Pain under left shoulder bladeobserved in musculoskeletal pathologies (osteochondrosis, myofascial syndrome, injuries), heart diseases (myocardial infarction, angina pectoris, rheumatic and non-rheumatic carditis), gastrointestinal diseases (pancreatitis, stomach ulcer). Rare causes of the 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. To relieve pain, analgesics are prescribed, after which medical or surgical treatment of the underlying disease is carried out.
Causes of pain under the left shoulder blade
Radical 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 process involves the 3-6th thoracic roots; discomfort just below the scapula indicates the localization of the lesion in the 7th-8th vertebra. Typically, the pain spreads from the shoulder blade to the lateral surface of the chest and intercostal spaces.
Myofascial pain syndrome
Poor posture and prolonged stay in an uncomfortable position lead to constant muscle tension. The syndrome manifests itself as pain in the shoulder blade area on the left, when the load is mainly on this side. Discomfort is felt by the patient as deep and moderately intense. At first, the pain occurs only during movement and effort, but over time it becomes constant. Sometimes there is pain that radiates to the forearm or left hand.
Injuries
Intense pain develops after a crack or fracture of the scapula or a bruise of the soft tissue over this area. If the integrity of the bone is preserved, the pain is moderate, the person can take deep breaths and move freely. When traumatic damage occurs to bony structures, acute pain occurs and mobility of the arm and shoulder girdle is often limited. When you change position or press on the injured area, a sharp pain is felt.
It also boils coals
Purulent inflammation of the skin surrounding the left shoulder blade is accompanied by severe pain, which, as a rule, is clearly localized. As the boil matures, "pulling" sensations appear, which intensify when the inflamed area is palpated or rubbed with clothing. After the tire breaks and the necrotic core comes out, the pain subsides. With a carbuncle, the pain is more intense and the general condition of the patient often worsens.
Cardiac diseases
Heart damage is a typical cause of pain under the left shoulder blade, which is related to the proximity of the anatomical site and the characteristics of the innervation. In this case, the symptoms are accompanied by chest pain of various types, a feeling of freezing or interruptions in the functioning of the heart. Tachycardia and other rhythm disturbances are usually detected. Pain under the shoulder blade manifests itself as:
- Myocardial infarction.Patients experience an unbearable burning sensation that spreads from the precordial region to the left arm and shoulder blade and less often to the collarbone and neck. The condition appears suddenly and is accompanied by a strong fear of death and fainting.
- Constant angina pectoris.Episodes of pressing or pressing pain radiating to the subscapular region are specific to attacks of ischemic heart disease. The unpleasant symptoms are caused by physical activity or emotional stress and last on average up to 10-15 minutes. After rest or taking nitrates, the pain disappears.
- Inflammatory heart diseases.Dull or stabbing pain in the chest, radiating to the left shoulder blade and bothering the patient for several days, is characteristic of acute carditis (myocarditis, pericarditis). The person also complains of shortness of breath, increased body temperature and swelling of the lower extremities.
- Rheumatism.Pain radiating to the left half of the back combined with heart palpitations is characteristic of the clinical picture of rheumatic carditis. The clinical picture is complemented by arthralgia, annular skin erythema and rheumatic nodules. Symptoms are more often found in children and adolescents.
Pancreatitis
Pain in the zone moving from the left hypochondrium to the subscapular region is observed with acute pancreatic inflammation. In addition to the pain syndrome, patients are concerned about debilitating vomiting with bile and mucus impurities and tension in the abdominal muscles. Movement increases the painful sensations, so the person tries to lie still on the side.
In chronic pancreatitis, radiating pain below the shoulder blade indicates an exacerbation of the process. Often, violations are caused by mistakes in nutrition - a big feast, drinking alcohol. The pain is paroxysmal in nature, sometimes spreading not only to the subscapularis, but also to the precordial region. Symptoms include 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 the end of a meal. The earlier the symptoms appear, the higher the localization of the ulcer. The discomfort becomes more intense when you eat acidic, spicy or fried foods. To reduce the intensity of pain, patients induce vomiting.
Diseases of the spleen
Pain and a feeling of fullness in the left subscapular region occurs with splenomegaly caused by infectious, autoimmune, or myeloproliferative processes. With the gradual enlargement of the organ, periodic discomfort develops with heaviness 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.
Somewhat less often, the cause of pain is surgical pathologies of the spleen: rupture, infarction, bulb. In this case, there are cutting pains or pulsations radiating below the shoulder blade, which are aggravated by the slightest movement. Therefore, the patient takes a forced position: lying on the left side or on his back with his knees pressed to the stomach. The clinical picture is complemented by a sharp drop 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. Discomfort increases with deep breaths, laughing and talking and coughing fit. 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 develop:
- Pneumonia.The patient feels a moderate dull pain, which has a clear localization in case of focal inflammation of the lungs or spreads throughout the shoulder blade region in case of lobar pneumonia. A deep cough occurs with the release of purulent sputum. Symptoms last up to 2-4 weeks.
