Pain under the left shoulder bladeit is observed in musculoskeletal pathologies (osteochondrosis, myofascial syndrome, injuries), heart diseases (myocardial infarction, angina pectoris, rheumatic and non-rheumatic carditis), gastrointestinal diseases (pancreatitis, gastric ulcer). Rare causes of this symptom include damage to the spleen, ulcers, and skin tumors. Diagnostic methods are selected based on the underlying syndrome: X-ray, ultrasound and endoscopic examinations are used. Painkillers are prescribed to relieve pain, after which medical or surgical treatment of the underlying disease is carried out.
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 in spondylolisthesis and ankylosing spondylitis. Acute pain occurring in the projection of the left scapula can be observed when steps 3-6 are involved in the process. thoracic roots are involved; the discomfort directly under the shoulder blade is the 7-8. indicates the localization of vertebral damage. The pain typically spreads from the shoulder blade to the lateral surface of the chest and the intercostal spaces.
Myofascial pain syndrome
Poor posture and prolonged sitting in an uncomfortable position lead to constant muscle tension. The syndrome appears as pain in the area of the left scapula when the load is predominantly on this side. The patient feels the discomfort as deep and moderately intense. At first, the pain appears only during movement and load, but becomes permanent over time. Sometimes radiating pain appears in the forearm or left hand.
Injuries
Severe pain develops after a crack or fracture of the scapula or a soft tissue bruise in this area. If the integrity of the bone is preserved, the pain is moderate, the person can breathe deeply and move freely. In the case of traumatic damage to bone structures, sharp pain occurs, and the mobility of the arm and shoulder girdle is often limited. A sharp pain is felt when changing position or when pressing on the injured area.
Boil and sizzle
Purulent inflammation of the skin surrounding the left shoulder blade is accompanied by intense pain, which is usually clearly localized. As the boil matures, there are "twitching" sensations, which intensify when the inflamed area is touched or rubbed with a cloth. After the tire breaks through and the necrotic core comes out, the pain decreases. In case of a carbuncle, the pain is more intense, and the patient's general condition often worsens.
Heart diseases
Heart damage is a typical cause of pain under the left scapula, which is related to the proximity of the anatomical site and the specifics of the innervation. In this case, the symptoms are accompanied by different types of chest pain, a feeling of freezing or interruption of heart function. Tachycardia and other arrhythmias are usually detected. Pain under the shoulder blade is manifested as follows:
- Myocardial infarction.Patients experience an unbearable burning sensation that spreads from the region in front of the heart to the left arm and shoulder blade, less often to the collarbone and neck. The condition comes on suddenly and is accompanied by a strong fear of death and weakness.
- Stable angina.Episodes of squeezing or pressing pain radiating to the subscapular area are typical of ischemic heart disease attacks. Unpleasant symptoms are triggered by physical activity or emotional stress and last on average 10-15 minutes. After rest or taking nitrates, the pain goes away.
- Inflammatory heart diseases.Acute heart inflammation (myocarditis, pericarditis) is characterized by dull or stabbing chest pain, which radiates to the left shoulder blade and bothers the patient for several days. The person also complains of shortness of breath, elevated body temperature and swelling of the lower limbs.
- Rheumatism.Radiating pain in the left half of the back combined with cardialgia is characteristic of the clinical picture of rheumatic carditis. The clinical picture is complemented by joint pain, ring-shaped erythema on the skin, and rheumatic nodules. Symptoms are more common in children and adolescents.
Pancreatitis
In acute pancreatitis, girdle pain moving from the left hypochondrium to the subscapular region is observed. In addition to the pain syndrome, patients are concerned about debilitating vomiting with bile and mucous impurities, as well as tension in the abdominal muscles. Movement increases painful sensations, so the person tries to lie motionless on his side.
In case of chronic pancreatitis, irradiation of pain under the shoulder blade indicates the worsening of the process. Violations are often caused by mistakes in the diet - a big feast, alcohol consumption. The pain is paroxysmal, sometimes extending not only to the scapular, but also to the precordial region. Symptoms are combined with nausea, bloating and steatorrhea.
Peptic ulcer
Pain under the left shoulder blade is a sign of localization of the defect on the back wall of the stomach, closer to the back. Unpleasant feelings appear within 20-50 minutes after finishing the meal. The earlier the symptoms appear, the higher the ulcer is located. The discomfort becomes stronger when you eat sour, spicy or fried foods. To reduce the intensity of pain, patients induce vomiting.
Spleen diseases
Pain and a feeling of fullness under the left scapula in case of splenomegaly caused by infectious, autoimmune or myeloproliferative processes. With the gradual enlargement of the organ, there is a periodic discomfort in the affected area, and the rapid change in the size of the spleen is accompanied by sharp cutting pains radiating under the left shoulder blade.
Somewhat less often, the cause of pain is surgical pathology of the spleen: rupture, infarction, volvulus. In such cases, cutting or throbbing pains radiate under the shoulder blade, which are aggravated by even the slightest movement. Therefore, the patient assumes a forced position: lying on his left side or on his back, with his knees pressed to his stomach. The clinical picture is completed by a sharp drop in blood pressure and tachycardia. In the absence of adequate analgesia, shock occurs.
