Pain in the shoulder blade and below: what discomfort can indicate

21 June 2022

Pain in the shoulder blade and below can occur with nerve damage, diseases of the spine, shoulder girdle or somatic pathologies. The cause can be determined by clinical signs, conditions of manifestation of the syndrome and anamnesis data.

Pain in the scapular region can be felt when inhaling, felt in half of the body and/or in the whole arm. In some cases, these symptoms are the "first bell" of the period of exacerbation, which can be prevented after the provoking factor has been established.

Causes and location

Pain under the shoulder blade usually appears during movement - it is preceded by an awkward bend, standing for a long time with a bent back. It signals local damage that appears for various reasons.

Pathologies with one-sided lesions, in which it hurts only on the right or left under the scapula, are few - usually the severity of the symptom is individual. This is due to the symmetrical arrangement of nerve roots branching from the spinal cord.

injuries

If it hurts under the right and left shoulder blades, it may be the result of damage to the bones and muscle structure. Symptoms do not have strict localization, the severity depends on the traumatic factor. The clinic is usually acute, begins abruptly and acquires a chronic course.

The causes of traumatic pain under the left or right shoulder blade are as follows:

Bruising - in such cases the pain is superficial, most often the muscles are damaged. Usually the back muscles under the shoulder blades and below are injured, swelling and local inflammation develop. After 2-3 weeks, the symptoms disappear.
Cracks and fractures are more serious injuries, the pain is concentrated in the shoulder blade itself. At the slightest movement, it intensifies, the patient can no longer move his arm or bend over.
Subluxation and displacement of the vertebrae - this leads to joint pain in the shoulder blades and below, sometimes the bony structures compress the nerve roots.

Injuries are characterized by severe pain under the right or left shoulder blade, which appears spontaneously. During movements, a crunch may be present, and swelling often appears.

Osteochondrosis

If the disease affects the thoracic spine, the patient has back pain near the shoulder blades and below. This is due to the pinching 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 articular discs in the chest region from 2 to 6, pain is felt in the scapula. It usually radiates to the neck and arm. When the vessels are compressed, dizziness appears, intracranial pressure may increase.
When the joints of 6-12 segments are affected, the pain radiates under the left or right shoulder blade, spreads lower, to the corresponding half of the body and lower back.

The vertebral roots of the thoracic region give rise to plexuses which innervate the arms and the torso. Therefore, when pressed, the pain spreads along their course.

With osteochondrosis, the discomfort is one-sided - it hurts the shoulder blade from the right or left side and below, depending on the inclination of the spine.

Scoliosis

It is a curvature of the spine in the transverse direction due to an overload of the muscles that support the posture. This leads to pinching of the roots and spinal cord, the appearance of pain under the shoulder blade on the right or left. Pathology is usually accompanied by:

Respiratory failure - a one-sided inclination of the spine deforms the chest, which affects the functioning of the lungs, one of which is compressed, and the second supports the lost function.
Violation of the work of the heart - the frequency of contractions and pulse changes, shortness of breath and pallor of the skin appear.
The appearance of a visible deformation of the chest is the main cause of pain under the right or left shoulder blade. The vertebrae, as well as the ribs, are displaced laterally, as a result of which, from the side of the curvature, the bone structures are displaced downwards 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 below, focusing is strictly limited. If the muscle spasms join together, the symptom spreads to nearby structures.

Kyphosis

It is characterized by a backward flexion of the spine, a forward displacement of the shoulder girdle, and an arch gradually appears. There is pain on the scapula - usually bilateral, gives to the arm and neck. The following mechanisms are involved in its formation:

Neurogenic - due to the curvature, the distances between the vertebral bodies in the anterior sections decrease, this causes pinching of the branches of the spinal cord. There is aching pain in the right and left shoulder blades, which may radiate to the collarbone, neck, and shoulder.
Muscular - the deviation of the spine leads to an overload of the muscles in the neck area, which can cause painful spasms in the shoulder blades and below.

As a result of kyphosis, the vertebral artery is compressed, cerebral circulation is disturbed. The work of the internal organs gradually worsens.

Spondylarthrosis

If the right or left shoulder blade hurts, one of the reasons may be spondylarthrosis - damage to the facet joints and intervertebral discs. It is accompanied by a loss of mobility, stiffness appears, more pronounced in the morning.

