrotic core is removed, the pain subsides. With a carbuncle, the pain is more intense, and the general condition of the patient often worsens.
Heart diseases
Heart damage is a typical cause of pain under the left scapula, which is related to the proximity of the anatomical site and innervation characteristics. In this case, the symptoms are accompanied by various types of pain in the chest, a feeling of freezing or interruptions in the work of the heart. Tachycardia and other rhythm disturbances are usually detected. Pain under the shoulder blade is manifested by:
- Myocardial infarction.Patients experience unbearable burning sensations, which spread from the precordial region to the left arm and shoulder blade, less often to the collarbone and neck. The condition occurs suddenly and is accompanied by a strong fear of death and a weak state.
- Stable angina.Episodes of throbbing or throbbing pain radiating to the lower back are typical of attacks of ischemic heart disease. Unpleasant symptoms are provoked by physical activity or emotional stress and last on average up to 10-15 minutes. After resting or taking nitrates, the pain disappears.
- Inflammatory heart diseases.Acute carditis (myocarditis, pericarditis) is characterized by a dull or stabbing pain in the chest that spreads to the left shoulder blade and bothers the patient for several days. A person also complains of shortness of breath, increased body temperature, and swelling of the lower limbs.
- Rheumatism.Pain radiating to the left half of the back along with cardialgia is characteristic of the clinical picture of rheumatic carditis. The clinical picture is completed with arthralgia, ring-shaped erythema on the skin, rheumatic nodules. Symptoms are more common in children and adolescents.
Pancreatitis
With acute pancreatitis, girdle pain moving from the left hypochondrium to the subscapular region is observed. In addition to the pain syndrome, patients are worried about vomiting and tension in the abdominal muscles, weakened by bile and mucus impurities. Movement increases painful sensations, so a person tries to lie motionless on his side.
Radiating pain under the scapula in chronic pancreatitis indicates an exacerbation of the process. Most often, violations are provoked by mistakes in the diet - a big party, drinking alcohol. The pain is paroxysmal in nature, sometimes spreading not only to the subscapularis, but also to the precordial region. Symptoms are combined with nausea, flatulence and steatorrhea.
Stomach ulcer
Pain under the left shoulder blade is a sign of localization of the defect in the back wall of the stomach, closer to the back. Unpleasant sensations appear within 20-50 minutes after eating. The earlier the symptoms occur, the higher the location of the ulcer. Anxiety worsens when eating sour, spicy or fried foods. To reduce the intensity of pain, patients induce vomiting.
Diseases of the spleen
With splenomegaly caused by infectious, autoimmune or myeloproliferative processes, there is a feeling of pain and fullness in the left subscapular region. With the gradual expansion 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 often, the cause of pain is surgical pathologies of the spleen: rupture, heart attack, volvulus. In this case, there are cutting or throbbing pains radiating under the scapula, aggravated by the slightest movement. Therefore, the patient takes a forced position: he lies on his left side or on his back with his knees pressed to his stomach. The clinical picture is completed by a sharp decrease 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. Anxiety increases with deep breaths, laughing and talking, coughing attacks. Pain is of different nature: sharp, stabbing, dull, oppressive. They are accompanied by fever, shortness of breath and other typical respiratory symptoms. Most often, patients who develop pain under the left shoulder blade experience:
- I have pneumonia.The patient feels moderate dull pain, which has a clear localization in the case of focal inflammation of the lungs, or spreads to the scapular area in the case of lobar pneumonia. A deep cough appears with the release of mucopurulent sputum. Symptoms last up to 2-4 weeks.
- Pleurisy.A person with exudative pleurisy experiences pressure and bursting under the scapula and along the side wall of the chest. When you feel this area, the discomfort becomes stronger. Dry pleurisy is characterized by sharp pain in the chest and lower back, which intensifies during movement.
- Tuberculosis.Tuberculosis infection lasts for a long time, so low-intensity pain lasts for several months. If the pain is localized in the scapula region, it is more likely that the pathological focus is located in the posterior segments of the lung.
- Pulmonary infarction.The death of a part of the lung parenchyma is manifested by severe pain that spreads under the left shoulder blade, clinically similar to an angina attack. The condition of patients is complicated by hemoptysis or pulmonary bleeding, external breathing dysfunction and arrhythmia.
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, aneurysm of the descending aorta.
- Acute surgical diseases: retroperitoneal abscess, hemoperitoneum, strangulated diaphragmatic hernia.
