Pain under the left shoulder bladeobserved in diseases of the musculoskeletal system (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. The selection of diagnostic methods depends on the underlying syndrome: X-rays, 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. Radicular pain occurs less frequently in spondylolisthesis and ankylosing spondylitis. Acute pain in the projection of the left scapula is noted when the 3rd to 6th thoracic spines are involved in the process. Complaints directly under the shoulder blade indicate that the damage is located in the 7th to 8th vertebrae. Typically, the pain spreads 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 lead to constant muscle tension. The syndrome is manifested by pain in the area of the shoulder blade on the left when the load is predominantly on this side. The patient experiences the discomfort as deep and moderately intense. The pain is initially only felt with movement and exertion, but over time it becomes constant. Sometimes radiating pain occurs in the forearm or left hand.
Injuries
Severe pain occurs after a tear or fracture of the scapula or a bruise to 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 there is traumatic damage to bone structures, severe pain occurs and mobility of the arm and shoulder girdle is often limited. Stinging pain is felt when changing position or when pressing on the injured area.
Boils and carbuncles
Purulent inflammation of the skin surrounding the left shoulder blade is accompanied by severe pain that is usually clearly localized. As the boil matures, "pulling" sensations occur, which increase when the area of inflammation is palpated or rubbed with clothing. After the tire has ruptured and the necrotic core emerges, the pain subsides. With a carbuncle, the pain is more severe andthe patient's general condition often worsens.
Heart disease
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 the 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 arrhythmias are usually detected. Pain under the shoulder blade manifests itself as:
- Heart attack.Patients experience an unbearable burning sensation that spreads from the precordial region to the left arm and scapula, and more rarely to the clavicle and neck area. The condition occurs suddenly and is accompanied by a strong fear of death and a state of fainting.
- Stable angina.Episodes of squeezing or pressing pain radiating to the subscapular area are specific to attacks of ischemic heart disease. Unpleasant symptoms are caused by physical activity or emotional stress and last on average up to 10-15 minutes. The pain disappears after rest or taking nitrates.
- Inflammatory heart disease.Typical for acute carditis (myocarditis, pericarditis) are dull or stabbing pains in the chest that radiate to the left shoulder blade and bother the patient for several days. The person also complains of shortness of breath, increased body temperature and swelling of the lower extremities.
- Rheumatism.The clinical picture of rheumatic carditis is characterized by radiating pain in the left half of the back in combination with cardialgia. The clinical picture is complemented by arthralgias, ring-shaped erythema on the skin and rheumatic nodules. Symptoms occur more frequently in children and adolescents.
Pancreatitis
In acute inflammation of the pancreas, girdle pain is observed, moving from the left hypochondrium to the subscapular region. In addition to the pain syndrome, patients fear debilitating vomiting with bile and mucus impurities as well as tension in the abdominal muscles. Movement increases the painful sensations, so the person tries to lie motionless on his side.
In chronic pancreatitis, the radiation of pain under the scapula indicates an exacerbation of the process. Violations are often provoked by errors in nutrition - a big feast, alcohol consumption. The pain is paroxysmal in nature and sometimes spreads not only to the subscapularis but also to the precordial region. Symptoms include nausea, bloating and steatorrhea.
Stomach ulcer
Pain under the left shoulder blade is a sign that the defect is localized on the back wall of the stomach, closer to the back. Unpleasant sensations occur within 20-50 minutes after finishing a meal. The earlier the symptoms appear, the higher the ulcer is located. The symptoms worsen when eating sour, spicy or fried foods. To reduce the intensity of pain, patients induce vomiting.
Spleen diseases
Pain and fullness in the left subscapular region occur in splenomegaly caused by infectious, autoimmune, or myeloproliferative processes. With the gradual increase in the size of the organ, periodic discomfort occurs with a feeling of heaviness in the affected area, and a rapid change in the size of the spleen is accompanied by sharp, cutting pain radiating under the left shoulder blade.
Slightly less often, surgical pathologies of the spleen are the cause of pain: rupture, infarction, volvulus. In this case, there is cutting or throbbing pain that radiates under the shoulder blade and increases with even the slightest movement. Therefore, the patient takes a forced position: lying on his left side or on his back, with his knees drawn to his stomach. The clinical picture is complemented by a sharp drop in blood pressure and tachycardia. Without 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, laughing and talking, and a coughing fit. The pain is of a variety of nature: sharp, stabbing, dull, pressing. They are accompanied by fever, shortness of breath and other typical respiratory symptoms. Pain under the left shoulder blade is most common in patients who develop:
- Lung infection.The patient feels a moderate dull pain, which has a clear localization in the case of focal inflammation of the lungs or spreads over the entire scapular area in the case of pneumonia. A deep cough develops with the release of mucous-purulent sputum. Symptoms last up to 2-4 weeks.