The clinical picture changes as the pathology progresses: >

Destruction of cartilage - with a lack of blood circulation, the integrity of connective tissue is violated, the articular disc becomes fragile, more damaged and recovers more slowly. At this stage, intense physical exertion leads to microtrauma, pain occurs, which radiates to the area of the shoulder blades and below.
Articular disc deformity - joints appear that impede mobility. This causes further destruction, which slows down the regeneration processes, the patient feels pain in the back and shoulder blades.
The appearance of bony growths is characteristic of the advanced stage of the disease. Neoplasms injure joints, muscles, blood vessels and nerves.

With spondylarthrosis, the back can hurt between the shoulder blades or below - an attack is usually preceded by physical activity. At rest, the symptoms subside, because the bony growths do not injure the surrounding tissues.

Protrusion and hernia

In these conditions, sharp pain under the left and right shoulder blades, which appears due to compression of the spinal cord or its roots, worries. As a result of pinching, the sensitivity along the nerve fibers is disturbed.

The location of the symptoms is as follows:

Pain in the shoulder blades and above - protrusion or herniation in the cervico-thoracic region or when 1-3 thoracic segments are affected. The symptom intensifies when you try to tilt your head, turn it to the side.
Pain in the interscapular region - in this case the midsections can be affected, from 3 to 6. Discomfort increases when both hands are moved to the side, inhaled deeply or rotated.
Severe pain under the right and left shoulder blades - articular discs from 6 to 12 are affected, the lower back may be involved in the pathology. In this case, there is a risk of developing a hernia, since this section of the spine is more loaded than the previous ones.

Unlike spondylarthrosis, hernia and protrusion pain does not go away for long at rest. This is due to constant compression of the nerve, which is aggravated by muscle spasms.

radiculitis

This is a pinching of the lumbar roots, which are collected in a powerful sciatic nerve. If its upper parts are affected, the patient feels pain under the scapula, and below it is bilateral, aggravated by bending and sudden movements.

As the disease progresses, additional symptoms may appear: >

There are back pains that radiate to the lower limb - sharp shooting pain is felt like an electric shock along the path of the nerve.
Burning pains in the back, in the lumbar region or under the shoulder blades indicate a prolonged pinching of the roots of the spine in the lumbar region.
Cramps and loss of feeling usually occur in the lumbar region, buttocks, sometimes there is numbness along the nerve fibers of the thigh, leg and foot.

Shoulder-scapular periarthrosis

This condition is understood as inflammation of the shoulder joint and surrounding tissues, stiffness occurs, which disappears only after warming up.

The pain is concentrated in the region of the right or left scapula and below, depending on the development of hemispheric motor skills (right-handed or left-handed). First it appears after exercise, then at rest. Along the way, additional symptoms appear:

headache;
numbness of the hands;
violation of the mobility of the spine.

With humeroscapular periarthrosis, clinical manifestations increase when the arm is raised - it hurts in the region of the right or left shoulder, scapula. Gradually, the range of motion decreases, the stiffness progresses.

Neuralgia

The next cause of pain under the right or left shoulder blade is inflammation of the nerves in this area. The disease is caused by hypothermia, drafts. Most commonly affected:

Suprascapular and supraspinous nerves - there is pain in the right or left shoulder blade of the back, concentrated mainly in the collarbone. Sometimes the discomfort spreads to the shoulder, which indicates the defeat of the skin branches in this area.
Subscapular and infraspinatus nerves - in this case it hurts on the right or left under the scapula, depending on the side of the lesion. If the muscles of the same name are affected, the clinical manifestations worsen when the arms descend, in abduction behind the back.
Intercostal nerves - usually 1-4 pairs. These branches run along the lower edge of the rib, the pain occurs not only in the shoulder blades and below, but also on the sides of the chest, sometimes in the front parts.

Symmetry is not typical for neuralgia - if the left half of the body has been exposed to drafts, pain is noted in the neck, chest and scapula on this side.

heart disease

The branches of the parasympathetic trunk, which is connected to the spinal cord and its roots, go to the heart. This is why heart disease can cause pain in the shoulder blade and below. Usually a mild form of myocardial infarction is latent. It may be accompanied by the following symptoms:

Dull or burning pain felt behind the sternum or under the left shoulder blade - may last for hours, increase with walking, but subside somewhat with rest.
Shortness of breath - accompanies the pain, can manifest itself within a few days.
Tachycardia - increased heart rate, sometimes arrhythmias occur.
Other symptoms are increased blood pressure, dizziness, nausea and vomiting.

Problems with the gastrointestinal tract

Similar to the previous mechanism, pain travels along nerve fibers. Clinical signs can be bilateral, but in most cases there is a certain pattern in which symptoms appear depending on the location of internal organs.

