Pain in the shoulder blade and below can occur with nerve damage, spinal disease, shoulder girdle or somatic pathologies. The cause can be determined by clinical signs, conditions for the onset of the syndrome, and medical history.
Pain in the scapular region can be felt during suction, felt in half of the body and or all over the arm. In certain cases, such symptoms are the "first bell" of the irritation period, which can be prevented once the provoking factor has been established.
Causes and localization
Pain below the shoulder blade usually occurs during movement - preceded by a difficult turn, long stay with the back bent. It signals local damage that occurs for a variety of reasons.
Pathologies with unilateral lesions, in which pain occurs only right or left under the scapula, are rare - usually the severity of the symptom is individual. This is due to the symmetrical arrangement of nerve roots extending from the spinal cord.
If it hurts under the right and left shoulder, it may be the result of damage to the bones and muscle frame. The symptoms do not have a strict localization, the severity depends on the traumatic factor. The clinic is usually acute, starts suddenly and takes a chronic course.
Causes of traumatic pain under the left or right shoulder are as follows:
- Bruising - in such cases the pain is superficial, most often the muscles are damaged. Usually the back muscles below the shoulder blades and below ache, local swelling and inflammation develop. After 2-3 weeks, the symptoms go away.
- Cracks and fractures are more serious injuries, the pain is concentrated in the scapula itself. At the slightest movement, it intensifies, the patient can not move the arm or bend.
- Subluxation and displacement of the vertebrae - this leads to joint pain 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, which appears spontaneously. During movements, a crack may be present and swelling often appears.
If the disease affects the thoracic spine, the patient has back pain near the shoulder blade and below. This is due to the tightening of the nerves or spinal cord due to the deformation of the articular disc. The pathology develops gradually and as the distance between the vertebrae decreases, the pathology clinic worsens.
The location of the pain depends on the affected area:
- If osteochondrosis destroys the articular discs of the chest region from 2 to 6, the pain is felt in the scapula. It usually radiates to the neck and arm. When the vessels are squeezed, dizziness appears, intracranial pressure may increase.
- When the joints of 6-12 segments are affected, the pain radiates under the left or right shoulder, spreads down, to the corresponding half of the body and to the lower back.
The spinal roots of the thoracic region create plexuses that innervate the arms and torso. Therefore, when they are squeezed, the pain spreads along their course.
With osteochondrosis, the discomfort is unilateral - it hurts in the shoulder blade on the right or left side and down, depending on the inclination of the spine.
This is a curvature of the spine in the transverse direction due to excessive strain of the muscles that support posture. This leads to tightening 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:
- Respiratory failure - a unilateral tilt of the spine deforms the chest, which affects lung function, one of which is congested and the second regains lost function.
- Violation of the work of the heart - appears the frequency of contractions and changes in the pulse, shortness of breath and pale skin.
- The appearance of a noticeable deformity of the chest is the main cause of pain under the blade of the right or left shoulder. The vertebrae, along with the ribs, move sideways, as a result of which, on the bending side, the bony structures shift downward 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 down, the focus is strictly limited. If muscle spasms join, the symptom spreads to neighboring structures.
It is characterized by a flexion of the spine, a forward displacement of the shoulder girdle, and gradually a flexion appears. There is pain on the shoulder blade - usually bilateral, giving the arm and neck. The following mechanisms are involved in its formation:
- Neurogenic - due to curvature, the distances between the vertebral bodies in the anterior sections are reduced, this provokes the constriction of the spinal cord branches. There is excruciating pain in the right and left shoulder, which may radiate to the clavicle, neck and shoulder bone.
- Muscular - spinal deviation leads to an overload of the collar area muscles, which can cause painful spasms in the shoulder blade area and below.
As a result of kyphosis, the vertebral artery is constricted, cerebral circulation is disturbed. The work of the internal organs gradually deteriorates.
If the blade of the right or left shoulder hurts, one of the reasons may be spondylarthrosis - damage to the aspect 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: >
- Cartilage destruction - with a lack of blood circulation, connective tissue integrity is compromised, the articular disc becomes brittle, more damaged, and recovers more slowly. At this stage, strong physical exertion leads to microtrauma, pain appears, which radiates to the area of the shoulder blades and below.
