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, peptic ulcer). Rare causes of the symptom include damage to the spleen, wounds and skin tumors. Diagnostic methods are chosen 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
Radicular syndrome
The pathological condition develops with thoracic osteochondrosis or intervertebral hernia. Less commonly, radicular pain occurs with spondylolisthesis and ankylosing spondylitis. Acute pain in the projection of the left scapula is noted when 3. -6. thoracic roots are involved in the process; discomfort directly under the scapula indicates localization of the injury in the 7th -8th. swirls. Typically, pain spreads from the scapula to the lateral surface of the chest and intercostal spaces.
Myofascial pain syndrome
Poor posture and prolonged stays in an uncomfortable position lead to constant muscle tension. The syndrome manifests itself as pain in the area of the scapula on the left when the load is predominantly on this side. The discomfort is felt by the patient as deep and moderately intense. At first, pain is experienced only during movement and exertion, but over time it becomes constant. Sometimes radiating pain occurs in the forearm or left hand.
Injuries
Intense pain develops after a tear or fracture of the shoulder blade or bruising 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, sharp pain occurs and the mobility of the arm and shoulder girdle is often limited. When you change position or press on the injured area, sharp pain is felt.
Boils and carbuncles
Purulent inflammation of the skin around the left shoulder blade is accompanied by intense pain, which is usually clearly localized. As the abscess matures, "pulling" sensations occur, which intensify when the inflamed area is palpated or rubbed with clothing. After the tire breaks through and the necrotic core comes out, the pain subsides. With a carbuncle, the pain is more intense, and the patient's general condition often worsens.
Heart diseases
Cardiac injuries are a typical cause of pain under the left shoulder blade, which is associated with the proximity of the anatomical location and the characteristics of the innervation. In this case, the symptoms are accompanied by pain in the chest 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 unbearable burning sensations that spread from the precordial area to the left arm and shoulder blade, and less often to the clavicle and neck area. The condition occurs suddenly and is accompanied by a strong fear of death and a weak state.
- Stable angina.Episodes of squeezing or pressing pain radiating to the subscapular area are specific to attacks of ischemic heart disease. Unpleasant symptoms are triggered 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.Dull or stabbing pain in the chest, which radiates to the left shoulder blade and bothers the patient for several days, is typical of acute carditis (myocarditis, pericarditis). The person also complains of shortness of breath, increased body temperature and swelling of the lower extremities.
- Arthritis.Radiating pain in the left half of the back in combination with cardialgia is characteristic of the clinical picture of rheumatic carditis. The clinical picture is complemented by arthralgia, ring-shaped erythema on the skin and gouty nodules. Symptoms are more often detected in children and adolescents.
Pancreatitis
Belt pain, moving from the left hypochondrium to the subscapular region, is observed with acute pancreatitis. In addition to the pain syndrome, patients are concerned about debilitating vomiting with impurities of bile and mucus and tension in the abdominal muscles. Movement increases the painful sensations, so the person tries to lie motionless on his side.
In chronic pancreatitis, irradiation of pain under the scapula indicates an exacerbation of the process. Often violations are provoked by mistakes in the diet - a big party, drinking alcohol. The pain is paroxysmal in nature and sometimes spreads not only to the subscapularis but also to the precordial region. Symptoms are combined with nausea, flatulence and steatorrhea.
Ulcer
Pain under the left shoulder blade is a sign of localization of the defect on the back wall of the abdomen, closer to the back. Unpleasant sensations occur within 20-50 minutes after finishing a meal. The earlier symptoms appear, the higher the location of the wound. The discomfort becomes more serious when eating sour, spicy or fried food. To reduce the intensity of pain, patients induce vomiting.
Spleen diseases
Pain and a feeling of fullness in the left subscapular area occur with splenomegaly caused by infectious, autoimmune or myeloproliferative processes. With 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.
Somewhat less often, the cause of pain is surgical pathologies of the spleen: rupture, infarction, volvulus. In this case, there is cutting or throbbing pain radiating under the scapula, which is aggravated by the slightest movement. Therefore, the patient takes a forced position: lying on the left side or on the back with the knees tucked 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 breathing, laughing and talking and a coughing fit. The pain has a varied character: 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 pneumonia or spreads throughout the shoulder blade area in case of lobar pneumonia. A deep cough appears with the release of mucopurulent sputum. The symptoms last up to 2-4 weeks.