- Pleurisy.With exudative pleurisy, a person feels pressure and bursting under the scapula and along the side wall of the chest. If you feel this area, the discomfort will increase. Dry pleurisy is characterized by acute pain in the chest and subshoulder areas that worsens with movement.
- Tuberculosis.Tuberculosis infection lasts a long time, so low-intensity pain lasts for several months. If the pain is localized in the scapula area, the pathological focus is more likely to be in the posterior sections of the lungs.
- Pulmonary infarction.The death of a section of the lung parenchyma is manifested by severe pain that radiates under the left shoulder blade and clinically resembles an attack of angina pectoris. The condition of patients is complicated by hemoptysis or pulmonary hemorrhage, dysfunction of external breathing and cardiac arrhythmias.
Rare causes
- neoplasms: Osteomas and osteosarcomas, bone cysts, 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 illnesses: retroperitoneal abscess, hemoperitoneum, strangulated diaphragmatic hernia.
diagnosis
Patients with pain under the left scapula are initially referred for consultation to an orthopedic traumatologist. If there are no diseases of the musculoskeletal system, other specialists are included in the diagnostic search: neurologist, cardiologist, surgeon, etc. To determine the causes of pain, a comprehensive set of instruments is prescribed, which includes the following:
- Radiography. An X-ray of the scapula in frontal and lateral projection allows exclusion or confirmation of a traumatic injury. If osteochondrosis, scoliosis, or spondylolisthesis is suspected, X-ray imaging of the spine is indicated. A simple x-ray of the chest cavity suggests damage to the lungs or heart.
- Electrocardiogram.A standard 12-lead ECG is a screening method on the basis of which the doctor makes a preliminary diagnosis and detects dangerous processes (myocardial infarction, life-threatening cardiac arrhythmias). The diagnostic complex is supplemented by classic or transesophageal echocardiography and cardiac electrophysiology.
- Ultrasound of the abdominal organs.A quick and non-invasive method detects common conditions that cause left shoulder blade pain. Ultrasound examination shows signs of peptic ulcer, inflammatory infiltration of the pancreas, and enlarged spleen. EGD is used to clarify the diagnosis of stomach ulcer.
- Additional methods. To clarify the type and severity of the bone changes, a CT or MRI of the spine is carried out. In cases of probable bronchopulmonary diseases, bronchoscopy with biopsy and pleural puncture is performed. If there are difficulties in diagnosing abdominal pathology, 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. Acute phase protein indicators and proteinograms are informative in the case of possible cardiac damage or an autoimmune process. Specific myocardial markers are examined for angina 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 inflammatory processes of the lungs and pleura, bacteriological seeding of the biomaterial is required, followed by a test for sensitivity of the isolated microorganisms to antibiotics.
Treatment
Help before diagnosis
Given the variety of causes of pain under the left scapula, it is extremely difficult for a doctor to give recommendations until the underlying pathology is identified. During the examination, it is recommended to reduce the load on the back muscles in order to avoid simple symptoms of fatigue and overexertion, which can lead to 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 determination of the etiological factors of pain under the left scapula. If the patient suffers from severe discomfort, anti-inflammatory drugs and muscle relaxants are recommended, which quickly relieve the painful sensations. If the pain is severe, therapeutic blocks and the administration of narcotic analgesics are effective. A type of physical activity is selected taking into account the disease.
Drug therapy is prescribed by a specialist with the appropriate profile. In case of 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 involvement of a pulmonologist and the use of antibiotics, expectorants and specific anti-tuberculosis drugs.
For gastrointestinal diseases, an appropriate 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 rheological properties of blood are indicated to eliminate radicular syndrome.
For posture disorders and other problems of the spine, non-drug methods are actively used: traction therapy, therapeutic massage, exercise therapy. Among physiotherapeutic methods, balneotherapy (sulfide 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 diseases, when delay endangers the patient's life and health. The second group of operations includes methods of stenting, angioplasty and bypass surgery for myocardial infarctions, as well as assisting abdominal or thoracic surgeons with injuries, purulent processes and internal bleeding.
In neurosurgery, planned surgical interventions are often prescribed for severe root syndrome and intervertebral hernias. To eliminate the pain associated with compression of nerve structures, microdiscectomy and laser vaporization of the intervertebral disc are performed. In rare cases, stabilizing operations on the spine are performed (body fusion, application of a halo device, transpedicular fixation).