- Deformities of the articular disc appear - seals that impede mobility. This provokes new destruction, which slows down the regeneration processes, the patient feels pain in the back and shoulder blades.
- The appearance of bone growths is characteristic of the advanced stage of the disease. Neoplasms damage the joints, muscles, blood vessels and nerves.
With spondyloarthritis, the back can ache between the edges of the shoulders or down - an attack is usually preceded by physical activity. At rest, the symptoms disappear because the bone growths do not damage the surrounding tissues.
Protrusion and hernia
In these conditions, acute pain under the left and right shoulder is disturbing, which appears due to compression of the spinal cord or its roots. As a result of the tightening, sensitivity along the nerve fibers is disturbed.
The localization of symptoms is as follows:
- Pain in the shoulders and upper back - extension or hernia in the cervicothoracic region or when 1-3 thoracic segments are affected. The symptom intensifies when you try to tilt your head, turn it sideways.
- Pain in the intercapular region - in this case, the middle parts can be affected, from 3 to 6. Discomfort increases when both hands move sideways, are deeply sucked or turned.
- Severe pain under the right and left shoulder - affects the articular discs from 6 to 12, the lower back may be involved in pathology. In this case, there is a risk of developing a hernia, as this part of the spine is loaded more than the previous ones.
Unlike spondylarthrosis, the pain of hernia and extension does not go away for a long time at rest. This is due to the constant compression of the nerve, which is exacerbated by muscle spasms.
This is a constriction of the lumbar roots, which are gathered in a powerful sciatic nerve. If the upper parts of it are affected, the patient feels pain under the scapula and down, it is bilateral, aggravated by bending and sudden movements.
As the disease progresses, additional symptoms may appear: >
- There is back pain radiating to the lower limb - a sharp stabbing pain feels like an electric shock along the nerve flow.
- Burning pains in the back, in the lumbar region or below the shoulder blade indicate prolonged tightening of the spinal roots in the lumbar region.
- Cramps and loss of sensation usually occur in the lumbar region, buttocks, sometimes there is numbness along the nerve fibers in the thighs, lower leg and feet.
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 region of the right or left shoulder and below, depending on the development of hemispherical motor skills (right or left). First, it appears after exercise, and then at rest. Along the way, additional symptoms appear:
- numbness of the hands;
- violation of spinal mobility.
With humeroscapular periarthrosis, clinical manifestations increase when the arm is raised - it hurts in the region of the right or left shoulder, the shoulder blade. Gradually, the range of motion decreases, stiffness progresses.
The other cause of pain under the right or left shoulder is inflammation of the nerves in this area. The disease is caused by hypothermia, outlines. Most often affected:
- Suprascapular nerves and supraspinosis - there is pain in the right or left shoulder from the back, mainly concentrated in the clavicle. Sometimes the discomfort spreads to the shoulder, which indicates the loss of skin branches of this area.
- Subcutaneous and infraspinatus nerves - in this case, it hurts right or left under the scapula, depending on the side of the lesion. If the muscles of the same name are involved, the clinical manifestations are aggravated when the arms move down, snatching behind the back.
- Intercostal nerves - usually 1-4 pairs. These branches go along the lower edge of the rib, the pain appears not only in the shoulder area and below, but also on the sides of the chest, sometimes in the front.
Symmetry is not typical for neuralgia - if the left half of the body was exposed to the sketches, then pain is seen in the neck, chest and shoulder blade on this side.
The branches from the parasympathetic trunk, which connects to the spinal cord and its roots, go to the heart. This is why heart disease can provoke pain in the shoulder and lower back. Usually a mild form of myocardial infarction is latent. May be associated with the following symptoms:
- Dull oppressive or burning pain felt behind the sternum or under the blade of the left shoulder - can last for hours, increase when you walk, but leaves a little at rest.
- Shortness of breath - accompanies pain, may appear within a few days.
- Tachycardia - increased heart rate, sometimes arrhythmias occur.
- Other symptoms include high blood pressure, dizziness, nausea and vomiting.
Problems with the gastrointestinal tract
Similar to the previous mechanism, the pain spreads along the nerve fibers. Clinical signs can be bilateral, but in most cases there is a certain pattern in which the symptoms appear according to the location of the internal organs.
Pain under the blade of the left shoulder from the back to the back occurs with the following diseases:
- stomach ulcer.