Bronchopulmonary pathologies
Left-sided focal processes in the lungs often cause pain in the projection of the scapula. Discomfort increases with deep breathing, laughing and talking, and coughing fits. The pain is of a varied nature: sharp, stabbing, dull, pressing. They are accompanied by fever, shortness of breath and other typical respiratory symptoms. Most often, pain under the left shoulder blade is experienced by patients who:
- Pneumonia.The patient feels a moderate dull pain, which has a clear localization in the case of focal inflammation of the lungs, or spreads to the shoulder blade area in the case of lobar pneumonia. A deep cough appears with the release of mucous-purulent sputum. Symptoms last 2-4 weeks.
- Pleurisy.With exudative pleurisy, a person experiences pressure and cracking under the shoulder blade and along the sidewall of the chest. When you feel this area, the discomfort increases. Dry pleurisy is characterized by acute pain in the chest and subscapular area, which worsens with movement.
- Tuberculosis.Tuberculosis infection lasts a long time, so low-intensity pain persists for several months. If the pain is localized in the area of the shoulder blade, the pathological focus is more likely to be located in the posterior segments of the lungs.
- Pulmonary infarction.The death of part of the pulmonary parenchyma manifests itself in severe pain radiating under the left shoulder blade, clinically similar to an anginal attack. The patients' condition is complicated by hemoptysis or lung bleeding, external breathing disorders, and heart rhythm disorders.
Rare reasons
- 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 left subscapular pain are first referred to an orthopedic traumatologist. If there are no abnormalities in the musculoskeletal system, other specialists are also involved in the diagnostic search: neurologist, cardiologist, surgeon, etc. To determine the causes of pain, a full range of instrumental tests is prescribed, which includes:
- Radiography.An X-ray of the scapula in frontal and lateral view allows to rule out or confirm a traumatic injury. Radiotherapy of the spine is recommended in suspected cases of osteochondrosis, scoliosis or spondylolisthesis. A simple X-ray of the chest cavity allows suspicion of damage to the lungs or heart.
- Electrocardiogram.The standard 12-lead ECG is a screening method based on the results of which the doctor prepares a preliminary diagnosis and identifies dangerous processes (myocardial infarction, life-threatening cardiac arrhythmias). The diagnostic complex is completed by classic or transesophageal echocardiography and cardiac electrophysiology.
- Ultrasound of the abdominal organs.They use a quick and non-invasive method to detect common conditions that cause pain in the left shoulder blade. Ultrasound examination shows signs of gastric ulcer, inflammatory infiltration of the pancreas and enlargement of the spleen. EGD is used to clarify the diagnosis of peptic ulcer.
- More methods. In order to clarify the nature and severity of the bone changes, a CT or MRI of the spine is performed. Bronchoscopy with biopsy and pleural puncture is performed in case of probable bronchopulmonary diseases. If there are difficulties in diagnosing abdominal pathology, diagnostic laparoscopy is recommended.
Laboratory testing methods play a major role in establishing a diagnosis. A clinical blood test indicates inflammation or a disorder of blood formation processes. Indicators of acute phase proteins and proteinograms are informative in case of possible heart damage or autoimmune process. Myocardial markers specific for anginal pain are evaluated.
A co-program is performed to diagnose gastrointestinal diseases: 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 granules. In the case of inflammatory processes of the lungs and pleura, bacteriological inoculation of the biological material is necessary, followed by an examination of the antibiotic sensitivity of the isolated microorganisms.
Treatment
Help before diagnosis
Considering the variety of causes of pain under the left shoulder blade, it is extremely difficult to give a doctor a recommendation until the underlying pathology is identified. During the examination, it is advisable to reduce the load on the back muscles in order to eliminate simple fatigue and overexertion, which can cause lasting pain symptoms. If the sensations are unbearable, painkillers are used and the patient is immediately hospitalized.
Conservative therapy
The treatment plan is selected only after a complete diagnosis and determination of the etiological factors of pain under the left shoulder blade. If the patient suffers from severe discomfort, anti-inflammatory drugs and muscle relaxants are recommended, which quickly relieve painful sensations. In case of severe pain, therapeutic blockades and the administration of narcotic pain relievers are effective. Taking into account the disease, the method of physical activity is chosen.
Drug therapy is prescribed by a specialist with the appropriate profile. In case of pain caused by heart damage, the cardiologist prescribes anti-anginal and anti-arrhythmic drugs, anti-platelet and blood-clotting agents, and anti-hypertensive drugs. Diseases of the bronchopulmonary system require the participation of a pulmonologist and the use of antibiotics, expectorants and specific anti-tuberculosis drugs.
In the case of gastrointestinal pathologies, a suitable diet is selected, and the therapy is supplemented with enzyme preparations, prokinetics, antacids and antisecretory drugs. In neurology, neurometabolic agents, B vitamins, and drugs that improve the microcirculation and rheological properties of blood are indicated for the elimination of radicular syndrome.
In the case of posture disorders and other problems related to the spine, non-pharmacological methods are actively used: traction therapy, therapeutic massage, exercise therapy. Among the physiotherapy 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 to the affected area.
Surgery
Surgical methods are recommended when conservative treatment is ineffective, or in acute life-threatening pathologies, when delay is dangerous to the patient's life and health. The second group of operations includes the stenting, angioplasty and bypass surgery methods for myocardial infarction, the help of abdominal or thoracic surgeons in case of injuries, purulent processes, and internal bleeding.
In neurosurgery, planned surgical interventions are often prescribed in case of severe radicular syndrome and intervertebral hernia. Microdiscectomy and laser vaporization of the disc are performed to eliminate the pain associated with the compression of the nerve structures. In rare cases, spinal stabilization surgeries are used (interbody fusion, use of the Halo device, transpedicular fixation).