- Pleurisy.With exudative pleurisy, a person experiences pressure and bursting under the scapula and along the side wall of the chest. When you feel this area, the discomfort intensifies. Dry pleuritis is characterized by acute pain in the chest and subscapular area, aggravated by 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 scapula, the pathological focus is more likely to be located in the posterior segments of the lung.
- Pulmonary infarction.The death of a section of the lung parenchyma is manifested by severe pain radiating under the left shoulder blade, clinically similar to an angina attack. The patients' condition is complicated by hemoptysis or pulmonary bleeding, dysfunction of external respiration and arrhythmias.
Rare causes
- Neoplasms: osteoma and osteosarcoma, bone cyst, malignant tumors of the skin over the scapula (basal cell carcinoma, melanoma).
- Rare cardiovascular pathologies: cardiac syndrome X, aneurysm of the descending aorta.
- Acute surgical diseases: retroperitoneal abscess, heoperitoneum, strangulated diaphragmatic hernia.
Diagnostics
Patients with pain under the left shoulder blade 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 instrumental examinations is prescribed, which includes:
- Radiography.An X-ray of the scapula in frontal and lateral projections allows to exclude or confirm traumatic injury. Radiographic imaging of the spine is indicated if osteochondrosis, scoliosis or spondylolisthesis is suspected. Plain x-ray of the chest cavity gives a suspicion of 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 identifies dangerous processes (myocardial infarction, life-threatening arrhythmias). The diagnostic complex is supplemented by classic or transesophageal echocardiography and cardiac electrophysiology.
- Ultrasound of abdominal organs.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 enlarged spleen. To clarify the diagnosis of gastric ulcer, EGD is used.
- Additional methods. To clarify the nature and severity of bone changes, a CT or MRI of the spine is performed. In case 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 research methods play a major role in making a diagnosis. A clinical blood test shows signs of inflammation or disruption of hematopoietic processes. Indicators of acute phase proteins and proteinograms are informative in case of possible heart damage or an autoimmune process. Specific myocardial markers are assessed for angina pain.
To diagnose gastrointestinal diseases, a coprogram 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 inoculation of the biomaterial is necessary, followed by a test for the sensitivity of the isolated microorganisms to antibiotics.
Treatment
Help before diagnosis
Given the many different causes of pain under the left shoulder blade, it is extremely difficult for a doctor to make recommendations until the underlying pathology is identified. During the examination, it is advisable to reduce the load on the back muscles to eliminate simple fatigue and overexertion, which can cause persistent pain symptoms. 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 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 severe pain, therapeutic blockades and administration of narcotic analgesics are effective. Taking into account the disease, a form of physical activity is chosen.
Drug treatment is prescribed by a specialist with the appropriate profile. For pain due to heart damage, the cardiologist prescribes antianginal and antiarrhythmic drugs, antiplatelet agents, and anticoagulants and antihypertensives. Diseases of the bronchopulmonary system require the participation of a pulmonologist and the use of antibiotics, expectorants and specific anti-tuberculosis drugs.
For gastrointestinal pathologies, an appropriate diet is chosen, and the therapy is supplemented with enzyme preparations, prokinetics, antacids and antisecretory drugs. In neurology, neurometabolic agents, B vitamins and drugs that improve blood microcirculation and rheological properties are indicated to eliminate radicular syndrome.
For postural disorders and other problems with the spine, non-drug methods are actively used: traction therapy, therapeutic massage, exercise therapy. Among physiotherapeutic methods, balneotherapy (sulphide 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 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 methods of stenting, angioplasty and bypass surgery for myocardial infarction, assistance of abdominal or thoracic surgeons for injuries, purulent processes and internal bleeding.
Planned surgical interventions are often prescribed in neurosurgery for severe radicular syndrome and intervertebral hernia. To eliminate pain associated with compression of nerve structures, microdiscectomy and laser vaporization of the disc are performed. In rare cases, stabilizing operations on the spine are resorted to (interbody fusion, application of a Halo device, transpedicular fixation).