Pain under the left shoulder blade from the back of the back occurs with the following diseases:

pancreatitis;
gastritis;
stomach ulcer.

Usually with these diseases, patients complain of dyspeptic disorders, nausea and vomiting. With internal bleeding, paleness of the skin, dark color of feces, decreased pressure and weakness are noted.

Pain under the right shoulder blade from the back of the back accompanies:

cholelithiasis;
hepatitis;
liver cirrhosis;
ulcerative lesion of the duodenum.

Other reasons

In addition to these factors, pain under the shoulder blades can cause:

Uncomfortable mattress - if it breaks down and you sleep on the right side, in the morning you may feel pain under the left shoulder blade from behind, because the curved spine pinches the roots of the spine.
Pleurisy - pain in the scapular region occurs when breathing due to the friction of the leaves against each other, reaches a peak during deep breathing.
Poliomyelitis - pathology is accompanied by neurological symptoms, back pain often appears.
Poisoning - severe poisoning or a cold may manifest as muscle aches, chills and fever.
VVD - vegetovascular dystonia is accompanied by a change in pressure, interruptions in the work of the heart and shortness of breath, and sometimes discomfort in the back.
Kidney disease - these pathologies are characterized by aching or throbbing pain under the right shoulder blade, a change in the diuresis and color of urine, and general symptoms.
Subdiaphragmatic abscess - if suppuration is noted on the upper floor of the abdominal cavity, when inhaling, pain under the shoulder blades, fever and symptoms of intoxication will be felt.
Mental disorders - in some cases, pain in the shoulder blades and below can be the result of such disorders. The exact mechanism of occurrence has not been studied.

The nature of pain

Pain in the area of the shoulder blades and below can be different, by its nature it is possible to assume a specific group of pathologies, sometimes a provoking factor can be established:

For pinched nerves, lumbago is characteristic - a sharp, throbbing pain that appears with a sharp bend of the body, raising the arm. This is the main difference with cholelithiasis, in which the symptom is not rolled up by movements.
Aching, stabbing or burning pain indicates a pathology of the internal organs. The latter option occurs when compressing the roots of the spinal cord, but it increases with movement and can turn into a seam.
A sharp constricting pain in the region of the shoulder blades and below is characteristic of a hernia. Sometimes it is preceded by lumbago, numbness of the limbs.
Cutting pain of varying intensity is characteristic of neuralgia, drilling often accompanies inflammation of the joints.

Which doctor treats pain in the shoulder blades?

If you experience pain in the shoulder blade and below, you need to make an appointment with a neurologist. If there are no pinched nerves, the specialist will refer you to a consultation with an orthopedist, cardiologist, gastroenterologist or urologist, depending on the suspected disease

Diagnostic

To identify the cause of discomfort in the region of the scapula 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, the shoulder joint or the 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 the pain under the shoulder blades is due to neurology. Therefore, CT and MRI are considered the "gold standard" in diagnostic protocol.

General principles of treatment

The main task is to eliminate the symptoms and the provoking factor. First, the patient's well-being is stabilized, then the underlying pathology is treated.

The therapeutic program includes:

Medications – Painkillers are usually prescribed to relieve pain and inflammation. Then the funds are prescribed depending on the underlying disease - antibiotics, gastroprotectors, diuretics.
Physiotherapy - strengthens the spine, treats somatic diseases. Medicinal electrophoresis is used in the field of shoulder blades, warming procedures, SWT.
Massage - warming up is carried out with damage to the spine. From such procedures, the muscles above and below the shoulder blades relax, posture improves. In this case, you need professional help from a chiropractor or osteopath.
Gymnastics - is performed after the elimination of pain, the program is compiled, depending on the disease suffered by a physiotherapist, a rehabilitation specialist.

Prevention

After successful treatment, patients are advised to follow a preventive program that will prevent the recurrence of the pathology:

watch your posture;
choose a mattress of moderate hardness and an orthopedic pillow;
twice a week, massage into the shoulder blade area and below;
following a low-calorie diet for obesity;
get rid of bad habits;
carry out prophylaxis of somatic pathology (if present in the anamnesis);
see a doctor every six months.

Pain in the shoulder blades and below can be neurological or somatic in nature. When the nerves are damaged, the symptoms are acute and sudden, appear spontaneously.

Pathologies of internal organs and joints are characterized by progressive and prolonged pain, the clinic is always accompanied by additional symptoms. At the initial stages, painkillers are prescribed, after the diagnosis, the program is supplemented with etiological therapy and strengthening procedures.