Usually, with these diseases, patients complain of dyspeptic disorders, nausea and vomiting. If internal bleeding occurs, skin pallor, dark stool color, decreased blood pressure, and weakness are noted.
Pain under the blade of the right shoulder from behind to back accompanies:
- cirrhosis of the liver;
- ulcerative lesions of the duodenum.
In addition to these factors, pain below the shoulder blade can provoke:
- Uncomfortable mattress - if you fail and sleep on your right side, in the morning you may feel pain under the blade of the left shoulder from back to back, as the curved back tightens the spinal roots.
- Pleurisy - pain in the scapular region occurs when breathing due to rubbing the sheets against each other, reaches its peak with a deep breath.
- Poliomyelitis - pathology associated with neurological symptoms, often appearing back pain.
- Intoxication - Severe poisoning or cold can manifest with muscle aches, chills and fever.
- VVD - vegetative-vascular dystonia is associated with a change in pressure, disruption of heart function and shortness of breath, and sometimes discomfort in the spine.
- Kidney disease - such pathologies are characterized by sharp or stabbing pain under the right shoulder, a change in diuresis and urine color, and general symptoms.
- Subdiaphragmatic abscess - if suffocation is observed in the upper floor of the abdominal cavity, pain will be felt below the shoulder blade, fever and intoxication symptoms.
- Mental Disorders - In some cases, pain in the shoulders and lower back may be the result of such disorders. The exact mechanism of occurrence has not been studied.
The nature of pain
Pain in the shoulder area and below can be different, by its nature it is possible to assume a specific group of pathologies, sometimes a provocative factor can be created:
- For crushed nerves, the lumbago is characteristic - a sharp stabbing pain that appears with a sharp twist of the body, raising the arm. This is the main difference from cholelithiasis, in which the symptoms do not bend from the movements.
- Painful, throbbing or burning pain indicates a pathology of the internal organs. The latter option occurs when you squeeze the spinal cord roots, but it increases with movement and can be turned into sutures.
- Strong cramping pain in the shoulder area and below it is characteristic of a hernia. Sometimes preceded by lumbago, numbness of the limbs.
- Cutting pain of varying intensity is characteristic of neuralgia, piercing often accompanies inflammation of the joints.
Which doctor treats shoulder pain?
If you have pain in the shoulder and below, you should make an appointment with a neurologist. If there are no suppressed nerves, the specialist will redirect you to a consultation with an orthopedist, cardiologist, gastroenterologist or urologist, depending on the suspected disease.
To identify the cause of concern in the scapular area and below, a laboratory and instrumental examination is performed:
- X-ray or CT - using these methods, you can detect osteochondrosis, curvature of the spine and the consequences of injuries.
- MRI >- The spine, shoulder joint or internal organs are examined, depending on the suspected pathology.
- ECG - helps identify heart disease.
- Blood and urine tests are informative for some somatic pathologies, inflammation of muscles and joints.
- Ultrasound - is prescribed for somatic diseases, if it is impossible to undergo an MRI.
Usually, pain below the shoulder blade 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 provocative factor. Initially, the patient's well-being is stabilized, then the underlying pathology is treated.
The therapy program includes:
- Medications - Analgesics are usually prescribed to relieve pain and inflammation. Funds are then prescribed depending on the underlying disease - antibiotics, gastroprotectors, diuretics.
- Physiotherapy - strengthens the spine, treats somatic diseases. Medical electrophoresis is used in the area of the shoulder blades, heating procedures, SWT.
- Massage - heating is performed with spinal cord injury. From such procedures, the muscles above and below the shoulder blade relax, the posture improves. In this case, you need professional help from a chiropractor or osteopath.
- Gymnastics - performed after the elimination of pain, the program is compiled, depending on the disease suffering from a physiotherapist, a rehabilitation specialist.
After successful treatment, patients are advised to follow a preventive program that will prevent recurrence of the pathology:
- look at your attitude;
- choose a mattress of moderate firmness and an orthopedic pillow;
- twice a week, massage into the shoulder area and down;
- follow a low calorie diet for obesity;
- give up bad habits;
- perform prophylaxis of somatic pathology (if present in the anamnesis);
- visit a doctor every six months.
Pain in the shoulders and below it can be neurological or somatic. When the nerves are damaged, the symptoms are acute 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.