Diagnostics
Patients with pain under the left shoulder blade are first referred to an orthopedic traumatologist. In the absence of disorders of the musculoskeletal system, other specialists are involved in the diagnostic search: neurologist, cardiologist, surgeon, etc. A number of instrumental studies are prescribed to determine the causes of pain, including:
- Radiography. X-ray of the back in frontal and lateral projections allows to exclude or confirm a traumatic injury. If osteochondrosis, scoliosis or spondylolisthesis is suspected, radiation imaging of the spine is indicated. A plain X-ray of the chest cavity allows to suspect damage to the lungs or heart.
- Electrocardiogram.Standard 12-device ECG is an examination method, based on its results, the doctor makes a preliminary diagnosis and identifies dangerous processes (myocardial infarction, life-threatening arrhythmia). The diagnostic complex is completed by classic or transesophageal echocardiography and cardiac electrophysiology.
- Ultrasound of the organs of the abdominal cavity.A quick and non-invasive method is used to detect common conditions that cause pain in the left shoulder blade. Ultrasound examination shows signs of peptic ulcer, inflammatory infiltration of the pancreas and an enlarged spleen. EGD is used to clarify the diagnosis of gastric ulcer.
- Additional methods. CT or MRI of the spine is performed to clarify the nature and severity of bone changes. Bronchoscopy with biopsy and pleural puncture is performed in case of suspected bronchopulmonary diseases. If there are difficulties in diagnosing the pathology of the abdominal cavity, diagnostic laparoscopy is recommended.
Laboratory examination methods play a major role in making the diagnosis. A clinical blood test shows signs of inflammation or disruption of hematopoietic processes. Indicators of acute phase proteins and proteinograms are informative during possible heart damage or autoimmune process. Specific myocardial markers are evaluated for anginal pain.
A coprogram is carried out for the diagnosis of gastrointestinal diseases: the presence of pancreatitis is indicated by a large number of undigested food particles, an increase in the number of striated muscle fibers and starch grains. In the case of inflammatory processes of the lungs and pleura, it is necessary to spread the biomaterial bacteriologically, and then to check the sensitivity of the isolated microorganisms to antibiotics.
Treatment
Help before diagnosis
Given the variety of causes of pain under the left shoulder blade, it is quite difficult for a doctor to give recommendations until the underlying pathology is detected. During the examination, it is advisable to reduce the load on the back muscles in order to eliminate simple fatigue and overstrain, which can cause persistent pain symptoms. If the sensations are unbearable, analgesics are used and the patient is immediately hospitalized.
Conservative therapy
The treatment plan is selected only after a complete diagnosis and identification of the etiological factors of the pain under the left shoulder blade. If the patient suffers from severe anxiety, anti-inflammatory drugs and muscle relaxants are recommended, which quickly relieve painful sensations. For severe pain, the use of therapeutic blockades and narcotic analgesics is effective. Taking into account the disease, the mode of physical activity is selected.
Drug therapy is prescribed by a specialist with an appropriate profile. For pain due to heart damage, the cardiologist prescribes antianginal and antiarrhythmic drugs, antiplatelet agents and anticoagulants, and antihypertensive drugs. Diseases of the bronchopulmonary system require the participation of a pulmonologist and the use of antibiotics, expectorants and special anti-tuberculosis drugs.
A suitable diet is selected for gastrointestinal pathologies, and the therapy is completed with enzyme preparations, prokinetics, antacids and antisecretory drugs. In neurology, neurometabolic agents, B vitamins, drugs that improve blood microcirculation and rheological properties are indicated to eliminate radicular syndrome.
Non-drug methods are actively used for posture disorders and other problems of the spine: traction therapy, therapeutic massage, exercise therapy. Among the physiotherapeutic methods, balneotherapy (sulfide and radon baths), mud therapy and reflexology are popular. It is possible to increase the effectiveness of drug treatment by direct electrophoresis of drugs to the effective area.
Surgery
Surgical methods are indicated when conservative treatment is ineffective or in acute life-threatening pathologies, when delay is dangerous for the patient's life and health. The second group of operations includes stenting methods, angioplasty and bypass surgery during myocardial infarction, injuries, purulent processes, and assistance of abdominal or thoracic surgeons during internal bleeding.
Planned surgical interventions are often prescribed in neurosurgery for severe radicular syndrome and intervertebral hernia. Microdiscectomy and laser vaporization of the disc are performed to relieve pain associated with compression of nerve structures. In rare cases, stabilizing operations on the spine are resorted to (interbody fusion, application of the Halo device, transpedicular fixation).