- Pleurisy.With exudative pleurisy, a person experiences pressure and a burst under the shoulder blade and along the side wall of the chest. When you feel this area, the discomfort intensifies. Dry pleurisy is characterized by sharp pain in the chest and subscapular region, which worsens with movement.
- Tuberculosis.Tuberculosis takes a long time, so low-intensity pain persists for several months. If the pain is located in the shoulder blade region, the pathological focus is more likely to be located in the posterior parts of the lung.
- Pulmonary infarction.The death of a part of the pulmonary parenchyma is manifested by severe pain radiating under the left shoulder blade, which clinically resembles an attack of angina pectoris. The condition of patients is complicated by hemoptysis or pulmonary bleeding, dysfunction of external breathing and arrhythmias.
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, descending aortic aneurysm.
- Acute surgical diseases: retroperitoneal abscess, hemoperitoneum, strangulated hiatal hernia.
Diagnostics
Patients with pain below the left scapula are first referred for consultation to an orthopedic traumatologist. If there are no disorders of the musculoskeletal system, other specialists are involved in the diagnostic search: neurologist, cardiologist, surgeon, etc. To determine the causes of pain, a full range of organic studies is prescribed, which includes:
- X-ray.X-ray of the scapula in frontal and lateral views allows one to rule out or confirm a traumatic injury. X-ray of the spine is indicated for suspected osteochondrosis, scoliosis or spondylolisthesis. Plain x-ray of the chest cavity allows one to suspect damage to the lungs or heart.
- Electrocardiogram.A standard 12-lead ECG is a screening method, based on the results of which the doctor makes a preliminary diagnosis and detects dangerous processes (myocardial infarction, life-threatening arrhythmias). The diagnostic complex is completed by classical or transesophageal echocardiography and electrophysiology of the heart.
- Ultrasound of the abdominal organs.A quick and non-invasive method is used to identify common conditions that cause pain in the left shoulder blade. Ultrasound examination shows signs of gastric ulcer, inflammatory infiltrate in the pancreas and enlarged spleen. To clarify the diagnosis of peptic ulcer, EGD is used.
- Additional Methods. To clarify the nature and severity of bone changes, a CT or magnetic resonance imaging of the spine is performed. In case of possible bronchopulmonary diseases, a bronchoscopy with biopsy and pleural puncture is performed. If there are difficulties in diagnosing abdominal pathology, diagnostic laparoscopy is recommended.
Laboratory examination methods play an important role in diagnosis. A clinical blood test shows signs of inflammation or disruption of hematopoietic processes. Markers of acute phase proteins and proteograms are informative in case of possible cardiac damage or autoimmune process. Specific myocardial markers are evaluated for angina pectoris.
For the diagnosis of gastrointestinal diseases, a joint program is performed: 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 case of inflammatory processes in the lungs and pleura, bacteriological seeding of the biomaterial is necessary, and then testing for the sensitivity of the isolated microorganisms to antibiotics.
Treatment
Help before diagnosis
Considering the variety of causes of pain under the left shoulder blade, it is extremely difficult for a doctor to give recommendations 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 overstrain, which can cause symptoms of persistent pain. If the sensations are unbearable, analgesics are used and the patient is hospitalized immediately.
Conservative therapy
The treatment plan is selected only after a complete diagnosis and determination of the causative 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. For severe pain, therapeutic blockades and the administration of narcotic analgesics are effective. Taking into account the disease, a mode of physical activity is chosen.
Pharmaceutical treatment is prescribed by a specialist of the appropriate profile. For pain due to heart damage, the cardiologist prescribes antianginal and antiarrhythmic drugs, antiplatelet agents, and anticoagulant and antihypertensive drugs. Diseases of the bronchopulmonary system require the involvement of a pulmonologist and the use of antibiotics, expectorants and special antituberculosis drugs.
For gastrointestinal pathologies, a suitable diet is chosen and the treatment is supplemented with enzyme preparations, prokinetic, antacid and antisecretory drugs. In neurology, neurometabolic agents, B vitamins, and drugs that improve microcirculation and blood rheological properties are indicated for the elimination of radicular syndrome.
For postural disorders and other problems with the spine, drug-free methods are actively used: traction therapy, therapeutic massage, exercise therapy. Among the physiotherapeutic methods, spa therapy (sulfide and radon baths), mud therapy and reflexology are popular. It is possible to increase the effectiveness of drug therapy by electrophoresis of drugs directly to the affected area.
Surgery
Surgical methods are indicated when conservative treatment is ineffective or in acute life-threatening pathologies, when delay is dangerous for the life and health of the patient. The second group of interventions includes methods of stenting, angioplasty and bypass surgery for myocardial infarction, the help of abdominal or thoracic surgeons for injuries, purulent processes and internal bleeding.
Planned surgeries are often prescribed in neurosurgery for severe radicular syndrome and intervertebral hernia. To eliminate the pain associated with the compression of nerve structures, a microdiscectomy and vaporization of the disc with a laser is performed. In rare cases, we resort to spinal stabilization procedures (intracorporeal fusion, application of a Halo device, bipedal fixation).